جابريون⁸ (جراحة عملي )

9️⃣ Inhalation injury ♦️Sign of inhalation injury: 🚑1.Decreased level of consciousness. 🚑 2.inflammation of the supra glottic structures. 🚑3.circumfernicial neck burn . 🚑4.burned nasal hairs. 🚑5.carbon deposits in the oral cavity . الـsign الي يسبب! 🚑 :-sustain marked edema of glottic and supraglottic airway. result is immediate or delayed airway obstruction. لذلك نسوي 🚑prophylactic endotracheal intubation 🚑mechanical ventilation

♦️small FB in the ear:- removed by syringing ♦️Disc battery : is emergency because: 🚑1-ionic (NaOH , KOH , mercury ) 🚑2-lead to perforation( In 8-12 hours ) ♦️insect : should be killed by : 🚑ethanol (fast) 🚑normal saline ♦️Fogarty :- embolectomy balloon catheter used to remove the foreign body only in circle foreign bidy ♦️only metallic Foreign body appear on x-ra عظم السمج ميبين عظم الدجاج يبين

8️⃣Foreign body in ENT

7️⃣Septal hematoma ♦️Every patient with nasal trauma should be : (evaluate for septal hematoma ♦️Treatment: should be drained within 48 hr 🚑1-incision with drain 🚑2-anterior packing bilateral . ♦️How diagnose septal hematoma ? 🚑1-red 🚑 2-swelling 🚑 3-compressable ♦️if not occure the drainge : 🚑1-cartilage necrosis will occur ( septal resorptions inevitable) 🚑 2-saddle nose in the future

6️⃣Auricular hematoma شوفوا ال cartilage مال الأذن ما بي blood supply خاص بي لذا ياخذ الدم من غلافه الي هو perichonderal اذا صار فاصا بينه و بين غلافه فراح ينقكع عنه الدم الاذن راح تصغر ب الحجم فيصير عدنه cauliflower ear ♦️mangement: 🚑should be drainge with multiple puncturing or incision 🚑cover the ear in both side by bandage with antinbiotic 🚑if nor drainage occure: 🧠perichondritis 🧠chondrites 🧠cauliflower ear

5️⃣Fracture nasal bone ♦️Presentation: 🚑1-pain 🚑 2-tender 🚑 3-deformity 🚑 4-ecchymosis ♦️ conditions should Not miss with fracture nose : 🚑1-CSF leak 🚑2-septal hematoma ♦️X-rayNot need because: 🚑1- 40% false positives 🚑2- old fractures 🚑3- bone overlap in child X-ray ♦️for medico legal not for diagnosis ♦️Treatment:Corrected in : 🚑 -less 2 weeks 🚑in adult -10 days in children by digital reduction اذا عدته هاي الفتره وممعالجة هنا نحتاج الى 🚑🚑septorhinoplasty

Complication of Retropharyngeal abcess

4️⃣Retropharyngeal abscess ♦️cause : suppuration lymph nodes between the pharynx and prevertebral fascia ♦️Physical examination : unilateral posterior pharyngeal wall swelling ♦️mangemennt : 🚑surgical emergency 🚑Tracheostomy

🚨ركزو ع الي محطوط عليهن لون

🚑 Steeple sign (subglottic stenosis)

3️⃣CROUP ACUTE (viral ) Largo trachea bronchitis ♦️Cause: parainfluenza 1 ♦️Sign & symptoms 🚑 1-barking cough 🚑 2-low grade fever 🚑3-flu 🚑5-mild stridor 🚑6-Steeple sign (subglottic stenosis) ♦️mangement: Croup is usually self-limiting; 50 percent of children improve within 24 hours of the onset of symptoms, and most recover within four days without treatment.. (mi 🚑In the absence of medical therapy, 20% of patients 🚑may be admitted to hospital and 10% of these may require intervention for acute airway obstruction, either intubation or tracheostomy (cricothyriodotomy possible). ♦️🚨if recurrent croup هنا نفكر بالـ : congenital or acquired laryngeal anomalies ( mild subglottic stenosis) 🚑Management : subglottic stenosis احتمال عنده فنسوي endoscopy

🚨🚨🚨 مهم Thumb sign

Tripod position

Sniff position

2️⃣ACUTE EPIGLOTTITIS ( SUPRAGLOTTITIS ) ♦️caused : H.infuenza type B ♦️sign and symptom : 🚑suddenonset of high grade fever 🚑respiratory striodor 🚑muffed voice 🚑drooling saliva 🚑dysphagia 🚑short history sore throat ♦️position : 🚑Early sniff position ( head extension and neck flexion ) 🚑in advance : tripod position (leaning forward) ♦️contraindication 🚑laryngoscope 🚑tongue depressor 🚑cannulation ♦️Management 🚑suspected or confirmed the diagnosis 🚑airway should be secured by 🔥endotracheal tube 🔥🔥if can not do endotracheal tube we should make tracheostomy tube

♦️-الاطفال اذا فقدوا 10 % من دمههم يعتبرون bleeding significant ♦️الجسم يحتوي70-80 cc /kg فاذاطفل وزنه20 كغ الsignificant تقريبا يعتبرراح140 فقط ♦️اذاجان البيشنت يمشي على warfarin نقيس اله الـINR اذاضمن الطبيعي نبقيه يستمر واذا مومن ضمن الطبيعي نگطعه ♦️تذكر : Don't treated epistaxis by putting pledge of cotton with adrenaline