Facial Trauma Flashcards
What’s the first and most important consideration when it comes to facial/neck trauma?
airway- low threshold for intubation. you want to protect from hemorrhage and obstruction
B in facial/neck trauma
monitor O2 sats and ABGs if intubated
aggressive suctioning
ID and treat PTX/HTX
C in facial/neck trauma
control hemorrhage
-watch for expanding hematoma
-never remove FB until you are in controlled environment
D in facial/neck trauma
disability/neuro
-GCS- consider ICH
-suspect SCI until proven otherwise
-maintain C spine immobilization
E in facial/neck trauma
exposure
-avoid hypothermia
Upon doing the eye exam, a ___________ indicates a globe injury.
teardrop pupil
What is the tx for a septal hematoma?
I/D to prevent avascular necrosis > saddle nose deformity
What is the gold standard treatment for a CSF leak?
serum beta 2 tranferrin
What is a battle sign?
ecchymosis over the mastoid process and its indicative of a basilar skull fracture
- Etiology for malignant otitis externa
- Exam
- Tx
- pseudomonas aurginosa, MRSA (15%) and fungal if immunocompromised, DM
- parotitis and trismus
-CN 7 involvement = bad. can lead to meningitis - IV cipro
What is the etiology for mastoidititis ? What is the treatment?
strep pneumo, strep pyogenes, pseudomonas.
Tx: IV abx- ceftriaxone
recurrent - vanco/zosyn
Blunt trauma is associated with __________
intracranial trauma
On exam in patients with frontal bone/sinus injury, otorrhea is ___________ until proven otherwise. To dx these patients a ________ is ordered and you want to consider ______ and ______. For the treatment, you want to give the patient _________ or ___________. Complications include __________ and __________.
CSF until proven otherwise.
CT, brain and c spine
1st gen cephs or augmentin
complications: cranial empyema and mucopyocele
On exam, what will a patient with an orbital blow out fracture present with?
2. What diagnostic tool will you use and what is the complication associated with it?
3. What is the tx?
- diplopia on upward gaze
- CT, complication: orbital fissure syndrome
- Tx: muscle entrapment
Orbital compartment syndrome is considered an optho emergency. What will you see on exam? What is the treatment?
-retrobulbar hematoma (bleeding behind globe, only seen on CT scan)
-exopthalmus
-decreased vision
-resistance when pushing back on globe
-increased IOP
Tx: lateral canthotomy
A child comes in and presents with foul smelling drainage/discharge. What do you want to make sure to inspect on exam? What diagnostic tool do you want to use and what is the treatment?
inspect bilaterally and remove any clot.
foul smell +/- visualized FB
Dx- CT acan
Tx- pain control/afrin
abx for staph coverage
removal of FB
What are the s/s of a maxillary fracture (LaForte)
It is a direct blow, high impact.
S/S
ecchymosis
swelling
possible deformity
instability noted when grasping the hard palate and rocking maxilla
Malocculsion
maxillary tenderness
diplopia
facial emphysema
CSF
MAY REQUIRE INTUBATION
GET A CT
In LaForte Type I, the _________ separate from the ________. What will you see on exam? What is the tx?
maxillary teeth, face
exam: malocculsion, tenderness, ecchymosis, +hard palate and upper teeth move
Tx: nothing specific, consult with facial trauma
Laforte Type II involves _________ and _________. What will you see on exam? What is the tx?
Laforte I, nasal complex
exam: malocclusion and ecchymosis along nasal dorsum and inferior eyelids. +hard palate/teeth/nose
Tx: trauma consult- pain control, admit vs DC
Laforte Type III is a _______________ and you have ____________ complications. What will you see on exam? What is the tx?
craniofacial disjunction, airway
exam: complete instability of the face, check vision, BLINDNESS IS A MAJOR COMPLICATION
Tx: admit
facial trauma c/s
pain control
avoid NGT (nasal gastric tube)
surgical repair
What is the second most common facial fx? What do you want to ensure in a patient with this type of fracture? You want to presume its an open fracture if___________ and __________. What do you want to have the pt do?
mandibular fracture. - direct blow
Want to ensure airway is open
intraoral lac + mandible fx
have pt bite down
What are the s/s of a patient with a mandibular fracture?
pain, malocclusion, trismus, mucosal lacerations, dysphagia, associated dental fractures, sublingual hematoma, evidence of condyle displacement/hemotympanum
What is the imaging for a mandibular fracture?
panorex- per text study of choice
CT maxillofacial series Is the best choice
What is the treatment for a mandibular fracture if open?
