one of the management in epitaxis is to apply Trotter's method

if epitaxis did not stop after packing we need to EUA and ligate mandibular artery

all patient with epistaxis need OGDS prior discharge

anterior epistaxis is common in elderly patient

inflammation of sinus mucosa less than 100 days

common features include fever, facial pain, hyposmia, nose block

sinusitis is better to treat with Functional Endoscopic Sinus Surgery (FESS)

One of the common organism isolated is E. coli

danger area of face lies between tip of nose and two angle of eye

facial vein in danger area has valve

Facial vein in danger area communicate directly with ophthalmic veins

Cavernous sinus is spared from the danger area

Supraglottic tumour is one of the febrile cause of stridor

Diphtheria is one of the afebrile cause of stridor

Laryngomalacia is one the acquired cause of stridor

Stridor - harsh vibrating noise when breathing cause by obstruction of larynx or trachea

commonest organism is parainfluenza virus

lateral neck x ray showed Thumb sign

patient will have low grade fever

cough is barking in nature

Cellulitis of the submaxillary space

80% is due to injury oral mucosa

Mainstay of treatment is surgical drainage

One of the complication is mediastinitis

even skin lacerated, as long as the bone is not exposed we treat as close fracture

in transverse fracture, bone will be still displaced after reduction

in comminuted fracture, the fracture have two or more fragments

in greenstick fracture: bone is buckled or bent, commonly seen in children

primary fracture healing means treated operatively without callus formation

fracture unite faster in elderly

good reduction and apposition of fractured bone result faster healing

soft tissue interposition fracture site will promote faster fracture healing

in stage 1: bone healing is tissue destruction and hematoma formation

in stage 2: soft granullation tissue form between fracture fragments

in stage 3: there is formation of callus/woven bone

in stage 4: lamellar bone will transform into woven bone

it is sufficient to treat any mandible fracture with an open jaw x ray

CT skull is warranted for any Lefort fracture

x ray of any fracture must consist of two views

x ray of any fracture must consist of two joints

principles in treatment of fracture is immobilization and rehabilitation

Thomas splint is one of the immobilization method

Plaster of Paris must not be change once it is applied

Rehabilitation should be started right after the operation is done

it is called ilizarov apparatus

it is used for immobilization of close fracture

it is used to treat mal-union fracture

it is minimal invasive apparatus thus pain is neglegible

thermoregulation

protect from infection

maintenance of skeletal frame

fluid maintenance

also known as bruise

epidermis is intact

formation of ecchymosis

diffuse swelling over contusion site

hematoma is similar to contusion but involve larger blood vessels

massive hematoma never result in shock

abrasion is cause by epidermal damage by scraping, rubbing or shearing force

laceration means break in skin of varying depth

systemic effect occur before the tissue is perfused

one of the muscle breakdown product is sodium

usually associated with profuse external bleeding

associated with renal failure due to nephrotoxic myoglobin

it can be cause by sharp object

it can be due to gunshot wound

internal bleeding might be severe

possibility of exit wound

it is usually due to a compartment massive tissue injury

may have pulses present and warm skin

pallor is one of the early sign

emergency fasiotomy is needed

tetanus vaccine is only given to MVA patient if not vaccinated before in life

clostridium tetani is an aerobic bacteria

tetanus vaccine is a toxoid vaccine

tetanus vaccine should be avoided during pregnant lady who sustained MVA injury