Chapter 26 - Head, Face, Eyes, Ears, Nose, Throat Flashcards
what joints make up the skull?
sutures - immovable joints
cranial vault
houses brain
bones of skull
frontal, ethmoid, sphenoid, 2 parietal, 2 temporal, occipital bones
cerebrum
2 hemispheres; voluntary muscle activity
interprets sensory impulse,
controls higher mental functions (memory, reasoning, intelligence, learning, judgement, emotions)
Cerebellum
controls synergistic movements of skeletal muscle
coordination of voluntary movements
pons
controls sleep, posture, respiration, swallowing, bladder
medulla oblongata
lowest part of brain stem, regulates HR, BP, coughing, sneezing, vomiting
Meninges: outer to inner
dura mater - subdural space - arachnoid mater - subarachnoid space - pia mater
where is the CSF located?
b/w arachnoid mater and pia mater
surrounds and suspends the brain
History: head injury
retrograde amnesia - loss of memory of events before injury
anterograde amnesia - loss of memory of events after injury
Observation: head injury
disorieneted, blank stare, slurred speech, delayed verbal/motor responses, coordination, unfocused, distracted, memory deficit, normal cognitive functioning
palpation: head injury
tenderness, deformity on neck or skull
Special tests: head injury
neurologic, eye function, balance tests
neuro exam: head injury
cerebral testing (cognitive)
cranial nerve testing
cerebellar testing (coordination of motor function)
sensory testing
reflex testing
motor testing
Eye function exams
PEARL, eyes tracking, blurred vision
PEARL
pupils equal and reactive to light
dilated or irregular,
inability to accommodate light variance
Eye tracking
smooth movement,
rotary movement - nystagmus (possible lesion in posterior fossa of brain)
Balance tests
Romberg, BESS, coordination, cognitive tests, neuropsychological assessments
Romberg test
stand in double leg, single leg, tandem stances with shut eyes and hands at the sides
(+) tendency to sway or fall
BESS
balance error scoring system
double, single (non dominant foot), tandem stances (non dominant food to back) on hard and airex pad.
hands on hips, eyes close, for 20 sec, opposite limb is in 30 degrees of hip flexion and 40-50 degrees of knee flexion
max error score of 10
BESS errors
hands lifted off iliac crest, opening eyes, step, stumble, fall, moving angle of hip or knee, lifting forefoot, or heel, can’t stay in position of more than 5 sec
coordination tests
finger to nose, heel toe walking, standing heel to knee test
(injury to cerebellum)
Cognitive tests
count backwards from 100 by 7s, backwards spelling, naming months in reverse, tests of recent memory
Neuropsychological assessments
SAC, SCAT, ANAM
SAC
standarized assessment of Concussion
measures of orientation, immediate memory recall, concentration, delayed recall, neurological screening (LOC, amnesia, strength, sensation, coordination)
ANAM
Automated Neuropsychological Assessment Metrics
ex. ImPACT
sensitive to measuring cognitive function most susceptible to deficit after concussion
Skull Fx Etiology
often from blunt traum
skull fx S/Sx
severe headache, nausea, defect or indentation, blood in middle ear/ear canal/nose; ecchymosis around eyes (raccoon eyes); ecchymosis behind the ear (Battle’s sign), cerebrospinal fluid in ear canal and nose
skull fx management
complications from intracranial bleeding
bone fragments in brain
infection
immediate hospitalization and referral to surgeon
cerebral concussions
mild head injury
concussion etiology
immediate and transient post-traumatic impairment of neural functions
direct blow
countrecoup
injury to opposite side of initial contact
concussion S/Sx
blurred vision, dizziness, drowsiness, excess sleep, easily distracted, fatigue, in a fog, slowed down, headache, irritable, LOC, disorientated, memory issue, poor balance, ringing in ears, sensitive to light or noise, sleep disturbance, nausea/vomiting
post concussion syndrome etiology
occurs following a concussion, may be a few hours or a day after the initial impact
post concussion symtpoms/signs
persisten headache, impaired memory, lack of concentration, anxiety and irritable, giddy, fatigue, depression, visual disturbances, (can be weeks - months long)
second impact syndrome etiology
rapid swelling and herniation of the brain after a second head injury that occurs before the first is resolved.
