Face And Throat Injuries Flashcards
How many bones are in the head?
22
What are the immovable joints that hold the head bones together?
Sutures
What is the scalp?
Loose connective tissue and skin
Parts of the brain (40
- cerebrum
- cerebellum
- pons
- medulla oblongata
Cerebrospinal fluid (CSF)
Surrounds and suspends the brain within the skull cavity
What does the CSF act as?
A cushion
Meninges
3 membranes surrounding brain/spinal cord
3 meninges
- dura mater
- arachnoid
- Pia mater
Dura mater
Outermost dense layer
Arachnoid
Weblike delicate layer
Pia mater
Innermost, thin layer that is highly vascularized and adheres closely to brain/cord
History in head injuries
- previous head trauma
- info regarding injury
- MOI
Possible MOI in head injuries
- direct blow
- deceleration of head (whiplash)
- shear force
Observation of head injury
What is normal for patient?
Palpation of head injury
- cervical spine
- skull
- point tenderness or deformity
Concussion
A type of mild traumatic brain injury that can result in variety or presentations or deficits
MTBI
Mild traumatic brain injury
Common deficits of concussion
- neurocognition deficits
- balance difficulty
- symptoms (headache, dizziness, ect)
What else can a concussion impact?
- sleep
- emotions or mood
- vision and eye tracking
- long term consequences
Does a concussion have diagnostic evidence/ is it a clear cut injury?
No
Why is a concussion hard to diagnose?
It is a disruption in brain function at a cellular level and doesn’t necessarily result in anatomical changes that you can see
Concussion evaluation
- clinical exam and impression
- neurocognitive function
- signs and symptoms
- balance assessment
Most important in concussion evaluation
Clinical exam
Optional steps in concussion evaluation
- visual acuity and eye tracking
- mood and emotional assessment
- sleep disturbance
How to asses static balance
Determine patients ability to stand and remain motionless
2 types of static balance testing
-Romberg and BESS
Dynamic balance testing
Sensory Organization Test
BESS
Clinical battery of test that utilizes difference stances on both firm and foam surface
Errors in BESS
- patient open eyes
- takes hands off hips
- step/ stumbles or falls
What happens with any LOC?
-ATC must remove athlete from competition and a cervical spine injury should be assumed
What measures should be used to determine readiness to play?
Objective
What is the timeline for return to baseline?
3-5 days
What should be resolved prior to returning to play?
All post-concussive symptoms
What can recurrent concussions produce?
Cumulative traumatic injury in the brain
Should return to play be immediate or gradual?
Gradual
What are the chances of another concussion after an initial concussion?
3-6 times greater
What must ATC be able to determine concerning care of concussion patient?
Need for physician referral and be able to decide if the patient can go home or go to the hospital
What should be at place at home following a concussion?
A system that allows for supervision and monitoring
Post concussion syndrome
Condition that occurs following a concussion
Symptoms of PCS
Patient complains of a range of post-concussion problems (persistant headaches, impaired memory, lack of concentration, anxiety and irritability, giddiness, fatigue, depression, visual disturbances).
When and how long does PCS start and last?
May begin immediately after injury and can last from weeks to months
Second impact syndrome results from…
Result of rapid swelling and herniation of brain after a second head injury before symptoms of the initial injury have resolves
What can second impact be like?
May be relatively minimal and not involve contact with the cranium
What does the impact lead to in SIS
Disrupts the brain’s blood auto regulatory system leading to swelling, increased intracranial pressure
Symptoms of SIS
- often does not lose consciousness
- looks stunned
- w/in 15 sec to several minutes patient’s condition degrades rapidly (dilated pupils, loss of eye movement, LOC leading to coma, respiratory failure)
Management of SIS
-life threatening condition that must be addressed w/in 5 minutes w/ life saving measures performed at an emergency facility
Best management of SIS
Prevention from ATC’s perspective
cause of skull fracture
Blunt trauma
Symptoms of skull fracture
- severe headache and nausea
- palapation may reveal deficit in skull
- blood in middle ear, ear canal, nose, raccoon eyes, battle sign
- CSF may appear in ear and nose
Management of skull fracture
Immediate hospitalization and referral to neurosurgeon
What causes epidural hematoma?
Blow to the head or skull fracture which tears meningeal arteries
Is an epidural hematoma quick or slow?
Blood pressure, blood accumulation and creation of hematoma occurs rapidly
Symptoms of epidural hematoma
LOC followed by a period of lucidity, showing few signs and symptoms of serious head injury
Gradual progression of symptoms of epidural hematoma
- head pains
- dizziness
- nausea
- dilation of one pupil (saw side as injury)
- deterioration of consciousness
- nick rigidity
- depression of pulse and respiration
- convulsion
Management of epidural hematoma
Urgent neurosurgical care and pressure must be relieved to avoid disability or death
What may be required to diagnose epidural hematoma?
CT scan
What causes subdural hematoma?
Acceleration/ deceleration forces that tear vessel that bridge dura mater and brain
Is subdural hematoma acute or chronic?
Either
Can subdural hematoma be in association with other brain injury?
Yes
What causes subdural hematoma to be chronic?
