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ENT Trauma

Clinical Medicine I

% 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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