Head And Face Injuries Flashcards
1
Q
Head and face injuries include:
A
Maxillofacial injuries Eye and ear injuries Oral and dental injuries Injuries to the anterior neck Head and traumatic brain injuries
2
Q
What are the scalp layers?
A
Skin, with hair Subcutaneous tissue Galea aponeurotica Loose connective tissue (alveolar tissue) Periosteum
3
Q
How many bones is the three anatomic groups of the skull?
A
28
6-auditory ossicles, 3 on each side
22-bones, cranium and face
4
Q
What are the eight bones of the cranial vault?
A
2 parietal 2 temporal Frontal Occipital Splendid Ethmoid
5
Q
What is the opening at the base of the skull where the brain connects to the spinal cord called?
A
Foramen magnum
6
Q
What are sutures?
A
Special joints that connect the bones of the skull.
7
Q
What joins the paired parietal bones?
A
Sagittarius suture
8
Q
What joins the parietal bone to the frontal bone?
A
Coronal suture
9
Q
What joins the occipital bone to the parietal bones?
A
Lambdoid suture
10
Q
Describe mastoid process.
A
Cone-shaped section of each bone
Located at the base of each bone
Site of attachment of various muscle
Contains hollow mastodon air cells
11
Q
What are the 3 compartments of the floor of the cranial vault?
A
Anterior Fossa
Middle Fossa
Posterior Fossa
12
Q
What forms a prominent bony ridge in the centre of the anterior fossa?
A
Crista galli
13
Q
Horizontal bone perforated with numerous openings allowing the passage of the olfactory nerve filaments from the nasal cavity is called…
A
The cribriform plate
14
Q
The cranial nerves for smell that send projections through the foramina in the cribiform plate and into the nasal cavity are called…
A
Olfactory nerves
15
Q
Base of the skull includes…
A
Occipital condyles
Hard palate
Zygomatic arch
16
Q
What are the 14 facial bones that form the structure of the face?
A
Maxilla Vomer Inferior nasal concha Zygomatic Palatine Nasal Lacrimal
17
Q
What is the function of the facial bones?
A
Protect the eyes, nose and tongue
Provide attachment points for the muscles that allow chewing
Lend shape to the cheeks
18
Q
What cranial nerves is the trigeminal nerve?
A
Fifth cranial nerve
19
Q
What nerve is the facial nerve?
A
Seventh cranial nerve
20
Q
What are the trigeminal nerve branches?
A
Ophthalmic nerve
Maxillary nerve
Mandibular nerve
21
Q
What supplies the skin of the forehead, upper eyelid and conjunctiva?
A
Ophthalmic nerve
22
Q
The maxillary nerve…..
A
Supplies the skin on the posterior part of the nose, lower eyelid, cheek and upper lip.
23
Q
What does the madibular nerve supply?
A
The muscles of chewing and the skin of the lower lip, chin, temporal region and part of the external ear.
24
Q
What arteries supply blood in the face?
A
Primarily though the External carotid artery
Temporal artery, Mandibular artery, Maxillary artery branch from the external carotid.
25
Describe the orbits.
```
Cone-shaped fossae
Enclose and protect the eyes
Contain blood vessels, nerves and fat
Extremities and break easily
Blowout fracture: transmission of forces away from the eyeball itself to the bone
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26
What are the hollow sections of bone lined with mucous membranes; decrease the weight of the skull and provide resonance for the voice?
Paranasal sinuses
27
Describe the hyoid bone...
Floats in the superior aspect of the neck just below the mandible
Supports the tongue
Point of attachment for many important neck and tongue muscles
28
Temporomandibular joint (TMJ) allows what?
Movement of the mandible
29
Third cranial nerve
Innervates the muscles that move the eyeballs and upper eyelids
Carries parasympathetic nerve fires that cause constriction of the pupil and accommodation of the lens
What nerve am I?
Oculomotor nerve
30
Second cranial nerve
Provides the sense of vision
What berve am I?
Optic nerve
31
What are the structures of the eyeball?
