ED 2 Head and Neck Trauma Flashcards
borders of the anterior triangle?
superior: mandible
anterior: midline
posterior: sternocleidomastoid
borders of the posterior triangle?
inferior: clavicle
posterior: trapezius
anterior: sternocleidomastoid
what 4 structures do we worry most about with a zone 1 injury?
1) subclavian
2) aortic arch
3) trachea
4) c-spine roots
what 4 structures do we worry most about with a zone 2 injury?
1) carotid/vertebral arteries
2) jugular vein
3) larynx
4) c-spine
which structures do we worry about most with a zone 3 injury?
1) trachea
2) vertebral bodies
3) carotids, jugular
4) CN 9-12
95 percent of penetrating neck wounds are caused by what? what makes up the other 5 percent?
knives and guns
5 percent MVA, sports
what is the most important thing to know in terms of…
1) gunshot wound
2) knife wound
gunshot = caliber makes all the difference
knives = how big was it?
high caliber gun shot wounds leave what type of injury pattern? what about low caliber?
high caliber = high velocity, predictable course
low caliber = low velocity, cavitate, track off in any direction (will shred you!)
should you remove the knife when your patient presents with a knife in their neck?
no, it could be holding together their carotid! leave it
if the ____ has not been violated, there is a very low likelihood that there has been a penetrating injury
platysma
what are 4 signs of underlying injury from blunt trauma that is not so apparent just by looking at the patient?
1) hematemesis
2) odynophagia
3) voice changes
4) subQ emphysema
if you have a known platysma injury or high suspicion of serious injury, what should your next step be?
SKIP IMAGING
transport to OR
when is a chest x-ray absolutely mandatory in head/neck trauma?
with a zone 1 injury (worry about hitting apices of lung leading to pneumothorax)
what is the imaging modality of choice if you suspect vascular injury in your neck trauma patient?
CT angiogram
which imaging will use use for C-spine fractures?
CT scan
what position should you place your neck trauma patient in while in the ED?
trendelberg position to avoid air embolus
surgical exploration is indicated for these 5 considerations?
1) shock
2) expanding hematoma
3) impending airway obstruction
4) bruit
5) blood in aerodigestive tract (hemoptysis, hematemesis)
if a neurological deficit is found on the contralateral side of the injury, what must you consider?
carotid/vertebral artery injury
a depression of the forehead should clue you into what DX? why are these injuries bad?
frontal bone fracture
these are THICK bones so this is typically a high velocity injury – worry about brain and everything else
where are the weakest aspects of the orbit? why do we worry about fractures here?
weakest = orbital floor and medial wall
fractures can lead to herniation of orbital contents into the sinus
pain below the eye and difficulty with eye movements should clue you into what DX? how do you manage?
orbital floor fracture (inferior rectus can become entrapped)
refer to opthalmology ASAP!
what is the imaging of choice for an orbital floor fracture?
non-contrast maxillofacial CT scan
what are the only two facial fractures that can be seen on x-ray?
nasal and mandibular fractures
what must you be sure not to miss with a nasal bridge fracture?
septal hematoma
also: your nose takes the front end of a hard hit, look for surrounding fractures
your patient with a nasal bridge fracture will likely develop what?
raccoon eyes
your patient presents with telecanthus, extremely swollen eyes, and constant tearing after trauma…whats going on?
nasoethmoidal FX
these are bad bad injuries, can damage medial canthus, lacrimal gland, nasofrontal duct, cribiform plate
how do we manage nasoethmoid FX?
CT scan and move them along their way (usually from severe trauma)
typical MOI of zygomatic arch fracture? how will they present?
MOI = direct punch to da face
present with tenderness, crepitus, and decreased ROM of mandible
what type of fracture typically presents with 1 of 3 presentations of free flowing elements of their face?
maxillary FX
le fort classification
lefort 1 classification has mobility of what? what other presentation?
palate and teeth
also facial edema
lefort 2 classification has mobility of what? what other presentation?
maxilla
will likely have epistaxis and CSF rhinorrhea
lefort 3 classification has mobility of what? what other presentation?
movement of all facial bones with respect to cranial base
they will also have facial elongation and flattening
patient presents with a hanging mandible and you suspect a mandibular fracture. what should you do to DX?
tongue blade test
gum and sublingual ecchymosis should clue you into which diagnosis?
mandible fracture
where should you store avulsed teeth if tooth is intact with the roots?
whole milk!
don’t rinse or scrub tooth (need the periodontal membrane and ligament intact)
what does a positive halo test show?
separation of blood and CSF on gauze in target-like pattern; useful in basilar skull fractures
what should you always do if you suspect fracture through the sinuses?
prescribe ABX!
kefzol, clindamycin, amoxicillin
if there is a CSF leak, what should you prescribe?
vancomycin + ceftazidime
what type of bandage is used for a mandible fracture?
barton bandage
