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ENT trauma

QuestionAnswer
Describe the most common areas for apistaxis. 90%-anterior, 10%-posterior.
What are some causes of nose bleeds? trauma, crushing, infection, FB, HTN, hematologic dz
Where does the internal nasal blood supply come from? internal and external carotids
Anterior bleeds usually occur in what area? Kiesselbachs plexus, a dry area where arterioles end.
What is the tx for anterior bleed? apply direct pressure to nasal bones for 10 minutes, if it continues you can use a vasoconstrictor with anesthesia/silver nitrate. Then do another 10min of pressure.
What is the prper way to apply silver nitrate? touch to nose to cauterize, do not paint on.
What is a practical way to prevent a rebleed? Apply vaseline or vaseline based abx to the inside of nose.
where do high anterior bleeds usually originate? anterior ethmoid artery (usually in old HTN patient)
What is seen on PE of a high anterior bleed? above the middle turbinate, unilateral, and brisk bleed.
How do you treat high anterior nose bleeds? start an IV, will probably need an anterior pack(small %need a posterior pack).
How would you monitor a high anterior bleed? do a hematocrit and evaluate for shock, especially in pts on blood thinners
Where do posterior bleeds originate most often? posterior ethmoid and posterior branch of sphenopalatine artery.
What is seen on PE in a posterior bleed? Heavy bleeding, blood going down throat, large clots, unilateral but because it is so high up blood may be coming from both nares.
What labs need to be done in a posterior bleed? hematocrit/hemoglobin, coags, electrolytes, and EKG
What is the tx for a posterior bleed? IV, posterior pack, possible surgical ligation. This is a potential life-threatening emergency.
How do you insert a traditional vaseline gauze anterior pack? Use a vasoconstrictor and anesthesia first. Good lighting. using long forceps, place packing in one layer at a time. Hydrate the active bleeding with saline(5-10cc)
Merisol sponge "nasal tampon" may not fill the entire cavity.
What is a complication of nasal packing? Sinusitis, TSS
Describe posterior packing. Only done by ENT or surgeon. Place balloon in uninflated, inflate outside ballon first, then inside balloon. PAck with gauze/sponge. admit to medicine.
What is the most common typr of fracture of the temporal bone? 80% are longitudinal
Describe longitudinal fractures in the temporal bone. in the parietal region. Disrupts the TM with bleeding. +/-conductive hearing loss. Possible sensorineural hearing loss from concussion.
Describe transverse fractures of temporal bone. in the occipital region. SN hearing loss, loss of vestibular fxn, hemotympanum and CSF from nose. may see bruising behind mastoid bone later.
What are two signs seen in temporal fractures? raccoon eyes, and the battle sign
When do you try to move bones back after a trauma? after 1 week, If you set earlier you will overcompensate bc of swelling.
What should be done with a flat depressed nasal bridge. facial films, adn check extra ocular movement
Created by: emeliza87
 

 



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