Blunt Trauma to Head and Neck -- SD Flashcards
If we have an injury in “zone 1”, what do we worry about?
Subclavian, aortic arch, trachea, c-spine roots
If we have an injury in “zone 2”, what injuries do we worry about?
Carotid/vertebral arteries, jugular vein, larynx, c-spine
If we have an injury in “zone 3”, what injuries do we worry about?
Trachea, vertebral bodies, carotids, jugular, CN 9-12
95% of penetrating neck wounds are caused by?
Knife/guns
If someone has a penetrating wound from a knife, what’s important to know about the knife?
How big is it
Must common cause of blunt trauma to the neck?
MVA
In reference to neck injuries, symptoms are a good or poor predictor of underlying damage?
Poor!
On PE we must know if the ________ has been violated. If it hasn’t, it’s very unlikely we have a penetrating injury.
Platysma
What are some signs of underlying injury from blunt trauma?
Hematemesis, odynophagia, voice changes, subQ emphysema
True or False:
If we know the platysma has been violated we should send them to CT immediately?
False – skip imaging, go the OR immediately
Shock, expanding hematoma, impending airway obstruction, bruit, or blood in aerodigistive tract are all indicators for?
Surgical exploration
If a neurologic deficit is found on contralateral side, we must consider what type of injury?
Carotid/vertebral artery injury
Should we remove foreign bodies in the ED? like knives and such?
no – many be only thing holding carotids together
True or False
It takes a lot of force to break the frontal bone
True! High velocity injuries
What will you find on exam of a frontal bone fracture?
Well feel a divot, depression of forehead
What type of fracture can be isolated or occur with medical wall fracture?
Orbital floor fracture
What do we need to worry about with orbital floor fractures?
Fracture can herniate orbital contents into sinus and can cause entrapment of the inferior rectus muscle
How do diagnose a orbital floor fracture?
Non-contrast maxillofacial CT scan
What can we not miss with a nasal bridge fracture?
Do not miss a septal hemaotma
This type of fracture may present with CSF rhinorrhea and constant tearing after trauma
Nasoethmoidal fracture
Nasoethmoidal fractures risk damage to what other structures?
Medial canthus, lacrimal gland, nasofrontal duct, and cribiform plate
How do we diagnose a nasoethmoidal fracture?
CT scan
This type of fracture usually occurs from a direct blow and is typically isolated
Zygomatic arch fracture
what kind of x-ray do we get to diagnose a zygomatic arch fracture?
X-ray of head tilted back to isolate the zygomatic arch
For what types of fractures do we use the LeFort classification?
Maxillary
Facial edema, mobility of palate and teeth is which type of classification?
LeFort 1
Telecanthus, mobility of maxilla, epistaxis, CSF rhinorrhea is what type of classification?
LeFort 2
Facial elongation/flattening, movement of all facial bones with respect to cranial base, CSF rhinorrhea is what type of classification?
LeFort 3
How do we treat maxillary fractures?
Surgery
What type of mandible fracture is most commonly overlooked?
Condyle fracture
What test on physical exam can we do to diagnose a mandible fracture?
Tongue blade test – bite on tongue depressor and twist it. With a broken jaw it will slide right out
What should you do if you have a broken tooth?
Store avulsed tooth in whole milk and give the the patient a temporary filling/dental block
Battle’s sign, raccoon eyes, and hemotympanum are symptoms of?
Basilar skull fracture
How do you know if a patient has CSF coming out of their ear/nose?
Grab a piece of gauze and if there is CSF you will see a separation of the CSF from blood – halo sign
What is hallmark of a Basilar skull fracture?
CN1 deficit with or without CN 7, 8
If someone has an orbital blowout fracture, who must be consult with?
Ophthalmologist +/- ENT
Nasoethmoidal fracture – who must be consult with?
Neurosurgery