Due to venous bleeding -slow bleed w/out serious intracranial pressure
Symptoms of subdural hematoma
- LOC generally does not occur
- headache, dizziness, nausea, sleepiness
Is a subdural hematoma generally fast or slow?
Slower onset and progression
Management of subdural hematoma
- immediate medical attention
- CT or MRI is necessary to determine the extent of the injury
What cause scalp injuries?
Blunt trauma or penetrating trauma
Can scalp injuries occurs with serious head trauma?
Es
Symptoms of scalp injuries
Patient complains of blow to the head and extensive bleeding (hard to pinpoint exact site)
Management of scalp injuries
- personal protective equipment
- manage bleeding with dressings, pressure, hemostatic gauze
- refer for suturing depending on location and size of wound
Bony landmarks of the face (5)
- TMJ
- supraorbital ridge
- zygomatic arch (cheek bones)
- nasal bone
- Mandible (lower jaw)
What cause a jaw fracture?
Direct blow
Symptoms of jaw fracture
- deformity
- loss of occupation
- pain when biting
- Bleeding around teeth
- lower lip anesthesia
Management of jaw fracture
- temporary immobilization with elastic wrap
- reduction
- fixation
Jaw dislocation cause
Generally a blow to an open mouth from the side
What does jaw dislocation involve?
TMJ joint
Symptoms of jaw dislocation
-locked-open position
Minimal ROM
-poor occulation
Management of jaw dislocation
- soft diet
- NSAIDs
- pain med
- gradual return to activity 7-10 days following acute period
Zygomatic fracture cause
Direct blow
Symptoms of zygomatic fracture
- deformity
- nose bleed
- numbness in cheek
Management of zygomatic fracture
-control swelling and refer to physician
How long will zygomatic fracture take to heal?
6-8 weeks
What will be required with zygomatic fracture when returning t play?
Proper equipment
Maxillary fracture (upper jaw)
Blow to upper jaw
Symptoms of maxillary fracture
- pain with chewing
- malocclusion
- nose bleed
- diplopia
- numbness of lip and cheek region
What is diplopia?
Double vision
Management of maxillary fracture
- due to severe bleeding, airway must be maintained
- must be aware of possible brain injury
- transport to hospital immediately
What causes a nasal fracture?
Direct blow
Symptoms of nasal fracture
Bleeding and deformity
Management of nasal fracture
-control bleeding
Refer to doctor for x-ray, exam, reduction
-uncomplicated and simple fractures will pose little problem for quick return
-splinting may be necessary
Tooth fractures cause
Direct impact to jaw or direct trauma
Symptoms of root fractures
Root fractures: difficult to determine and require follow up with x-ray
uncomplicated tooth fracture
fragments w/o bleeding
complicated tooth fracture
bleeding w/ tooth chamber being exposed w/great deal of pain
Subluxated tooth
Referral should occur w/in first 48 hours
Luxated tooth
Repositioning should be attempted along with immediate follow up
Avulsion tooth
Should not be re-implanted except by dentist (use Save a Tooth kit, milk, or saline)
Auriculaire hematoma
Cauliflower ear
What cause cauliflower ear?
Either from compression or shear injury to the ear (single or repeated)
What does cauliflower ear cause?
Subcutaneous bleeding
What causes a tympanic membrane rupture?
- fall or slap to the unprotected ear
- sudden underwater pressure variation
TM rupture healing time
-small or moderate perforations usually heal in 1-2 weeks
What can occur with TM rupture
Infection so it must be continuously monitored
Symptoms of TM rupture
- loud pop followed by pain in ear
- nausea
- vomiting
- dizziness
- hearing loss
- visible rupture seen through otoscope
Parts of the eye (7)
- eyelid
- eyelashes
- eyebrow
- cornea
- pupil
- optic nerve
- retina
What causes an orbital hematoma?
Blow to the area surrounding the eye
Orbital hematoma
Capillary bleeding
Symptoms of orbital hematoma
Swelling and discoloration
Management of orbital hematoma
-manage swelling
Do not blow nose
Symptoms of orbital fracture
- diplopia
- restricted eye movement
- downward displacement of eye
- soft tissue swelling and hemorrhaging
What is needed to confirm orbital fracture?
X-ray
What causes corneal abrasion?
Foreign object produces considerable pain and disability
Should you try to remove foreign object in corneal abrasion?
No
Symptoms of corneal abrasion
-severe pain
-watering of eye
Photophobia
Management of corneal abrasion
-patch eye and refer to physician
What is required to diagnose corneal abrasion?
Flouresein strip (stains abrasion bright green)
Hyphema
Blunt blow to the eye
-major eye injury that can lead to serious problems with eh lens, chronic or retina
Globe rupture
Blow to the eye by an object small than the eye
-if globe is nit ruptured it can still result in blindness
Retinal detachment
Blow to the eye can partially or completely separate the retina from the underlying retinal pigment epithelium
Throat injuries causes
- direct blow (clothes-lining)
- trauma to the carotid artery, impacting blood flow to the brain
Symptoms of throat injuries
- Severe pain with coughing
- speaking with hoarse voice
- complaining of difficulty swallowing
Management of throat injuries
- airway integrity
- manage swelling and pain
- severe neck contusion may require stabilization w/ well padded collar
