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ENT Trauma
Clinical Medicine I
| Question | Answer |
|---|---|
| % ant or post. Bleed | 90% ant 10% post |
| Causes of epistaxis | Trauma, crulsting, infection, FB reaction, HTN, hematologic dz |
| MC local for Anterior bleed | Kiesselbachs plexus |
| Anesthetic soln’s | 4% lidocaine, tetracaine, or cocaine |
| Tx for ant. Bleed | Direct pressure 10 mins leaning forweard, add vasoconstrictor w/ anest. Or silver nitrate stick |
| Chemical cauterization agent | Silver Nitrate Stick: direct pressure 10 sex, Don’t paint |
| Ways to prevent ant. Re bleed | Vaseline or Vaseline based abx ointment for moisture |
| Local for high anterior bleed | anterior ethmoid A. |
| MC cause for high ant. Bleed | elderly HTN pt |
| During PE, what is noted with a high ant. Bleed | above the middle turbinate, usually can’t see it, but can r/o not an ant. Bleed by not finding source, usally pretty brisk |
| Labs needed for high ant. Bleed | hematocrit and evaluate for shick |
| Tx for high ant. Bleed | most likely an ant. Pack, start IV, sm might need post. Pack |
| Local for Post. Bleed | post. Ethmoid A. or post. Branch of sphenopalatine A. |
| RF for post. Bleed | elderly, smoker w/ HTN |
| Sxs/PE for post. Bleed | HEAVY bleeding, down back throat, vomiting, d/t swallowing blood |
| Labs for Post. Bleed | Hbg/HMC, coags, electrolytes, EKG, Type and Corss |
| Tx Post bleed | Start IV, usually surgical ligation of artery, post pack? LIFE-THRETNING |
| Types of Ant. Packs | Vaseline gauze or Merisel sponge |
| Must use prior to using a ant pack | vasoconstrictor and anesthetic |
| Prior to inserting the Merisel sponge, this has to be done | Immediately before, hydrate w/ 5-10cc saline for expansion |
| Complications w/ ant pack | risk rebleed during removal, Severe bacterial sinusitis (can prophalx w/ abx) |
| Who performs a post. Pack? | ENT or surgeon |
| Types of temporal bone fractures | Longitudinal (80%) Transverse (20%) |
| Sxs of a bad temporal bone fracture | SNHL, loss vestibular fxn, hemotypanum, CSF leaking from no\se, brusing behind mastoid-later |
| Should temporal bone fractures be admitted or sent home? | depends on individual pt and their at home support system |
| Healing time for fractures and precations to be taken | 4-6 wks, if heavy duty job, stay home! |
| Signs of a temporal bone fracture | raccoon eyes, battle sign (mastoid bone bleeding area) |
| When are nasal bone fracture reductions done | when swelling has decrease (unless airway obstruction is present) |
| What needs to be evaluated w/ depressed nasal bridge? | need nacial films, CT w/o contrast and check EOM (must evaluate neighboring skull bones) |
| Unilateral foul nasal drainage | main sxs for Nasal foreign body |
| What is critical when fixing a lip laceration | to correctly align the vermillion border |
| Are tongue lacerations sutured | no, unless done by ENT, heal fast |
| Test for mandible fractures | tongue blade test + trismus, malocclusion, pain |
| Diagnosis imagine for mandible fracture | orthopentamogram or dental panorex |
| Keep a dislocated tooth in what outide of the mouth? | mild or saliva |
| Steps for dental trauma | handle crown, avoid touching the root, DO NOT SCRUB |
| Voice change, stridor, sub-q emphysema, pain | Laryngeal blunt trauma |
| Radiology for laryngeal trauma | plain film XR CT? |
| Tx for laryngeal trauma | Voice rest, no whispering, humidified air, CL diet, +/-steroids |
| With a penetrating laryngeal trauma, what MUST be done | surgical referral, even if stable |
| Major concern with facial fractures | respiratory problems |
| CN’s that involve vision | CN II, III, IV, VI |
| XR’s needed for facial fracture | Facial series, AP, PA, lateral and water’s view(sinuses) |
| Three grades of Le Fort fractures | transverse: above teeth, involves inferior orbital rim, complete disruption, involves zygomatic arch |
| Facial fracture unilateral with zygomatic arch involvement | Tripod Fracture (can be managed w/o surgery) |
| Chief concerns w/ deep neck infections | airway compromised, the deep complex anatomy, difficult to palpate |
| Swelling w/ diffuse cellulitis Space from hyoid to the mucosa of floor of mouth | Ludwig’s angina |
| MC cause of ludwig’s angina | odontogenic, or periodontal dz |
| Sxs of ludwig’s angina | mouth pain, dysphagia, drooling, stiff neck, muffled voice |
| Tx of ludwig’s angina | airway control! Abx, surgical drainage is needed |
| MC for retropharyngeal and prevertebral abcesses and spaces | kids w/ infectious causes, trauma for adults |
| Dx for Retropharyngeal abscess | XR of neck (lateral usually) |
Created by:
becker15
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