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ENT trauma
| Question | Answer |
|---|---|
| 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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