```
Sclera
Cornea
Conjunctiva
Iris
Pupil
```
32
Lens and retina are structures of....
The eye
33
What is filled with aqueous humour?
Anterior chamber
34
What is the posterior chamber filled with?
Vitreous humour
35
What are signs and symptoms of a head injury?
Lacerations, contusions or hematoma to the scalp
Soft area or depression noted on palpation of the scalp
Visible skull fractures or deformities
Battle sign or raccoon eyes
Cerebrospinal fluid rhinorrhea or otorrhea
36
Symptoms of traumatic brain injury?
Pupillary abnormalities (unequal pupil size, sluggish or non-reactive pupils)
A period of unresponsiveness
Confusion or disorientation
Repeatedly asking the same questions
Amnesia
Combativeness or other abnormalities behavior
Numbness or tingling in the extremities
Loss of sensation and/or motor function
Focal neurological deficits
Seizures
Cushing triad: hypertension, bradycardia and irregular or erratic respirations
Dizziness and vertigo
Visual disturbances, blurred vision or double vision
37
Subarachnoid hemorrhage
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Bleeding into where CSF circulates
Sudden severe headaches
Later diffuse headache
Increased ICP
Sudden severe subarachnoid hemorrhage usually results in death
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38
Penetration injury, rapid deceleration
Can occur with DAI
Frontal and temporal lobes most affected
once symptoms occur, patient deteriorates quickly
Hugh mortality rate
Intracerebral hemorrhage
39
Signs and symptoms of a subdural hematoma?
Fluctuating level of consciousness
Focal neurologic signs (hemiparesis)
Slurred speech
40
5% of all head injuries
Rupture of veins bridging dura and cortex
Venous bleeding-slower development
Subdural hematoma
41
What are the signs and symptoms of epidural hemorrhage?
LOC - Los of consciousness, lucid interval, unresponsiveness
Pupil changes - pupil on side of hematoma fixed/dilated
Oculomotor never compressed
42
Describe an epidural hemorrhage...
0.5-1.0% of all head injuries
Usually blow to head with linear fracture
Common at temporal bones
Middle meaningful artery
43
Describe an intracranial hemorrhage.
No room in skull for book to accumulate
Increased ICP from bleeding
Bleeding can occur:
Between skull and dura mater (epidural)
Beneath dura mater, outside brain (subdural)
Within the brain tissue itself (intracerebral)
Into the CSF (subarachnoid)
44
What are cerebral contusions?
Brain tissue that is bruised or damaged.
45
What is a Focal brain injury?
Specific, clearly defined brain injury
Cab be seen on CT scan
Includes cerebral contussiins and intracranial hemorrhage
46
What are the signs and symptoms of cerebral concussion?
Transient confusion and disorientation
Loss of consciousness
Retrograde amnesia
Anterograde (posttraumatic) amnesia
47
Rapid acceleration-deceleration forces
Transient dysfunction of cerebral cortex
Are indicative of...
Cerebral concussion
48
What does the medulla coordinate?
Heart rate, blood vessel diameter, breathing, swallowing, vomiting, coughing and sneezing
49
What are signs and symptoms of a nasal fracture?
Swelling, tenderness, and crepitus
Deformity of the nose
Epistaxis
50
Signs and symptoms of maxillary fractures?
Massive facial swelling
Instability of midfacial bones
Malocclusion
Elongated appearance of pts face
51
Causes of maxillary fractures?
Massive blunt facial trauma (motor vehicle collisions, falls and assaults)
52
When should madibular fractures/dislocations be suspected?
In pts with history of blunt force trauma to the lower third of the face who present with dental malocclusion, numbness of the chin and inability to open the mouth
53
Signs and symptoms of maxillofacial fractures?
Deep facial lacerations, ecchymosis and pain to bony palpation
Swelling, bony crepitus or instability
Dental malocclusions, facial asymmetry
Impaired eye movement, visual disturbances
54
Define a le fort 1 fracture.
Horizontal fracture of the maxilla that involves the hard palate and inferior maxilla
55
Define le fort 2 fracture.
