Trauma and Emergencies
Core concepts
Prioritise airway, breathing, circulation in every trauma scenario. Know maxillofacial trauma: Le Fort I–III patterns, zygomatic complex fractures (malar flattening, diplopia, infraorbital numbness), orbital blowout (entrapment, restricted upgaze, diplopia), mandibular fractures (occlusion, mental nerve numbness), and nasal bone fractures. Understand laryngeal trauma (hoarseness, subcutaneous emphysema, stridor - airway emergency; CT and early exploration for displaced fractures). Know epistaxis escalation: pressure, topical vasoconstrictor/cautery, packing, sphenopalatine artery ligation or embolisation. Recognise caustic ingestion, foreign body airway obstruction (back blows/abdominal thrusts; bronchoscopy), and sudden airway loss (cricothyroidotomy).
Traps
Do not miss orbital compartment syndrome (proptosis, pain, visual loss - emergency decompression). Beware laryngeal trauma masquerading as minor neck injury - subcutaneous emphysema is a red flag. Do not pack posterior epistaxis blindly without airway awareness. Airway first in facial trauma, even if the face looks dramatic.
Rule of thumb
In any ENT emergency, secure the airway before definitive repair. For orbital compartment syndrome, perform lateral canthotomy/cantholysis immediately - vision is time-critical.