Trauma

Question 1

What is the most common broken bone in the body?

Answer 1

Nose

Question 2

Nose - common mechanism of injury

Answer 2

Fight
Sport
Falls

Question 3

Nose - key history points

Answer 3

Any nosebleeds?

Any difficulties breathing?

Question 4

Nose - clinical examination

Answer 4

Look at person from behind and tilt their head back 
- to view any deviation 
bruising
swelling
facial tenderness
palpate around the orbit 
- check for bony orbital fracture
look at extra ocular movements

Question 5

Nose - Septal haematoma

Answer 5

Boggy swelling in one of the nasal apertures which may lead to destruction of the septum as the septal cartilage is avascular

Question 6

How do you know if the nose is deviated?

Answer 6

The nose will be firm and not move

Question 7

Nose - septal haematoma - management

Answer 7

Drain haematoma so that blood supply to the nose is not lost

Question 8

Nasal fracture - fixed and one sided

Answer 8

Think of septal injury

Question 9

Nasal fracture - which side do most noses deviate to?

Answer 9

Right side (left side is broken) 
- bcos most people are right handed during a fight

Question 10

Nasal fracture - investigations?

Answer 10

Clinical diagnosis

Question 11

Nasal fracture - management

Answer 11

Push nose back into place asap

Question 12

Nasal fracture - complications

Answer 12

Epitaxis
CSF leak
Asomnia

Question 13

Epitaxis - definition

Answer 13

Nose bleed

Question 14

Epitaxis - common sites

Answer 14

Little’s area of anastomosis in the nasal septum
Venous plexus anastamosis
Internal and external carotid arteries

Question 15

Epitaxis - how to stop the bleed

Answer 15

Squeeze lower part o the nose and the nosebleed should stop in around 10 mins
Sit patient forward

Question 16

Epitaxis - management after bleeding has stopped

Answer 16

Clean out nose to find bleeding source
Remove blood clot (by suction or nose blowing)
Cauterise vessel - silver nitrate
DO NOT sedate patient

Question 17

Ear - pinna haematoma

Answer 17

Bleeding under the perichondrium which has lifted the perichondrium up

Question 18

Ear - what can pinna haematoma result in?

Answer 18

Cauliflower ear

• blood deposition
• calcium
• this can become an abcess if not drained

Question 19

Ear - pinna haematoma cause

Answer 19

Rugby injury

Question 20

Ear - pinna haematoma management

Answer 20

Aspirate or
Incision and drainage or
Pressure dressing

Question 21

Ear - management of laceration

Answer 21

Local anaesthetic
Debridement
Put ear back in anatomical position of suturing
Wrap detached ear in gauze in box of ice
Give antibiotics for 5 days

Question 22

Temporal bone fracture - points from history

Answer 22

Hearing loss
Facial palsy
Vertigo
CSF leak

Question 23

Temporal bone fracture - clinical examination

Answer 23

Bruising behind the ear 
Bruising around the eyes 
Check tympanic membrane and ear canal function 
Test CNVII 
Hearing test

Question 24

Temporal bone fracture - otic capsule involvement is more or less common?

Answer 24

Less common

Question 25

Temporal bone fracture - otic capsule involvement

Answer 25

Transverse fracture Due to frontal blow which causes the compression of the skull Can cross the IAM causing damage to auditory and facial nerves Vertigo

Question 26

Temporal bone fracture - otic capsule not involved

Answer 26

Longitudinal fracture Due to lateral blow Can get bleeding from the external ear canal

Question 27

Neck - zone 1

Answer 27

Lower part of neck | - trachea, oesophagus, thoracic duct, thyroid, spinal cord, brachiocephalic vein, subclavian vein, common carotid

Question 28

Neck - zone 2

Answer 28

Most accessible area | - larynx, hydropharynx, spinal cord, CN X, CN XI, CNXII, carotids, internal jugular vein

Question 29

Neck - zone 3

Answer 29

Upper part of the neck | - pharynx, carotids, IJV, spinal cord

Question 30

Neck - penetrating injuries usually affect which neck zone?

Answer 30

Zone 2 (most accessible area of the neck)

Question 31

Neck - how do you differentiate between proper / superficial penetrating injuries?

Answer 31

If penetration goes through the platysma then it is penetrating

Question 32

Neck - penetrating injury management

Answer 32

Surgical exploration OR Laryngoscopy, bronchoscopy OR Angiography

Question 33

Facial trauma - investigations

Answer 33

CT scan

Question 34

Le Fort 1

Answer 34

Horizontal | Passes horizontally above teeth

Question 35

Le Fort 2

Answer 35

Pyramidal | Can get significant airway obstruction

Question 36

Le Fort 3

Answer 36

Craniofacial dysfunction