ENT emergencies

Question 1

what can significant nasal trauma be associated with?

Answer 1

• brain injury

- septal haematoma

Question 2

how are septal haematomas treated?

Answer 2

drained in theatre

Question 3

how can you tell if a lump in the nose is a septal haematoma?

Answer 3

-if its boggy and swollen

Question 4

what can an untreated septal haematoma lead to?

Answer 4

-brain abscess

Question 5

what is one of the most common emergencies seen in ENT?

Answer 5

epistaxis

Question 6

what arteries are involved in epistaxis?

Answer 6

-internal and external carotid arteries

Question 7

what is the management for epistaxis?

Answer 7

• pinch soft cartilage of nose for 5 minutes at a steady pressure
• may need to cautarise nose with nitrate
• if this doesn’t work may need to pack the nose for 24 hours

If bleeding controlled:

• arrange admission if packed/poor social circumstances
• FBC
• G&S

If bleeding not controlled:

• arrange admission
• FBC
• G&S
• consider arterial ligation (sphenopalatine artery, anterior ethmoid, external carotid)

Question 8

what is the management for a patient who is really ill/ hypovolaemic with epistaxis?

Answer 8

• resus
• arrest/slow flow: pressure, ice, topical vasoconstrictor +/- LA (Lignocaine + adrenaline, Co-phenylcaine)
• remove the clot using suction and nose blowing
• cauterise using silver nitrate/diathermy and pack if you can
• Tranexamic acid
• take off anticoagulants/change
• platelet transfusion
• treatment for hypertension
• correct clotting abnormalities

If bleeding controlled:

• arrange admission if packed/poor social circumstances
• FBC
• G&S

If bleeding not controlled:

• arrange admission
• FBC
• G&S
• consider arterial ligation (sphenopalatine artery, anterior ethmoid, external carotid)

Question 9

what are rapid rhino packs used for?

Answer 9

• for ‘packing’ in epistaxis

- this can be very painful so may need analgesia on nose

Question 10

what often causes a CSF leak?

Answer 10

-nasal trauma leading to a fracture in the cribriform plate

Question 11

how long does it tend to take a CSF leak to resolve?

Answer 11

10 days

Question 12

what is pinna haematoma?

Answer 12

cauliflower ear

Question 13

what is the treatment for pinna haematoma?

Answer 13

either aspirate or incise and drain

if recurrent or big incise and drain (however this leaves a larger scar)

Question 14

what is the management of lacerations?

Answer 14

• Debridement
• Closure (primarily if can)
• Antibiotics especially if cartilage showing to avoid infection