HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Manzoor NF, Rezaee RP, Ray A, et al. Contemporary management of carotid blowout syndrome utilizing endovascular techniques. Laryngoscope . 2017; 127(2):383-390. EBM level 4.............124-131

Summary : This is a retrospective review to illustrate complex interdisciplinary decision making and the utility of modern endovascular techniques in the management of patients with carotid blowout syndrome (CBS). Between 2004 and 2014, 33 patients had 38 hemorrhagic events related to head and neck cancer that were managed with endovascular means. Of these, 23 were localized to the external carotid artery (ECA) branches and five were localized to the ECA main trunk; nine were related to the common carotid artery (CCA) or internal carotid artery (ICA), and one event was related to the innominate artery. Seven events related to the CCA/ICA or innominate artery were managed with endovascular sacrifice, whereas three cases were managed with a flow-preserving approach (covered stent). Only one patient developed permanent hemiparesis. In two of the three cases in which the flow- preserving approach was used, the covered stent eventually became exposed via the overlying soft tissue defect, and definitive management using carotid revascularization or resection was employed to prevent further hemorrhage. In cases of soft tissue necrosis, vascularized tissues were used to cover the great vessels as applicable. C. Caustic ingestion Bird JH, Kumar S, Paul C, Ramsden JD. Controversies in the management of caustic ingestion injury: an evidence-based review. Clin Otolaryngol . 2017; 42(3):701-708. EBM level 3......................132-139

Summary : This article discusses evidence-based guidance in the acute management of caustic ingestion injury. The article addresses the limited role of CT imaging in the acute setting.

D. Management of burns to the head and neck Wong S, Melin A, Reilly D. Head and neck reconstruction. Clin Plast Surg . 2017; 44(4):845-856. EBM level 5.....................................................................................................................................140-151 Summary : This article discusses the acute treatment of head and neck burns, including management based upon burn depth, and timing and extent of reconstruction based upon the involved anatomic site in the head and neck.

E. Perioperative care of the otolaryngology patient 1. Pain control (narcotic and nonnarcotic therapies)

Cramer JD, Wisler B, Gouveia CJ. Opioid stewardship in otolaryngology: state of the art review. Otolaryngol Head Neck Surg . 2018; 158(5):817-827. EBM level 4.......................................152-162

Summary : This systematic review evaluates the risk of opioid abuse after otolaryngology surgeries and discusses strategies to avoid misuse. Among opioid-naïve patients who underwent otolaryngology procedures, the rate of postoperative chronic opioid use was 6%. The article summarizes recommendations for how to counsel patients about opioid use and screen for abuse, and gives examples of pain management strategies to use for various surgical procedures.