brains blood auto regulatory system causes swelling of brain - increases pressure
second imapct S/Sx
no LOC, may look stunned, happens rapidly, dilated pupils, loss of eye movement, LOC –>coma, respiratory failure,
50% mortality rate
second impact management
must be noticed within 5 min, send to EMS,
prevention is key to avoiding second impact syndrome
Cerebral Contusion etiology
focal injury to brain that involves small hemorrhages or intracerebral bleeding in cortex, brainstem, or cerebellum
impact injury, head strikes immoveable object
cerebral contusion S/Sx
LOC, later becomes very alert and talkative, neuro exam will be normal, (headache, dizzy, nausea will persist)
cerebral contusion management
hospitalization, CT or MRI tests
Malignant Brain Edema etiology
occurs in young athletic population
diffuse brain swelling resulting from hyperemia or vascular engorgement
little to no injury to the brain
raises intracranial pressure, can be life-threatening
hyperemia
an excess of blood in the vessels supplying an organ or other part of the body.
Malignant Brain Edema S/Sx
rapid neuro detioration to coma and sometimes death
management of malignant brain edema
immediate recognition
rapid tx in emergency facility
Epidural hematoma etiology
blow to the head or skull fracture can cause tear of meningeal arteries
rapid blood accumulation –> hematoma
(happens in minutes o hours)
Epidural hematoma S/Sx
LOC, gradually worsening symptoms,
head pain, dizziness, nausea, dilation of one pupil (same side as injury), sleepiness
later symptoms: deteriorating consciousness, neck rigidity, depression of pulse/respiration, convulsions
management epidural hematoma
CT scan to diagnose, pressure must be surgically released
Subdural hematoma etiology
more frequent than epidural,
most common cause of death in athletes
acute: progress rapidly, like an epidural hematoma, arterial bleeding, assoc with brain contusion and skull injury
chronic: venous bleeding, low pressure, takes longer to become “serious”
S/Sx of subdural hematoma
complicated: LOC, dilation of one pupil (same side as injury)
Uncomplicated and complicated mutual symptoms: headache, dizzy, nausea, sleepiness
management for subdural hematoma
immediate transfer, CT scan, MRI needed
Migraine headaches etiology
neurological disorder which can last 4-72 hours
common in women
may be genetic
triggers: foods, meds, sensory stimuli, lifestyle changes
migraine symptoms
throbbing, pulsating pain on one side of head, nausea, vomiting, sensitive to light/sound/smell, aura, visual changes, tingling sensation, numbness, dizziness
management for migraine
prevention - prophylactic meds
where are frontal sinuses housed
supraorbital ridges
temporomandibular joint
articulation b/w mandibular condyle and mandibular fossa of temporal bone
hinge joint, also glides forward and backward, side-to-side when chewing.
mandible fracture etiology
mostly in collision sports;
usually lower jaw frontal angle
mandible fx S/Sx
deformity, loss of normal occlusion of teeth, pain when biting, bleeding around teeth, lower lip numbness
mandible fx management
temporary immobilization,
reduction and fixation by physician
4-6 week recovery, resume full activity in 2-3 months
mandibular dislocation etiology
prone to dislocation,
side blow to open mouth, forces condyle forward out of temporal fossa
mandibular dislocation s/sx
locked open position, malocclusion of teeth
managemtn - mandibular dislocation
ice, immobilize, reduce
soft food diet, NSAIDs, analgesics,
TMJ Dysfunction etiology
usually involves disk-condyle derangement
disk is positioned anteriorly when the jaw closes, when jaw opens condyle translates forward
audible click is heard -
causes deterioration of posterior stabilizing structures and eventually anterior dislocation of disc
TMJD s/sx
headache, earache, vertigo, inflammation, neck pain - trigger points,
inflammation of synovial capsule, disk derangemetn, malocclusion, hyper/hypo-mobility, msucle dysfunction, limited ROM
management of TMJD
correct mobility issue, strengthening exercises, joint moves,
dental appliance is recommended
Zygomatic Complex (Cheekbone) Fx Etiology
direct blow to cheekbone,
can be classified as a LeFort Fx
Lefort Fx
fx of one or more facial bones
facial bones
zygomatic, maxillary, orbital, nasal