PCN, clinda, erythromycin. you want to admit if open/displaced
When closing facial lacerations, it is important to do a __________ before washout and closure. You want to wash out and close within ____________. You want to update _______________. You want to leave open ________________ unless active bleeding.
xray
24 hours
tetanus
bite wounds to face
For lip lacerations, you want to align the _________________ first. There is no repair for _________________. The _______________ is a highly vascular area.
vermillion border, maxillary frenulum, lingual frenulum
For nasal lacerations, you want to avoid ___________ into _________ and you want to ________________.
epi into the tip
consider topical
When do you want to remove sutures from a face?
5 days
What are important factors to consider for epistaxis?
careful history important- ASA or anticoag. use.
consider pregnancy status- may change Rx
When do you want to consider a posterior source for epistaxis?
if bilateral nosebleed without clear ant. source or fresh active bleed in post oropharynx
What is the treatment for anterior epistaxis?
phenylephrine, lidocaine/epi or topical cocaine, cautery using silver nitrate, packing
What is the treatment for posterior epistaxis?
ARTERIAL SOURCE= DANGER
consider nasostat packing
In terms of dental pain, if there is surrounding erythema, swelling, fluctuance > _______________
abscess
What is one of the main differential dx for dental abscess?
acute necrotizing ulcerative gingivitis (ANUG)
What is the ellis criteria as it pertains to dental trauma?
it is a criteria that exists based on the position of the tooth thats been fractured
What is the etiology of viral parotitis (mumps)
paramyxovirus
>influenza> parainfluenza > coxasackie> HIV
most common in children <15
spreads airborne
What is the etiology for suppurative parotitis?
bacterial infection occurs in patients with compromised salivary flow.
s aureus, strep pneumonia, S pyogemes, H flu
What is the presentation of a pt with suppurative parotitis?
erythema and tender**
pus from stenson duct**
rapid onset
fever
trismus
What is sialolithiasis? What presents on the PE?
stone in stagnant salivary duct. symptomatic men 20s-60s
80% originate from submandibular or parotid
PE: pain/swelling/tenderness
**unilat
**colicky and worse by eating
TM perforation is secondary to a __________ ear infection, ________, and blunt penetrating/noise trauma or lightening strikes. What will you find in the HPI? What do you do for tx?
middle, barotrauma
HPI: acute pain and hearing loss, +/- bloody otorrhea, +/- vertigo tinnitus.
Tx: can heal spontaneously, dont allow water to enter the canal. ABX if cause was infection
What is the history for a patient with epiglottitis?
immunocompromised hx- risk for H influenza
-severe dysphagia
-severe odonophagia
systemic sx(HA, body aches, arthralgias) > think VIRAL
What will the PE be for a pt with epiglottitis?
drooling, tripod position, difficulty moving air, stridor (late) > upper airway abnormality, high pitched
What will the PE be for a pt with epiglottitis?
drooling, tripod position, difficulty moving air, stridor (late) > upper airway abnormality, high pitched
What are the 3 Ds associated with epiglottitis?
drooling, dysphagia, distress
How is the Dx for epiglottitis made?
lateral neck XR or CT with IV, THUMB PRINT SIGN
What is the tx for a patient with epiglottitis?
definitive airway, O2, IV hydration, monitor
IV antibiotics and steroids
-rocephin/zosyn or levaquin if PCN allergic
Odontogenic abscess (dental abscess) arise from infected tooth or after tooth extraction. The etiology is _____________ and most ___________ infections originate from this source. What presents in the PE? How is it diagnosed and what is the tx?
polymicrobial, deep neck
PE: neck mass, trismus, fever, leukocytosis, dysphagia, dyspnea
Dx: bedside U/S + CT neck with IV
Tx: IV abx and surgical drainage
Ludwigs angina is an infection of the __________, _________ and ___________ spaces. It progresses rapidly so you want to think ______________. What is the hx, PE, dx and tx for this diagnosis?
submental, submandibular, sublingual spaces.
AIRWAY
hx: poor dental hygiene, dysphagia, odynophagia
PE: trismus and edema of upper neck and floor of the mouth
Dx: clinical and CT
Tx: definitive airway
__________________ is the most common deep space infection in the throat. What presents on the PE? What diagnostic do you want to order? How about tx?
Peritaonsilar abscess. “quincy”
PE: **hot potato voice, **halitosis, trismus, difficulty opening mouth, fever, dysphagia
Want to order a CT with contrast
Tx: I/D
IV abx: PCN/clinda
What is a complication in peritonsilar abscess?
avoid deep penetration with instrument > carotid nearby
HPI/DX/ TX of a patient with retropharyngeal abscess
HPI: sore throat, dysphagia, neck pain, muffled voice, cervical nodes, poor intake
DX: CT with IV contrast if stable
TX: ENT, IV hydration, IV abx- staph/strep/ anaerobes as clinda + flagyl
