ENT trauma
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| Describe the most common areas for apistaxis. | 90%-anterior, 10%-posterior.
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| What are some causes of nose bleeds? | trauma, crushing, infection, FB, HTN, hematologic dz
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| Where does the internal nasal blood supply come from? | internal and external carotids
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| Anterior bleeds usually occur in what area? | Kiesselbachs plexus, a dry area where arterioles end.
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| 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.
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| What is the prper way to apply silver nitrate? | touch to nose to cauterize, do not paint on.
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| What is a practical way to prevent a rebleed? | Apply vaseline or vaseline based abx to the inside of nose.
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| where do high anterior bleeds usually originate? | anterior ethmoid artery (usually in old HTN patient)
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| What is seen on PE of a high anterior bleed? | above the middle turbinate, unilateral, and brisk bleed.
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| How do you treat high anterior nose bleeds? | start an IV, will probably need an anterior pack(small %need a posterior pack).
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| How would you monitor a high anterior bleed? | do a hematocrit and evaluate for shock, especially in pts on blood thinners
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| Where do posterior bleeds originate most often? | posterior ethmoid and posterior branch of sphenopalatine artery.
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| 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.
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| What labs need to be done in a posterior bleed? | hematocrit/hemoglobin, coags, electrolytes, and EKG
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| What is the tx for a posterior bleed? | IV, posterior pack, possible surgical ligation. This is a potential life-threatening emergency.
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| 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)
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| Merisol sponge | "nasal tampon" may not fill the entire cavity.
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| What is a complication of nasal packing? | Sinusitis, TSS
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| 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.
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| What is the most common typr of fracture of the temporal bone? | 80% are longitudinal
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| 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.
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| 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.
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| What are two signs seen in temporal fractures? | raccoon eyes, and the battle sign
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| When do you try to move bones back after a trauma? | after 1 week, If you set earlier you will overcompensate bc of swelling.
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| What should be done with a flat depressed nasal bridge. | facial films, adn check extra ocular movement
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