RB Y2 ENT > ENT Trauma > Flashcards

ENT Trauma Flashcards

(53 cards)

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1
Q

name 5 keys points to determine in the history

A
  1. mechanism of injury
  2. when
  3. loss of consciousness?
  4. epistaxis
  5. breathing
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2
Q

examination of the nose - what are you looking for?

A
  • bruising
  • swelling
  • tenderness
  • deviation
  • epistaxis
  • facial tenderness
  • infraorbital sensation
  • CNS
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3
Q

what happens to the nose after frontal trauma

A

broadened and flattened

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4
Q

how is the nose examined in order to see deviation properly

A

from behind

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5
Q

septal haematoma

A

occurs in around 5% of cases of nasal trauma, is described to be boggy and moves

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6
Q

what is the DD of septal haematoma

A

septal deviation - this is firm

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7
Q

why is there a need for immediate treatment of septal haematoma

A

as the nasal blood supply comes from the perichondrium an untreated septal haematoma can lead to destruction of the nasal septum due to AVN

this can result in cartilage necrosis and collapse (saddle nose deformity)

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8
Q

treatment of septal haematoma

A

immediate drainage and excision

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9
Q

symtoms of deviated septum

A

obstruction of nostrils (breathing), nosebleeds, facial pain etc

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10
Q

is there a need for review after nasal injury?

A

yes, 5-7 days post incident in ENT

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11
Q

undisplaced nasal fracture treatment

A

may need none

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12
Q

displaced nasal fracture treatment

A
  • Reduction under GA with post-op splintage within 2 weeks
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13
Q

post-op care of nasal reduction

A
  • apply ice for 1 hour
  • sleep with head elevated
  • dont breathe through nose
  • dont blow nose
  • no vigorous exercise
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14
Q

septoplasty

A

corrects a deviated septum

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15
Q

septorhinoplasty

A

aims to striaghten and/or refashion the shape of the nose for cosmesis and to help breathing by improving the airway

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16
Q

complications of nasal trauma

A

epistaxis

CSF leak, meningitis

anosmia

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17
Q

which artery most commony causes epistaxis post nasal trauma

A

anterior ethmoidal

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18
Q

what causes a CSF leak post nasal trauma

A

ethmoid fractures that disrupt the dura and arachnoid mater

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19
Q

management of CSF leak post nasal trauma

A

conservative, usually lumbar drain and bedrest. often settle spontaneously, need repair if they dont within 10 days

  • a dye is inserted into the CSF during lumbar drain, and then the nose it examined to determine the site of drainage so that it can be repaired
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20
Q

what causes anosmia post nasal trauma

A

cribriform plate fracture

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21
Q

most common site for epistaxis

A

anterior epistaxis most commonly occurs at Little’s area in the nasal septum

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22
Q

management of epistaxis

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A
  • resuscitate on arrival if necessary (eg dizzy, low BP)
  • arrest/slow blood flow
    • pressure: pinch the base of the nose and bend forward, breath through mouth
    • ice: pack on dorsum of nose
    • topical vasoconstrictor and numb: spray on co-phenylcaine (vasoconstrictor) ± lidocaine + adrenaline (numb)
  • remove clots
  • find bleeding points: anterior rhinoscopy
  • apply cautery to stop bleeding: silver nitrate/diathermy
  • nasendscopy
23
Q

what should be elicited in history of a patient with epistaxis

Study These Flashcards
A

anticoagulants? warfarin/heparin

24
Q

lidocaine action

Study These Flashcards
A

blocks Sodium channels responsible for signal propagation, can result in failure of postsynaptic neuron to depolarize and transmit AP

25
how are clots removed in management of epistaxis
ask patient to blow out nose, use suction
26
epistaxis management: what should be done if bleeding continue
try an anterior nasal pack
27
why should you not sedate patients presenting with epistaxis
there is a risk of aspiration
28
what is often referred to as cauliflower ear
pinna haematoma
29
pinna haematoma
haematoma occurs under sub perichondrium there is a risk of necrosis and calcification, and the formation of an abscess that can destroy the elastic cartilage of the ear
30
management of pinna haematoma
aspirate incise and drain pressure dressing
31
when are ear lacerations usually seen
due to blunt trauma, avulsion, dog bites etc
32
management of ear lacerations
there is often tissue loss, essentially putting the ear back in place and suturing it debridement may be necessary a local anaesthetic is usually used eg adrenaline
33
what is recommended if an ear laceration has resulted in cartilage exposure
ABx for 5 days
34
what is checked in examination of temporal bone fracture?
hearing - condition of TM and ear canal CNVII
35
Battle's sign
temporal bone fracture - bruising over mastoid process
36
Raccoon eyes
periorbital bruising indicates a high risk of temporal bone fracture
37
which type of temporal bone fracture would a lateral blow cause
longitudinal
38
longitudinal temporal bone fracture - occurrence - associated symptoms - deafness? - complications
80% there may be bleeding from the external canal due to laceration of skin and ear drum haemotympanum and ossicular chain disruption can cause conductive deafness CSF otorrhoea
39
facial nerve involvement in temporal bone fractures
20% longitudinal 50% transverse
40
which type of temporal bone fracture does a frontal blow cause
transverse
41
transverse temporal bone fracture
can cross the IAM damaging CNVII and CNVIII (damage can cause sensorineural hearing loss and vertigo)
42
management of temporal bone fracture
* often a high velocity injury and there is polytrauma * manage CSF leak if necessary * check CN * restore hearing if necessary - aid or ossiculoplasty
43
describe where transverse and longitudinal temporal bone fractures are in relation to the petrous pyramid
longitudinal fractures travel parallel to the long axis tranverse are at right angles
44
45
longitudinal fracture
46
what is the best mode of imaging for checking the cervical spine after neck trauma
CT
47
which neck zone is the mortality highest in
zone 1
48
what are the vulnerable structures in a zone 1 neck injury
trachea, oesophagus, thoracic duct, thyroid , large vessels spinal cord
49
in which neck zone are the CN most vulnerable
CNX, XI and XII in zone 2
50
what determines whether neck trauma is superficial or penetrating
if it has penetrated the platysma
51
Le Fort Fractures
a simplification of maxillary fractures, in most instances, maxillary fractures are a combination of Le Fort types
52
which Le Fort fractures can disrupt the cribriform plate
II and III, result in spread of infection from nasal cavity and paranasal sinuses to anterior cranial fossa
53
imaging of maxillary fracture
X ray: C spine and Waters view (to image the maxillary sinuses) CT is imaging of choice
RB Y2 ENT
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