Face & Neck Injuries Flashcards
The head is divided into two parts
- Cranium
- Face
The most posterior portion of the cranium is called the ___
Occiput
On each side of the cranium, the lateral portions are called the ___
Temples or temporal regions
Between the temporal regions and the occiput lie the ___
Parietal regions
The forehead is called the ___
Frontal region
Just anterior to the ear, in the temporal region, you can feel the pulse of the ___
Superficial temporal artery
The face is composed of the ___
Eyes, ears, nose, mouth, and cheeks
6 major bones of the face
- Nasal bone
- Two maxillae
- Two zygomas
- Mandible
Maxillae
Upper jaw bones
Zygomas
Cheek bones
Mandible
Jaw bone
The orbit of the eye is composed of the ___
Lower edge of the frontal bone of the skull, the zygoma, the maxilla, and the nasal bone
The ___ protects the eye from injury
Bony orbit
Only the proximal third of the nose is formed by ___
Bone
The distal two thirds of the nose are composed of ___
Cartilage
The exposed portion of the ear is composed entirely of ___
Cartilage that is covered by skin
External, visible part of the ear
Pinna
Fleshy portions at the bottom of each ear
Ear lobes
Small, rounded, fleshy bulge immediately anterior to the ear canal
Tragus
The superficial temporal artery can be palpated just ___
Anterior to the tragus
About 1” posterior to the external opening of the ear is a prominent bony mass at the base of the skull called the ___
Mastoid process
Forms the jaw and chin
Mandible
Motion of the mandible occurs at the ___
Temporomandibular joint
Lies just in front of the ear on either side of the face
Temporomandibular joint
Below the ear and anterior to the mastoid process, the ___ is easily palpated
Angle of the mandible
Number of cervical vertebrae
7
The spinal cord exits from the ___
Foramen magnum
The upper part of the esophagus and trachea lie in the ___
Midline of the neck
The carotid arteries are found on ___
Either side of the trachea
Firm prominence in the center of the anterior surface of the neck
Upper part of the larynx, formed by the thyroid cartilage (Adam’s apple)
The other portion of the larynx is the ___
Cricoid cartilage
The only complete circular cartilage structure of the trachea
Cricoid cartilage
The cricoid cartilage is located ___
Below the thyroid cartilage
Between the cricoid cartilage and the thyroid cartilage is a ___
Soft depression called the cricothyroid membrane
The cricothyroid membrane is a ___
Thin sheet of connective tissue that joins the two cartilages
Fascia
Connective tissue
The cricothyroid membrane is covered only by ___
Skin
Below the larynx, ___ are palpable in the anterior midline
Several additional firm ridges
The firm ridges palpable below the larynx
Cartilage rings of the trachea
Connects the oropharynx and the larynx with the main air passages of the lungs
Trachea
Main air passages of the lungs
Bronchi
On either side of the lower larynx and the upper trachea lies the ___
Thyroid gland
Palpating the thyroid gland
Not usually palpable unless it is enlarged
Pulsations in the carotid arteries are easily palpable in ___
A groove about .5” lateral to the larynx
Lying immediately adjacent to the carotid arteries, but not palpable, are the ___
Internal jugular veins and several important nerves
Lateral to the internal jugular veins and nerves, lie the ___
Sternocleidomastoid muscles
These muscles originate from the mastoid process of the cranium and insert into the medial border of each collarbone and the sternum at the base of the neck
Sternocleidomastoid muscles
These muscles allow movement of the head
Sternocleidomastoid muscles
Series of bony prominences lie posteriorly, in the midline of the neck
Spines of the cervical vertebrae
The lower cervical spines are more ___ than the upper ones
Prominent
The spines of the cervical vertebrae are more easily palpable when the neck is ___
In flexion
At the base of the neck posteriorly, the most prominent spine is the ___
Seventh cervical vertebra
Eye diameter
About 1”
The eye is located within ___
A bony socket in the skull called the orbit
The orbit forms the base of the floor of the ___
Cranial cavity
Directly above the eye is the ___ of the brain
Frontal lobes
How much of the adult eye is protected in the orbit?
