ENT Flashcards by Ryan Govier

describe the injury and management steps

Injury:
Auricular haematoma to the right pinna with small skin tear
negatives - no involvement of tragus

management:
analgesia
drainage
check for damage to other aspects of ear
block pinna
pressure dressing after
ADT
follow up

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list the indications for surgical review of this injury?

What are contraindications to ED drainage?

large overlying skin avulsion
severe crush injury
complete or near amputaiton/avulsion
large cartilage defect
devitalization of tissue
large haematoma

Contraindications:

over 7/7 haematoma
recurrent haematoma

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What is the diagnosis and three supportive findings?

Acute suppurative otitis media

Bulging TM
Erythematous TM
pus behind TM

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What are the options for analgesia?

paracetamol 15mg.kg
ibuprofen 10mg/kg
IN fentanyl 1.5mcg/kg

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what are the indications for antibiotics?

Prior hearing impairment
Failure of conservative Rx (ie worsening Symptoms at 48hrs)
Cochlear Implant
Immunosuppression

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List four methods and pros and cons of removing ear foreign body

Method - suction catheter
Pros - soft and atraumatic
Cons - nosy

Method - alligator forceps
Pros - not noisy
Cons - difficult to grip small objects and may cause trauma

Method - wax curette/bent paperclip
Pros - good for smooth objects to get behind
Cons - risk of trauma or pushing deeper

Method - irrigation or syringing
Pros - can flood out loose objects
Con - cant use if grommets or perforation

Method - refer to ENT
Pros - little risk to ED
Cons -

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with epistaxis, what are key features in a history?

- estimate amount of blood loss eg duration, volume
effects of blood loss - dizziness, collapse
co-morbidities eg uncontrolled hypertension
reason for anticoagulation if reversal is needed
social situaiton - can they manage at home
other meds - to increase bleeding
?trauma

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What are the steps for controlling untraumatic epistaxis

first aid- sit up lean forward and squeeze
suction clots and blood
topical constrictor eg adrenaline or co-phenylcaine
cautery eg nitrate sticks
optimise anticoag
rapid rhino

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list three pieces of advice for epistaxis on discharge

general - do not pick or blow nose for 4/7, moisturise nostrils
see GP for anticoag FU
when to return - on going bleeding not controlled with first aid or needing pack removal

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what are the causes of epistaxis in adult patient

alcohol
htn
bleeding disease eg VWD
meds - antiplatelets
recreational drugs eg cocaine
trauma
neoplasm eg SCC

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what are the features concerning for a malignant cause of epistaxis?

Unilateral nasal blockage +/- discharge
Local oral features – eg ill-fitting dentures or loose teeth and buccal soft tissue swelling
Localised lymphadenopathy
Hearing loss
Trismus
Neuralgia
Risk factors for nasopharyngeal malignancy - alcohol, tobacco, race – SE Asian, Chinese
predominance

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What are the specific managements for posterior epistaxis?

posterior cauterisation under GA
arterial ligation
local injection of lidocaine and adrenaline around sphenopalantine artery
embolisation via femoral artery under IR

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what are the relevant features of this x ray

radio opague FB in oesophagus - likely coin
it is below laryngeal inlet and not obstructing trachea

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Likely diagnosis?
What are the anatomical structures involved?
what is the approach to imaging?

bilateral TMJ dislocation
mandibular condyle moves anteriorly out of mandidular fossa

imaging:
spontaneous - none
traumatic - CT

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What is the approach to managing TMJ dislocation?

syringe technique -
10ml syringe place between maxillary and mandibular molars and roll back and forth awaiting reduction

manual reduction-
using gloves place thumb on mandibular molars and firm constant pressure inferioposteriorly until reduction

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what are the discharge instructions post tmj relocation

Simple analgesia – paracetamol / ibuprofen
Soft / liquid diet
Avoid yawning / taking large bites
if recurrent, maxillofacial review

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What are the features of occult nasal FB in kids?

unilateral epistaxis
unilateal blockage
foul smell
unilateral nasal breathing
septal necrosis

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What equipment is used in nasal FB extraction

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topical anaeasthetic and vasoconstrictor
airway equipment incase of obstruction
nasal speculum
head torch
PPE
forceps

with nasal FB what are the indications for referral to surgeon?

