General ORL, Ethics, and Patient Safety
General ORL, Ethics, and Patient Safety
This domain tests airway emergencies, epistaxis, foreign bodies, informed consent, confidentiality, error disclosure, and surgical safety. The exam favors systematic ABC assessment and transparent communication.
Core rules
- Airway obstruction, stridor, and expanding neck hematoma take priority over diagnostic completeness; call for senior help early.
- Anterior epistaxis is usually controlled with direct pressure, topical vasoconstrictor, and cautery; posterior bleeding may need packing and reversal of anticoagulation when safe.
- Informed consent requires capacity, disclosure of risks and alternatives, and voluntary agreement. Minors and incapacitated adults require appropriate surrogate consent except in emergencies.
- Disclose harmful errors promptly and honestly; document the discussion. Use the WHO surgical safety checklist and mark the operative site.
- Confidentiality can be breached only with consent or a legal mandate such as mandatory reporting.
Worked example
A 70-year-old on warfarin has persistent anterior epistaxis. After ABC assessment, direct pressure and cautery fail. The next steps are nasal packing, checking INR, and reversing anticoagulation in consultation. Consent for packing is documented. The reasoning is control of bleeding while addressing coagulopathy and airway risk.
Traps
Do not discharge brisk posterior epistaxis without airway and bleeding control. Do not hide a surgical error. Do not obtain consent without discussing alternatives. Do not overlook anticoagulation in epistaxis.