A pyramidal fracture involving the nasal bone and inferior maxilla
56
Define a le fort 3 fracture.
Fracture of all midfacial bones, separating the entire midface from the cranium
57
If a patient reports double vision and loss of sensation above the eyebrow or over the cheek secondary to associated nerve damage.
What may be the problem?
Orbital fracture
58
Side of pts face appears flattened
Parasthesia or loss of sensation over the cheek, nose and upper lip
Paralysis of upward gaze
What are these signs and symptoms of?
Zygomatic fractures
59
What is the management of facial fractures?
Begin with protecting the cervical spine
Open the airway
-jaw thrust manoeuvre
-if severe pain, immobilize in position found
-insert airway adjunct as needed
-oropharyngeal bleeding poses immediate threat to airway
Treat lacerations and avulsions as you would any other soft-tissue injury
Epistaxis following facial trauma can be severe
-prevent blood from draining down throat
-asses for hemorrhagic shock
Ecchymosis
-cold compress may help minimize swelling and alleviate pain
-do not apply cold compress to the eye all following an injury
60
What is conjunctivitis?
Conjunctiva becomes inflamed and red. The eye begins to produce tears in an attempt to flush out the object.
61
Define hephema.
Bleeding into the anterior chamber of the eye that obscures vision, partially or completely.
62
Explain orbital blowout fractures.
Fragments of fractured bone can entrap some muscles that control eye movement, causing double vision
63
Explain retinal detachment.
Separation of the inner layers of the retina from the underlying choroid
Flashing lights, specks, or floaters in field of vision
64
What are the different types of eye burns?
Chemical
-acid or alkali
Thermal
-eyes usually close rapidly but eyelids remain exposed and are frequently burned
Infrared
- solar eclipse light
- laser burns
- superficial burns from ultraviolet rays
65
What are the signs and symptoms of ocular injury?
```
Vision loss that doesn't improve
Double vision
Severe eye pain
Foreign body sensation
Obvious ocular damage
```
66
What are you looking for when you evaluate the structure of the orbital rim?
Ecchymosis
Swelling
Lacerations
Tenderness
67
What are the guidelines for treatment of an eye injury?
Best treated in an emergency department
Never exert pressure on globe
Of globe is exposed
-gently apply moist sterile dressing
-cover injured eye with a protective shield
Hyphema or globe rupture (caused by significant force)
-spinal motion restrictions
-elevate head of backboard approximately 30° to 40°
-discourage coughing sneezing etc
68
How do you treat an avulsiin of the globe from socket?
```
Do not manipulate or reposition
Stabilize avulsed eye
Cover avulsed eye with moist sterile dressing
Conver uninjured eye
Supine position to prevent fluid loss
Immediate transport
```
69
Treatment for ultraviolet light to the eye.
```
Sterile moist pad
Eye shield
Cool compress, lightly placed
Supine position
Protect from exposure to bright light
```
70
Treatment for chemical burns to the eye.
Chemical
Irrigate with sterile water or saline solution for 5 min
Strong acid or alkali
Irrigate for 20min
Direct the greatest amount of solution or water into the eye as gently as possible.
May have to force eyelids open
Always flush from the nose side of the eye outward to avoid flushin material into other eye.
*Never use chemical antidotes like vinegar or baking soda
71
What are 4 ways to effectively Irrigate the eye?
Nasal cannula
Eyewash station
Bottle
Basin
72
What can cause tympanic membrane perforation?
Foreign bodies
Blast injury from explosion
Diving-related injury (barotrauma)
73
Signs and symptoms or eardrum rupture.
Loss of hearing
| Blood drainage from ear
74
Steps for avulsion of Pinna
```
Gently realign and bandage
If complete, retrieve part
Treat as any amputated part
Note any blood or CSF leakage
Do not stop the flow and look for signs of a skull fracture.
```
75
Steps for an Impaled object in ear.
Do not remove an impaled object
Stabilize object and cover ear
Isolated ear injuries typically are not life threatening
Perform a careful assessment to detect or rule out serious injuries