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posterior or not easily visualised
chronic or impacted with marked inflammation
penetrating or hooked FB
failure to remove eg bleeding, uncooperative patient

name three methds for nasal FB removal and pros and cons

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Method - direct instrumentation eg forceps or hooks
Pros - useful if object easily visualised
Cons - may not be able to grasp, may pusch deeper

Method - suction catheter
Pros - can remove anterior things and blood/mucours
Cons - loud

Method - positve pressre eg mothers kiss or blowing out one nostrol
Pros - easy if coooperate and can sooth child
Cons - needs cooperation and may be difficult for larger objects

what are the complications of nasal FB?

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mucosal necrosis
aspiration
sinus infection

what are the options for ensuring child is cooperative?

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GA
physical restraint
procedural sedation

with nasal FB what clinical features would suggest need for bronchoscopy?

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stridor
unilateral wheeze
hypoxia
coughing and choking

what are the differentials for neck lump?
What investigations may help diagnose?

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HL or NHL
EBV
bacterial tonsilitis
reactive lymph node
hyperthyroidism

what clinical features are used to assess severity of upper airway obstruction?

nature of stridor eg continuous or not self positioning - relaxed or upright ?swallow secretions ?hot potato voice respiratory distress anxiety

how do you manage acute upper airway obstruction eg quinsy

keep sitting up keep calm IV hydrocortisine 200mg IV abx ceftriaxone 2g nebulsed adrenaline involved ENT early difficult airway equipment to bed

What are the considerations needed when transferrings someone with airway compromise?

Patient- severty, difficulty of airway, response to treatment Equipment - airway equipment, drugs Escort - senior doctor Distance - road v air - plan for deterioration

Describe injury

large zig zag shaped would penetrates platysma evidence of blood soaked gauze soft tissue swelling at mandible face not involved

List the indications for emergent intbation of someone with penetrating neck injury

stridor acute resp distress profound shock altered mental state expanding haematoma airway obstruction from blood or secretions

list differentials and features that would suggest that

chronic supparative otitis media meningits - photophobia, rash mastoiditis - boggy swelling over mastoid encephalitis - confusion cerebral abscess - ataxia, cerebellar signs cholesteatoma

with strangulation what features or in the history suggest further investigtion

hoarse voice ligature marks LOC haematoma/petichial rash carotid bruit dyspnoea

what are the differentials for stridor in kids

croup laryngomalacia laryngeal FB epliglottis bacterial tracheitis retropharyngeal abscess

what are the indications for intubation with stridor?

exhaustion type 1 failure type 2 failure reduced level of consciousness

What is the intubation equipment for a child

Bag Valve Mask (with size - child) Laryngoscope with Miller blade (size 2) and Macintosh blade (size 2) ETT 4.0-4.5 and one size below due to anticipated laryngeal oedema Bougie Suction Laryngeal Mask Airway (size 2) Surgical airway equipment – needle cricothyrotomy Ketamine 2mg/kg or Fentanyl 2-5 mcg/kg or Propofol 1-2 mg/kg Suxamethonium 1-2 mg/kg or Rocuronium 1.2 mg/kg

what is the radiographical sign of epiglottitis? What is the usual causative agent and treatment?

thumb printing strep pneumonae in adults h.influenzae if not vaccinated ceftriaxone 1g

epiglottis and intubation factor, anticipated problem and solution

What is this? Why

large unilateral swelling below mandible with surrounding erythema ludwigs angina (submandibular abscess)

what is the management of ludwigs angina

analgesia eg fentanyl iv abx - metro and benpen urgent ent/max fax review for drainage or airway support

what are the initial management steps of a post tonsillectomy bleed?

2 large iv cannula bolus nacl at 20ml/kg o neg blood aim for pulse under 120 and bp over 90

with a post tonsillectomy bleed what intubation difficulties may you experience and how will you prepare?

what are four methods for reducing bleeding in post tonsillectomy blood

ice gargles co-phenylcaine spray adrenaline soaked gauze packing

what are the risk factors for TMJ dislocation?

previous tmj dislocation CTD eg ehlor danlos prior TMJ trauma

what mechanisms can cause TMJ dislocation?

seizures trauma yawning/screaming iatrogenic eg dental procedures * dystonic drug reaction

ENT Flashcards

(44 cards)