80%
Between and below the orbits are the ___
Nasal bone and the sinuses, respectively
Eyeball
Globe
The eyeball keeps its global shape as a result of the ___
Pressure of the fluid contained within its two chambers
Clear, jellylike fluid near the back of the eye
Vitreous humor
In front of the lens is a clear fluid called ___
The aqueous humor
In penetrating injuries of the eye, ___ can leak out
Aqueous humor
The inner surface of the eyelids and the exposed surface of the eye, are covered by ___
A delicate membrane, the conjunctiva
The conjunctiva are kept moist by ___
Lacrimal glands
Tear glands
Lacrimal glands
The tears drain on the ___
Inner side of the eye through two lacrimal ducts into the nasal cavity
White of the eye
Sclera
Tough fibrous tissue that helps maintain the eye’s globular shape and protects the more delicate inner structures
Sclera
On the front of the eye, the sclera is replaced by ___
The cornea
Clear, transparent membrane on the front of the eye
Cornea
Allows light to enter the eye
Cornea
Circular muscle behind the cornea with an opening in the center
Iris
Adjusts in size to regulate the amount of light that enters the eye
Iris
The iris is ___
Pigmented
The opening in the center of the iris
Pupil
Born with unequal pupil size
Anisocoria
Unequal pupil size may indicate ___
Serious injury or illness of the brain or eye
Behind the iris is the ___
Lens
Focuses images on the light-sensitive area at the back of the globe
Lens
Light-sensitive area at the back of the globe
Retina
Within the retina are numerous nerve endings that respond to light by ___
Transmitting nerve impulses through the optic nerve to the brain
In the brain, impulses from the optic nerve are interpreted as ___
Vision
The retina is nourished by ___
A layer of blood vessels between it and the sclera at the back of the globe
Layer of blood vessels between the retina and the sclera at the back of the globe
Choroid
If the retina detaches from the underlying choroid and sclera, ___
Blindness, retinal detachment
Direct injuries to the ___ are often a source of significant bleeding and/or respiratory arrest
Nose and mouth, the larynx, or the trachea
If you are unable to control airway bleeding, you may need to ___
Suction the airway
The ___ may be affected with the patient’s head is turned to the side
Airway
If the great vessels in the neck are injured, ___ are common
Significant bleeding and pressure on the upper airway
If there is significant impact to the face, suspect ___
Accompanying cervical spine injury
Soft-tissue injuries of the face and neck are common, because the face and neck are extremely ___
Vascular
Blood collects under the skin
Hematoma
Mandible fractures are relatively common because of the ___
Prominence of the mandible itself
Mandible fractures are second only to ___ in frequency
Nasal
Most mandible and nasal fractures are the result of ___
Vehicle collisions and assaults
If your patient has a mandibular fracture, then consider ___
The major force necessary to cause that fracture, there is a strong possibility of additional facial trauma and/or cervical injuries
Signs of mandibular fracture
- Misalignment of the teeth
- Numbness of the chin
- Inability to open the mouth
- Swelling, bruising, and loosened or missing teeth
Maxillary fractures are predominately found after ___
Blunt-force trauma, high-energy impacts, a fall, or direct blow from an object
Signs of maxillary fractures
- Massive facial swelling
- Instability of the facial bones
- Misalignment of the teeth
Fractured or avulsed teeth are common following ___
Facial trauma
Dental injuries may be associated with ___
Motor vehicle crashes or an assault
Why to always assess the patient’s mouth following a facial injury
Teeth fragments can become an airway obstruction and should be removed from the patient’s mouth immediately
Patients who are conscious and supine and have oral or facial bleeding may ___
Protect their airway by coughing, projecting blood at you
Internal bleeding in face and throat injuries may ___
Compromise blood flow to the brain
A patient who has a significant MOI but whose condition appears stable should ___
Also be transported promptly to the nearest appropriate hospital
If a patient has an injury involving the eye it should be considered ___
Potentially serious
Consider transporting a patient with serious, isolated eye injuries to ___
An eye care specialty center
During the physical examination, your eyes will be looking for ___
- Swelling
- Contusions
- Discoloration
During the physical examination, your hands will be ___
Gently palpating the face, looking and feeling for any abnormalities such as deformity or tenderness
Questions to ask yourself during the physical examination
- Do the facial bones seem to be in alignment?
