Throat and mouth emergencies Flashcards
(26 cards)
Who is most at risk of neck trauma?
Higher incidence in males, especially adolescents/YAs
What are some mechanisms of penetrating neck trauma?
- Knife/BSW/MVA
- Industrial accidents
- Household accidents
What are some mechanisms of blunt neck trauma?
- MVA (Motor vehicle accidents)
- Sporting injuries (E.g. clothesline tackle)
What are the 3 classes of new trauma?
What are some affected structures within zone I neck trauma?
- Trachea
- Oesophagus
- Thoracic duct
- Thyroid
- Vessels - brachiocephalic, subclavian, common carotid, thyrocervical trunk
- Spinal cord
What are some affected structures within zone II neck trauma?
- Larynx
- Hypopharynx
- CN X, XI, XII
- Vessels - carotids, internal jugular
- Spinal cord
What are some affected structures within zone III neck trauma?
- Pharynx
- Cranial nerves
- Vessels - carotids, IJV, vertebral
- Spinal cord
What are some important questions to ask in neck trauma?
- Mechanism of injury
- Pain
- Aerodigestive tract - dyspnoea, hoarseness, dysphona, dysphagia, haemoptysis
- CNS problems - paraethesias, weakness
What are some points to examine in neck trauma?
- ABCDE
- Inspect through platysma
- Zone of neck
- Bleeding/haematoma
- Aerodigestive injuries
- Neurological - power, sensation upper arm
What are some investigations required in neck trauma?
- FBC, G+S/XM
- CXR - haemopneumothorax, emphysema
- CT angiogram
- Urgent exploration - expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract
- Laryngoscopy, bronchoscopy, pharyngoscopy, and oesophagoscopy
- Angiography - embolise, occluse
What causes deep neck space infection?
Extension of infection from tonsil or oropharynx into deeper tissues e.g. from quinsy
What are some symptoms of deep neck space infection?
- Sore throat
- Unwell
- Limited neck movement
What are some signs of deep neck space infection?
- Febrile
- Trismus
- Red/tender neck
How is deep neck space infection managed?
- IV access, bloods, fluid rehydration
- IV antibiotics - co-amoxiclav or clinamycin
- May need theatre for incision and drainage unless abscess is small and improves with conservative treatment
What is a possible complication of deep neck space infection?
Infection may extend into medistinum through fascial compartments
How are swallowed foreign bodies managed?
- Impacted foreign body must be removed
- May be able to remove without anaethesia but if in airway may need general anaethetic and bronchosopy
What are some causes of airway obstruction?
- Inflammatory/infective causes, allergy
- Foreign bodies
- Physical compression/invasion of airway
- Trauma/iatrogenic trauma
- Neurological causes
- Neoplastic causes
- Burns
- Congenital airway pathology
How does the larynx in a neonate differ from an adult?
- Large head
- Small nares
- Neonates are obligate nasal breathers
- Relatively large tongue
- Small, soft larynx
- Higher position of larynx (C1)
- Weak neck muscles; floppy head
- Narrow subglottis (3.5 mm at the cricoid)
What are some symptoms of airway obstruction?
- SOB on exertion
- SOB at rest
- Choking
- Coughing
- Inability to complete a sentance
What are some signs of airway obstruction?
- Sternal/subcostal recession
- Tracheal tug
- Dusky skin colour of skin
- Pyrexia
- Cyanosis
- Stridor - high-pitched harsh noise due to turbulent airflow resulting from airway obstructions
- Stertor (snoring) - low-pitched sonorous sound arising from nasopharyngeal airway e.g. child when sleeping due to OSA
How is airway obstruction managed?
- ABC resuscitation
- High flow oxygen/heliox (79% helium and 21% oxygen)
- Nebulised budesonide 2mg
- Dexamethasone 0.15-0.6 mg/kg
- Nebulised adrenaline 1:10000 (5ml)
- Flexible fibre-optic endoscopy
- Secure airway with ET tube/tracheostomy
- Try and avoid tracheostomy
- Treat underlying pathology
How is supraglottitis managed?
- Treat as foreign body but add:
- Broad spectrum Abx
- Airway plan
- Senior help
What is shown?
Supraglottitis
What is stridor?
High pitched harsh noise due to turbulent airflow resulting from airway obstruction
