Face and Neck Injuries Flashcards
Function of hyoid bone
Supports and stabilizes larynx and serves as a point of attachment for many neck and tongue muslces.
Which nerve carries parasympathetic nerve fibers that cause constriction of pupils?
Oculomotor nerve
Which nerve provides the sense of vision?
Optic nerve
How does the eyeball keep its global shape?
Pressure of fluid contained within anterior and posterior chamber.
Aqueous humor
Clear watery fluid filling anterior chamber of eyeball.
Loss of aqueous humor will gradually replenish.
Vitreous humor
Jellylike substance in posterior chamber.
Maintains shape of globe.
Loss of vitreous humor will cause blindness as it cannot be replenished.
What is the external ear compose of?
Pinna and external auditory canal
What does the middle ear contain?
Three bones - malleus, icus, and stapes. Move in response to sound waves hitting the TM.
What is the inner ear composed of?
Bony chambers filled with fluid
Injury to major vessels in the neck can cause :
Cerebral hypoxia
Infarct
Air embolism
Permanent neurologic impairment
s/s of facial fx
Ecchymosis Swelling TTP Crepitus Misalignment of the teeth, facial deformities or asymmetry Instability of facial bones Impaired ocular movement Visual disturbances
Nasal fx are characterized by :
swelling, tenderness, and crepitus when palpated
Anterior or posterior epistaxis
Deformity of the nose usually appears as ____ displacement.
lateral
When should you suspect a mandibular fx?
Hx of blunt force trauma to lower third of face
Dental malocculsion
Numbness of the chine
Inability to open mouth
Maxillary fx are most commonly associated with which MOI?
Massive blunt force trauma such as MVCs, falls, and assaults
Signs of maxillary fx
Facial swelling
Instability of midfacial bones
Malocculsion
Elongated face
Le Fort I fx
Horizontal fx of maxilla that separates the hard palate and lower maxilla from skull.
Le Fort II fx
Separates nasal bone and lower maxilla from skull and cranial bones.
Le Fort III fx
All midfacial bones, separating the entire midface from cranium.
Orbital fx sxs
Diplopia
Loss of sensation above the eyebrow or cheek
Paralysis of upward gaze
Massive nasal discharge
Signs of zygomatic fx
Side of face appears flattened
Loss of sensation over cheek, nose, and upper lip
Paralysis of upward gaze
When do zygomatic fx commonly result?
Blunt trauma in MVCs and assaults
Common MOI for face and neck injuries include :
MVCs, sports, falls, penetrating trauma, and blunt trauma
Provide rapid transport for :
Signs of shock Poor general impression AMS Abnormal vital signs Dyspnea Severe pain Isolated injuries to the eye
What should be the focus of your physical exam w/ a responsive patient who has an isolated injury w/ limited MOI?
Isolated injury
Pt’s cc
Body region affected
Management of chemical burns to eye
Flush w/ water or sterile saline irrigation
Irrigate for 20 minutes if alkali or strong acid
Management of thermal burns to eye
Cover both eyes w/ sterile dressing moistened w/ sterile saline
Management of burns from UV rays, sun lamp, reflect light, snow blindness
Cover each eye w/ sterile, moist pad and an eye shield
Three important guidelines when treating penetrating injuries of the eye :
Never exert pressure on or manipulate the injured eye in any way.
Eyeball exposed : apply a moist, sterile dressing to prevent drying
Cover the injured eye w/ a protective metal eye shield, cup, or sterile dressing.
Hyphema
Bleeding into the anterior chamber of the ye
Hyphema may signal what type of injury?
Spinal injury
Management for hyphema
Cover the eye
Suspect spinal injury
Elevate head of the backboard 40 degrees to decrease IOP and discourage activities that may increase IOP
Retinal detachment
Separation of the inner layers of the retina from underlying choroid
sxs of retinal detachment
Flashing lights, specks, or floaters in visual field
Eye findings that would alert you to a possible head injury :
One pupil larger than the other Deconjugate gaze Eyes fail to follow movement of your finger Bleeding under the conjunctiva Protrusion or bulging of one eye
When is the only time you should remove a contact lens in the field?
Chemical burn of the eye
Suspect an artificial eye when it :
Does no respond to light
Does not move in concert w/ opposite eye
Appears different from opposite eye
Signs of anterior epistaxis
Originate from area of septum
Bleed slowly
Resolve quickly
Signs of posterior epistaxis
Blood draining into throat causing n/v
Management of non-traumatic epistaxis
Place in sitting position, leaning forward, and pinch nares together or press on upper gums
s/s of perforated TM
Loss of hearing
Blood drainage
In addition to danger of external hemorrhage from facial fractures, ____ may become lodged in ____ and cause an ____.
Blood clots; upper airway; obstruction
What are the primary risk associated w/ oral and dental injuries?
Airway compromise from oropharyngeal bleeding
Occlusion by displaced dental appliance
Aspiration of avulsed or fx teeth
Procedure for severe oropharyngeal bleeding in patients w/ inadequate ventilation?
Suction airway for 15 seconds
Provide ventilatory assistance for 2 minutes
Repeat
Reimplantation of avulsed tooth is recommended within :
20 minutes to 1 hour
Avulsed tooth should be placed in what solution?
Tooth storage solution
Cold milk
Sterile saline
What structures in the neck are vulnerable to blunt trauma?
Upper airway Esophagus Carotid arteries and jugular veins Thyroid cartilage Cricoid cartilage Upper part of trachea
What can a fracture of the cartilages in the upper airway and larynx lead to?
Loss of voice
Difficulty swallowing
Severe and sometime fatal airway obstruction
Subcutaneous emphysema
Management of subcutaneous emphysema secondary to blunt force trauma to neck
Maintain airway as best as you can and provide immediate transport.
A large amount of air in the ___ atrium and ___ ventricle can lead to cardiac arrest.
right; right
Why should you apply an occlusive dressing on a bleeding wound from the neck?
Prevent air embolism from entering vein or artery
Impaled objects in the neck present life-threatening condition including :
Injury to major blood vessels w/ massive hemorrhage
Damage to the larynx, trachea, or esophagus
Injury to c-spine
When is acceptable to remove an impaled object from the neck?
Only if it’s obstructing the airway or impeding your ability to effectively manage the airway.
s/s of larynx injury
Respiratory distress Hoarseness Pain Dysphagia Hemoptysis Cyanosis Pale Sputum in wound Subcutaneous emphysema Bruising on the neck Structural irregularity Hematoma or bleeding
Mediastinitis
Inflammation of the mediastinum often resulting from gastric contents leaking into the thoracic cavity after esophageal perforation.
Management of laryngeal injuries
Provide oxygenation and ventilation, preferably two-person BVM
Apply soft c-collar
Ready for suction
ALS rendezvous
IV access
20 mL/kg isotonic crystalloid to maintain adequate perfusion
Sprain
Stretching or tearing of ligaments
Strains
Stretching or tearing of muscle or tendon
What is the most common form of cervical strain?
Whiplash
Management of muscular injury to c-spine
Focus on preventing further injury by restricting ROM w/ c-collar and immobilization to backboard