- Does the nasal bone seem to deviate from the midline?
- Note any variations from the normal facial examination; is there any facial drooping
- Does one eye appear to be lower than the other?
- Does the mandible appear to deviate toward one side or the other?
One eye lower than the other is an indication of ___
An orbital fracture
Assess all underlying systems, including ___
- Neurologic system
- Sensory organs
- Respiratory system
- Circulatory system
When you are evaluating the eyes, start at ___
The outer aspect of the eye and work your way in toward the pupils
___ is considered the vital sign of the eye
Visual acuity
How to quickly assess visual acuity
Gently cover one eye and holding fingers up at arm’s length in front of the open eye. Test for the ability to see fingers in both the injured and uninjured eyes
What to look for in the eye during the physical examination
- Obvious foreign matter
- Visual acuity
- Discoloration
- Bleeding in the iris or redness
- Eye symmetry
- Pupils equal size and reactivity
- Ability to follow objects with eyes side to side and up and down
- Ability to read print, blurry vision, or sensitivity to light
___ surgery can cause unequal pupil size
Cataract
Determine if the unequal pupils are caused by ___
Physiologic or pathologic issues
When an injury exposes the brain, eye, or other structures, ___
Cover the exposed parts with a moist, sterile dressing to protect them from further damage
For injuries in which the skin is not broken, ___
Apply ice or a cold pack locally to help control the swelling or bruised tissues
For soft-tissue injuries around the mouth, always check for ___
Bleeding inside the mouth
Patients who swallow significant amounts of blood are prone to ___
Vomiting
If you find a portion of avulsed skin that has become separated, ___
Wrap them in a sterile dressing, place them in a plastic bag, and keep them cool. Never place tissue directly on ice. Label the bag with the patient’s name and deliver it to the ED with the patient
If the avulsed skin is still attached ___
Hold it in place with a dry sterile dressing
The conjunctiva becomes inflamed and red
Conjunctivitis
If a small foreign object is lying on the surface of the patient’s eye, you should ___
Use a normal saline solution to gently irrigate the eye
If you see the foreign object on the surface of the eyelid, you may be able to remove it with ___
A moist, sterile cotton-tipped applicator
In the eye, never attempt to remove a foreign body this is stuck to the ___
Cornea
How to stabilize an object sticking out of the eye
- Bandage the object in place
- Cover the eye with a moist, sterile dressing
- Surround the object with an eye shield or doughnut-shaped collar made from roller gauze or a small gauze pack
- Bandage both eyes to minimize eye movement
After irrigating the eye, apply ___
A clean-dry dressing to cover the eye
If the eyelids are burned, it is best to ___
Provide prompt transport without further examination. Cover both eyes with sterile dressing, moistened with sterile saline
Retinal injury caused by exposure to very bright light is generally not ___
Painful
Superficial burns of the eye from UV rays, welding, or snow blindness may become painful after ___
3 to 5 hours later
How to treat a patient with corneal burns
Cover each eye with a sterile, moist pad and an eye shield. Have them lie down and protect from further exposure to bright light
Treat lacerated eyelids
Apply gentle, manual pressure
If the globe is lacerated ___
Apply no pressure to the eye
Three guidelines for treating penetrating injuries of the eye
- Never exert pressure on or manipulate the injured eye in any way
- If part of the eyeball is exposed, gently apply a moist, sterile dressing to prevent drying
- Cover the injured eye with a protected shield. Apply soft dressings to both eyes, and provide prompt transport to the hospital
