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SCS > Eye and Dental Injuries > Flashcards

Eye and Dental Injuries Flashcards

1
Q

Epidural Hematoma

A

Blow to head or fracture that tears meningeal arteries. Blood accumulates.

  1. LOC followed by period of lucidity (few S/S’s of serious injury)
  2. Gradual progression of S/S’s
  3. Head pain, dizziness, nausea, dilation of same side pupil (compression of CN 3; eye may be positioned down/out due to unopposed CN 6), deteriorating consciousness, neck rigidity, depression of pulse/respiration, convulsion, extremity weakness on same side (compression of crest on opposite side?), loss of visual field opposite of lesion
  4. Need immediate neurosurgical care/CT
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2
Q

Subdural hematoma

A

Results from acceleration/deceleration forces that tear vessels (veins) bridging dura mater and brain. Occurs between dura and arachnoid space. Similar S/S’s do epidural hematoma and needs immediate medical attention/CT.

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3
Q

Scalp injuries

A

Usually bleed a lot and look worse than they are. Clean with soap/water, cut away hair if necessary, apply firm pressure. Palpate around for a soft spot, if you find this they need immediately referral.

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4
Q

Types of tooth injuries

A
  1. Chipped tooth
  2. Crown fracture
  3. Tooth luxation
  4. Tooth avulsion
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5
Q

When to send a tongue injury for further medical management?

A
  1. Larger than 1 centimeter
  2. Bleeds longer than 30 minutes
  3. You see a flap
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6
Q

Chipped tooth

A

Not an emergency and usually pain-free. Can go back into the game but need to see a dentist later.

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7
Q

Crown Fractures

A

Also call Ellis fractures. Classified into 4 levels:
1. Enamel
2. Enamel and dentin
3. Enamel, dentin, and pulp
4. Root fractures

Can be divided into uncomplicated and complicated fractures.

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8
Q

Uncomplicated vs complicated tooth fracture management

A

Uncomplicated will produce fragments without bleeding and not emergent situation. Complicated will produce bleeding and whole tooth chamber exposed. Usually significant amount of pain. If not significant pain then control bleeding and have them f/u with dentist in 1-2 days. Athlete can continue to play.

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9
Q

Tooth luxation

A

Tooth is loose/dislodged but still in the socket. May or may not be painful. Immediate referral should be placed to reposition tooth.

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10
Q

Tooth avulsion

A

Can be pushed up, laterally displaced, and fully pulled out. Not all of them are going to be unstable.

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11
Q

Do’s/Don’t for lost tooth

A

Do:
1. Attempt re-implantation
2. Save tooth
3. Use save a tooth if you have it
4. Can use milk > saliva if accessible

Don’t:
1. Wash tooth (no matter how dirty it is)
2. Hold by root
3. Wait > 20 minutes to get to dentist

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12
Q

Types of ear pathologies?

A
  1. Auricular hematoma (cauliflower ear)
  2. Tympanic membrane rupture
  3. Otitis externa
  4. Otitis media
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13
Q

Managing auricular hematoma

A
  1. Ice it right away to prevent hematoma
  2. Pack the inside with gauze, and behind it. Then wrap the entire head for sustained compression. Needs to be fairly tight.
  3. May need to refer to have it drained
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14
Q

Tympanic membrane rupture

A

Usually a hit/slap to the hear. Often will feel a loud pop with nausea/dizziness/intense pain. Significant hearing loss. Can see rupture with otoscope. Small/moderate perforations will heal on their own in a few weeks. Don’t fly until the symptoms resolve.

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15
Q

Otitis externa

A

Also called swimmer’s ear. Caused by a gram-negative bacillus infection in ear canal. Water gets trapped and get infection. Usually get pain, discharge, maybe partial hearing loss, itching, discharge. Avoid sticking objects in there, cold wind. If persistent may need to get antibiotics.

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16
Q

Ototitis media

A

Middle ear infection. Fluid accumulation/drainage, usually hearing loss, potentially systemic infection symptoms, intense pain. May need antibiotics and analgesics. The tympanic membrane will look inflamed/irritated.

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17
Q

Types of nasal injuries

A
  1. Epistaxis (nose bleed)
  2. Nasal fractures
  3. Deviated septum
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18
Q

Epistaxis care

A

Sit upright with cold compress and pressure over affected nostril. Gauze between upper lip and gum can limit blood supply. If bleeding not stopping in 5 minutes can use astringent or styptic on gauze or cotton nose plug. They can return to play once bleeding stops but don’t blow nose for 2 hours.

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19
Q

Nasal fracture

A

Usually profuse bleeding and immediate deformity. Control the bleeding, refer immediately.

20
Q

Deviated septum

A

Usually comes from a trauma, can occur with a nasal fracture. Is visible, if can’t see from straight on then look under or above.

21
Q

Laryngeal injury

A

Usually happens from clothesline injury (direct blow). Usually severe pain with spasmodic coughing, speaking with hoarse voice, difficulty swallowing. If fractured cartilage may have difficulty breathing or expectorate frothy blood. May get cyanosis. If airway is intact get cold applied.

22
Q

Facial fractures

A
  1. Mandibular
  2. Zygomatic
  3. Maxillary
23
Q

Mandibular fracture s/s? Management?

A
  1. Potential deformity
  2. Loss of occlusion
  3. Pain c biting
  4. Bleeding with the teeth
  5. Anesthesia/paresthesias of lower lip

Immobilize mouth/jaw with elastic wrap. Needs reduced/fixated in OR.

24
Q

Zygomatic fracture

A

Often show signs of sunken in face (hallmark sign). Usually nosebleed, numbness in cheek, diplopia. Apply cold and get to MD. May need gear to protect it.