Zygomatic Fx - S/Sx
obvious deformity, bony discrepancy, nosebleed, double vision, numbness of cheek
management zygomatic fx
cold application, immediate referral, healing takes 6-8 weeks
epistaxis
nosebleed
diplopia
double vision
Maxillary fx etiology
severe blow to upper jaw
maxillary fx s/sx
pain with chewing, malocclusion, nosebleed, double vision, numbness in lip and cheek
maxillary fx management
airway maintained, transportation in upright forward leaning position,
fx reduction, fixation, immobilization
crown
portion protruding from gum - covered by enamel
root
portion that extends into alveolar bone of the mouth
covered by cementum
dentin
beneath enamel and cementum, bulk of tooth
pulp
lies w/in dentin,
contains nerves, lymphatics, blood vessels that supply entire tooth
Preventing dental injuries
mouth guards, dental hygiene
progression of cavity
abscess –> gingivitis (gums inflamed) —> periodontitis (degeneration of dental periosteum, surrounding bone, and cementum)
Tooth Fx etiology
impact, direct trauma
uncomplicated crown fx
small portion broken, no bleeding, pulp chamber not exposed,
complicated crown fx
larger portion broken, bleeding from fx, pulp chamber exposed, great deal of pain
root fx
occurs below gum line
tooth may appear normal, bleeding from gum,
crown of tooth may be pushed back or loose
Tooth Subluxation, luxation, avulsion S/Sx
slightly loosened tooth, completely dislodged,
luxated - extremely loose,
Tooth Subluxation, luxation, avulsion management
sublux - immediate tx not required
luxation - move tooth to normal position if possible, see dentist ASAP
avulsion - rinse tooth, put in save a tooth, re-implant if possible - transport to dentist
nose functions
clean, warm, and humidify inhaled air
nasal fx / chondral separations etiology
lateral force causes greatest deformity
nasal fx/chondral separation s/sx
separation of frontal processes of maxilla, separation lateral cartilage, or combo of 2
profuse bleeding, swelling, hemorrhaging, crepitus
deviated septum
cause: compression or lateral trauma
s/sx: bleeding, septal hematoma, nasal pain
tx: compression applied, must be drained and packed
3 parts of the ear
external ear
middle ear
internal ear
middle ear
tympanic membrane
internal ear
labyrinth, formed partly by temporal bone of skull
eustachian tube
aids the organs of hearing and equalizing pressure between the middle and internal ear
joins ear and nose
external auditory canal
meatus
auricle
pinna
auricle hematoma aka
cauliflower ear
auricular hematoma etiology
compression or shearing to the auricle
causing subcutaneous bleeding
auricular hematoma s/sx
hematoma,
untreated - keloid formation
keloid
elevated, rounded, white, nodular, and firm (like a cauliflower)
auricular hematoma management
petroleum jelly and headgear
cold pack,
aspiration by physician
pack ear with cotton
tympanic membrane rupture etiology
fall/slap to unprotected ear
sudden underwater pressure variation
otoscope
inspection device for ear
tympanic membrane rupture management
heal in 1-2 weeks; infection is possible
swimmer’s ear known as
otitis externa
otitis externa etiology
infection of external auditory ear canal
caused by: Pseudomonas Aeruginosa (Bacillus)
otitis externa s/sx
pain, dizziness, itching, discharge, partial hearing loss,
otitis externa management
prevent by drying ears, using ear drops, and an alcohol solution
tx with acidification through drops into the ear or antibiotics
Otitis media aka
middle ear infection
otitis media etiology
accumulation of fluid in middle ear caused by local and systemic inflammation and infection
otitis media s/sx
intense pain, fluid drainage, loss of hearing, systemic infection which could cause fever, headache, irritability, loss of appetite, and nausea
otitis media management
analgesics, antibiotics
Impacted Cerumen etiology
excessive amounts of earwax
impacted cerumen s/sx
muffled hearing, little to no pain
no infection
impacted cerumen management
remove earwax with irrigation, do no use a q-tip,
may need a physician to remove with a curette
sclera
tough, white outer layer covering the eye
cornea
transparent portion of the sclera, covers pupil
how do we see
light passes through the cornea, then the anterior chamber, past the iris and the lens, and through the vitreous body - which focuses the image on the retina, where it is detected by the optic nerve