If the eye is dislocated ___
Cover the eye and stabilize it with a moist, sterile dressing. Cover both eyes. Lie the patient supine to prevent further loss of fluid from the eye
Bleeding into the anterior chamber of the eye, that obscures part or all of the iris
Hyphema
25% of hyphemas are associated with ___
Underlying globe injuries
Treat a hyphema
Cover the eye and transport to the hospital
The bones of the lower orbit are displaced
Blow-out fracture
The fragments of fractured bone in a blow-out fracture can ___
Entrap some of the muscles that control the eye movement, causing double vision
Any patient who reports pain, double vision, or decreased vision following a blunt injury about the eye should be ___
Placed on a stretcher and promptly transported to the ED
Painless, but produces flashing lights, specks or floaters in the field of vision and a cloud or shade over the patient’s vision
Retinal detachment
Eye findings that should alert you to a possible head injury
- One pupil larger than another in an unconscious patient
- The eyes not moving together or pointing in different directions
- Failure of the eyes to follow the movement of your finger as instructed
- Bleeding under the conjunctiva, which obscures the sclera
- Protrusion or bulging of one eye
If the patient has severe swelling or a hematoma to the eyelid, do not attempt to ___ because ___
- Force the eyelid open to examine the eye
- This increases the pressure already present in the globe
The only time contact lenses should be removed in the field
In the case of a chemical burn because of trapped chemical making irrigation difficult
How to remove hard contact lenses in the field
Use a small suction cup, moistened at the end with saline
How to remove soft contact lenses in the field
Place one or two drops of saline in the eye, gently pinch in your gloved fingers, and lift it off the eye
Epistaxis
Nosebleeds
___ nosebleeds are usually more severe
Posterior
Layers of bone within each nasal chamber, which are covered with a moist lining
Turbinates
Humidifies air as it passes through the nose
Turbinates
Three parts of the ear
- External ear (outer ear)
- Middle ear
- Inner ear
Parts of the outer ear
- Pinna (auricle)
- External auditory canal
- Tympanic membrane
Parts of the middle ear
- Hammer
- Anvil
- Stirrup
Eardrum
Tympanic membrane
Move in response to soundwaves hitting the tympanic membrane
Hammer, anvil, and stirrup
The middle ear is connected to the nasopharynx by the ___
Eustachian tube
The eustachian tube permits ___
Equalization of pressure in the middle ear when external atmospheric pressure changes
The inner ear is composed of ___
Bony chambers filled with fluid
Treat an avulsed ear
Wrap in a dry sterile dressing and pit it in a plastic bag with the patient’s name. Keep cool and transport with the patient to the ED
Patients with a ruptured tympanic membrane will often report ___
Severe ear pain, difficulty hearing, or ringing in the affected ear
Facial fractures alone are not acute emergencies unless there is ___
Serious bleeding
Treat an avulsed tooth
Handle it by the crown. Place in a special storage solution. Notify the receiving facility.
Teeth are best reimplanted within ___ of the trauma
1 hour
Special storage solutions for teeth
- Special tooth storage solution
- Cold milk
- Sterile saline
The presence of air in the soft tissues produces ___
Subcutaneous emphysema
Air sucked into a vein and taken to heart
Air embolism
Significant injuries to the larynx pose an immediate risk of ___
Airway compromise
Signs and symptoms of larynx injuries
- Respiratory distress
- Hoarseness
- Pain
- Dysphagia
- Cyanosis
- Pale skin
- Sputum in the wound
- Subcutaneous emphysema
- Bruising on the neck
- Hematoma
- Bleeding
Manage a laryngeal injury
Secure the patient’s airway and provide oxygenation and ventilation as needed