25
Q

Maxillary Fractures

A

Can have a long face, bloody nose, and may require airway management. Divided into 3 categories: Le Fort classification.

26
Q

Le Fort Type 1

A

Horizontal fracture of alveolar ridge (bony sockets that hold teeth), lateral/inferior nasal bones, and through maxillary sinus.

27
Q

Le Fort Type 2

A

Called pyramidal fracture. Extends from nasal bridge, through lacrimal bones, inferior orbital bones, through the anterior wall of maxillary sinus.

28
Q

Le Fort Type 3

A

Transverse fracture. Injury typically begins at the nasofrontal area and extends across the orbital walls, zygomatic arch (cheek bone), and pterygoid plates.

29
Q

Types of eye pathologies

A
  1. Orbital hematoma
  2. Orbital fractures (blowout fracture)
  3. Ruptured globe
  4. Corneal abrasion
  5. Corneal laceration
  6. Hyphema
  7. Iritis
  8. Detached retina
  9. Conjunctivitis
  10. Hordeolum
  11. Periorbital lacerations
  12. Foreign bodies
  13. Contact lens removal
30
Q

General Eye Evaluation

A
  1. History
  2. Inspection
    -Periorbital region
    -Eyebrows
    -Eyelids
    -Globe orientation
  3. Palpation
    -Supraorbital ridges
    -Nasal, frontal, zygomatic bone/arch
  4. Functional Test
    -PEARL
    -Tracking
    -Vision
    -CN Testing (II, III, IV, VI)
  5. Neuro Testing
  6. Ophthalmoscope

Remember to look for S/S of head injury

31
Q

Orbital Hematoma

A

Black eye. Put ice on it for 30 minutes and encouraged them not to blow their nose right after (May increase the hemorrhaging). Almost always just resolves on its own.

32
Q

1.Conjunctiva
2.Cornea
3.Sclera
4. Lens
5. Choroid
6. Retina

A
  1. Mucous membrane that lines eye and eyelid.
  2. Transparent part of eye that covers cornea and pupil
  3. The white, outer layer of the eyeball
  4. Right behind iris, focuses light onto retina
  5. Thin layer of tissue in the middle layer of the eye (between sclera and retina)
  6. Thin layer on inside of eye that transmits light into electrical signals
33
Q

Orbital “blowout” fracture

A

Blow to the eyeball and forces the eyeball posteriorly. The floor of the orbit will rupture. Usually from ball bigger than the eye.
S/S’s:
1. Restricted movement of eye.
2. Diploplia
3. Downward displacement of eye
4. Swelling
5. Numbness (due to infraorbital nerve resting on floor of orbit)

Get to ER, may need antibiotics due to proximity of maxillary sinus.

34
Q

Ruptured globe

A

Occurs when outer membrane of eye is disrupted by a blow or penetrating trauma. Full thickness injury of either/both cornea or sclera.

Ophthalmological emergency. Damage to the posterior segment of the eye is associated with high frequency of permanent vision loss.

35
Q

Corneal Abrasion

A

Sudden onset of pain, aggravated by blinking. Have photophobia.

Opthmologist will detect with special dye and light. Not much you can do from a PT stance. Treated with topical antibiotic.

36
Q

Corneal Laceration

A

Usually occurs when people rub the eye a lot to get a foreign object out. Pain usually pretty bad. Watering of eye, photophobia.

Usually have a patch over the eye to prevent blinking as much. Usually use topical antibiotic.

37
Q

Hyphema

A

Blunt blow to eye (major eye injury). Serious problem in the lens, choroid, or retina. Collection of blood in the anterior chamber of eye. Vision partially or completely blocked.

Immediate referral. Bed rest with elevation to 30-40 degrees. Sometimes both eyes patched or may be sedated or medication to reduce anterior chamber pressure.

38
Q

Detached retina

A

Usually caused by blow to eye, can be atraumatic. Is painless. Early signs are usually specks floating before the eye, flashes in the eye, blurred vision. Hallmark sign is curtain falling over field of vision.

Immediate referral and usually requires surgery.

39
Q

Acute conjunctivitis

A

Infection of the conjunctiva. Usually caused by allergens or bacteria. Can be caused by wind/dust or from a cold. Eyelid will swell, may have discharge, itching. This is highly infectious!!!! Don’t want this passed around locker room.

40
Q

Eye Hordeolum

A

Sty. Acute infection of secretory glands of eyelid. Glands get blocked. Forms a lump and can get very red. If very red/swollen there may be bacteria in there blocking it and may need antibiotics or surgery. NOT CONTAGIOUS, often resolves on its own.

41
Q

Periorbital lacerations

A

Anything < 1/2 inch can usually be dealt with non-operatively. Anything about an inch usually needs sutures. If potential for infection best to refer anyways.

42
Q

Foreign body

A

Usually you can see it. Don’t try to pick it away and don’t have athlete rub it. Flush it with saline or eye drops or blink it out.

43
Q

What eye injuries should you immediately refer?

A
  1. Globe ruptures
  2. Periorbital fractures
  3. Hyphema
  4. Iritis
  5. Detached retina
  6. Corneal laceration
  7. Persistent visual disturbance
44
Q

What eye injuries can wait?

A
  1. Corneal abrasion with minimal irritation
  2. Conjunctivitis
  3. Hordeolum
  4. Dermal lacerations
45
Q

Tooth anatomy

A

Enamel = outer layer
Dentin = just below enamel
Pulp = contains neuro vascular structures

Crown is portion above gum
Root is below gum line

46
Q

Tooth injury management

A

Wash the area with sterile water and dab with cause. Replant the avulsed tooth within 5-10 minutes. After 20 minutes implantation is much less likely. Wash with saline if there is debris and trying to reimplant. They can’t go back in right away if reimplanted, if not reimplanted they can go back in within 48 hours.

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