when dealing with the eye what injuries would require immediate referral
retinal detachment
perforation of the globe
foreign object embedded in cornea
blood in anterior chamber,
decreased vision
loss of visual field
poor pupillary adaptation
double vision
laceration
Testing pupillary reaction
pupil dilation and accommodation by covering eye then exposing it to full light
testing for visual acuity
snellen eye chart
ophthalmoscope
instrument for observing interior of the eye (especially the retina)
Orbital Hematoma aka
black eye
orbital hematoma etiology
blow to eye may initially injure the surrounding tissue & produce capillary bleeding into tissue spaces
orbital hematoma s/sx
ecchymosis, pain
more serious: subconjunctival hemorrhage or faulty vision
oribtal hematoma management
ice, do not blow nose
orbital fx etiology
blow to eyeball that forces it posteriorly, compresses the orbital fat until a blowout or rupture occurs to the floor of the orbit
orbital fx s/sx
diplopia, restricted eye movement, downward displacement of the eye, pain accompanied by soft tissue swelling and hemorrhage
orbital fx management
prophylactic antibiotics
treated surgically
corneal abrasions and lacerations etiology
caused by rubbing of a eye where there is a foreign body
corneal abrasion s/sx
severe pain and watering eyes, photophobia, spasm of the orbicular muscle of the eyelid
corneal abrasion management
eye patch
diagnose with fluorescein strip
antibiotics
hyphema etiology
collection of blood within the anterior chamber,
caused by being struck in the eye (by a ball)
hyphema s/sx
referral to physcian, hospitialize, bed rest, patch both eyes, sedation,medication
globe rupture etiology
blow to eye by a small object (golf ball)
globe rupture s/sx
pain, decreased visual acuity, diplopia, irregular pupils, increased intra-ocular pressure, orbital leakage
globe rupture management
immediate rest, eye protection, antiemetic medication to avoid increasing intra-ocular pressure
retinal detachment etiology
blow to the eye that partially or completely separates the retina from underlying retinal pigment epithelium
common among those with myopia or nearsightedness
retinal detachment s/sx
specks floating in the eye, flashes of light, blurred vision
as it progresses, may notice a ‘curtain’ closing over the field of vision
retinal detachment management
immediate referral to ophthalmologist
acute conjunctivitis etiology
usually caused by various bacteria or allergens,
acute conjunctivitis s/sx
eyelid swelling, purulent discharge, itching, burning
acute conjunctivitis management
highly infectious; 10% solution of sodium sulfacetamide
hordeolum (sty) etiology
infection of the eyelash follicle or the sebaceous gland at the edge of the eyelid;
caused by staphylococcal
hordeolum s/sx
erythema of the eye, localized into a painful pustule within a few days
hordeolum management
application of hot, moist compresses and 1% yellow oxide or mercury;
may need surgery
throat contusion etiology
getting “clotheslined”
could injure carotid artery, causing a clot to form that occludes blood flow to the brain or it becomes dislodged and migrate to the brain
throat contusion s.sx
severe spain, spasmodic coughing, hoarse speaking voice, difficult to swallow and breathe, inability to breathe, expectoration of froth body, cyanosis
throat contusion management
immediate concern is integrity of airway; apply cold intermittently to control hemorrhage and swelling, immediate referral
thyroid gland disorder
thyroid gland produces thyroxine and triiodothyronine
Hyperthyroidism
overproduction of thyroxine which impairs glucose metabolisms, and causes increased metabolism, rapid fatigue during exercise, weight loss, hyperthermia during exercise
Grave’s disease
may lead to weakness, tremors, difficulty swallowing/speaking
Hyperthyroidism
deficient secretion of thyroid hormone,
causes lowered metabolism, poor circulation, dry skin, low blood pressure, slow pulse, depressed muscular activity, intolerance to cold, increasing obesity, development of goiter
thyroid gland disorders management
refer to physciant, may need meds or surgery
how long can the brain last without oxygen without incurring damage
4-6 minutes
