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upper body - ATP 2324 > head & neck > Flashcards

head & neck Flashcards

1
Q

frequent site of injury

A
  • head comprises 10% body surface area

- minor injuries: laceration, contusion, concussion

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2
Q

skull composed of flat bones, interlock @ immobile joints - sutures

A
  • frontal, occipital, sphenoid, ethmoid, parietal(2), temporal(2)
  • material properties & thickness varies
  • foramen magnum- opening @ base skull, allow SC pass
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3
Q

facial bones - face structure

A
  • form sinuses, orbits, nasal cavity, mouth
  • zygomatic, palatine, nasal, lacrimal, inferior nasal concha, maxillary, bridge, mandible
  • zygomatic: cheek
  • mandible: chin
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4
Q

TMJ (temporomandibular joint)

A
  • movement allows mastication
  • can become roughened, dislocated
  • malocclusion - poor function of joint
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5
Q

32 permanent teeth in upper & lower jaw

A
  • upper teeth fixed - alveolar process (maxilla)

- lower teeth fixed - (mandible)

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6
Q

teeth - each row 4 different types

A
  • incisors (4) cutting
  • canines/cuspids (2) tearing
  • premolars/bicuspids (4) crushing
  • molars (6) crushing/grinding
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7
Q

tooth - 3 major areas

A
  • root (anchored by cementum, small periodical lig)
  • neck
  • crown
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8
Q

tooth formed

A
  • dentin - hard classified substance, covered by even harder substance (enamel)
  • core formed by pulp chamber, houses pulp (strong connective tissue with nerves and blood vessels
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9
Q

loosened tooth

A
  • can be partially displaced, intruded extruded avulsed

- should try to return tooth to normal position & to dentist

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10
Q

tooth fractures

A
  • occur through, enamel, dentin, pulp, or root
  • enamel - no symptoms, smoothed by dentist
  • dentin - painful, sensitivity heat/cold
  • pulp - very painful, extensive dental work
  • hallmark fracture (mobile tooth) - radiographs verify, horizontal fracture: splinted to teeth 6 wks, vertical fracture: length of root and crown require extraction
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11
Q

dislocated tooth

A
  • found & placed back in individuals mouth w/ immediate transport
  • dont touch root/brush off
  • rinse w/ cool saline solution
  • attempt place tooth in socket/under tongue
  • reimplantation successful w/in 2hrs
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12
Q

fascial muscles

A
  • muscles of mastication - masseter: spans mandibular arch to inferior zygomatic arch - mouth open: digastric, mylohyoid, medial /lateral pterygoid
  • muscle expression - rare significance
  • most affected by: lacerations, contusions, fractures
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13
Q

scalp - 3 layers

A
  • skin, subcutaneous tissue, pericranium: protective, loose to deflect glancing blow
  • scalp & face: extensive blood supply, bleed profusely
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14
Q

brain - 4 main regions

A
  • 2 cerebral hemispheres(R/L)
  • diencephalon
  • brain stem
  • cerebellum
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15
Q

cerebral hemispheres (R/L)

A
  • 85% total brain mass
  • frontal, parietal, temporal, occipital lobes
  • interior composed primarily white matter(myelinated nerve axons)
  • outer composed gray matter(neuron cell bodies, dendrites, short unmyelinated axons - responsible for motor/sensory function, consciousness, understanding, memory)
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16
Q

diencephalon

A
  • thalamus, hypothalamus, epithalamus
  • center processing conscious/unconscious brain input
  • hypothalamus: center autonomic nervous system (body temp, water balance, GI activity, hunger)
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17
Q

brain stem

A

-midbrain, pons, medulla oblongata
-relay info to/from CNS
-controls involuntary systems
pons links cerebellum to brain stem
-medulla: interface btwn SC & rest of brain

18
Q

cerebellum (R/L halves)

A

-control motor function

19
Q

corpus callosum

A
  • joins 2 hemispheres

- conduit of axons

20
Q

meninges - 3 layers protective tissue enclose brain & SC

A
  • dura mater (outer) : thick fibrous tissue contain dural sinuses, transport blood from brain to jugular veins
  • arachnoid mater (central) : thin, weblike, separated from dura mater by subdural space
  • subarachnoid space : beneath arachnoid mater, filled with cerebrospinal fluid(circulates around brain & Spinal canal, function in force dissipation), contains largest blood vessel supplying brain
  • pia mater (inner) : direct contact w/ brain, contains numerous small blood vessels
21
Q

blood supply to brain - provided by vertebral & carotid arteries

A
  • common carotid artery divides into external/internal carotid
  • external carotid supply head/neck
  • internal carotid supply brain
  • circle of willis : internal carotid arteries & vertebral arteries converge - forms collateral circulation network (if one vessel obstructed others supply blood to region)
22
Q

12 pairs cranial nerves

A

I-olfactory-smell
II-optic-vision
III-oculomotor-extrinsic eye muscle control
IV-trochlear-extrinsic eye muscle control
V-trigeminal-sensation face, jaw movement
VI-abducens-control lateral eye movement
VII-facial-control face movement, taste, secretion saliva/tears
VIII-vestibulocochear-auditory, hearing, equilibrium
IX-glossopharyngeal-taste, control tongue/pharynx, secretion saliva
X-vagus-taste sensation to pharynx/larynx/trachea, ANS
XI-spinal accessory-control movements pharynx/larynx/head.shoulders
XII-hypoglossal-control tongue
-On Old Olympus’ Towering Top, A Finn And German Viewed Some Hops
-Oh Oh Oh, To Touch And Feel Very Green Vegetables, AH
-Sensory/Motor/Both: functions of cranial nerves
-Some Say Money Matters But My Brother Says Big Breasts Matter Most

23
Q

impact forces - sustained locally by direct impact or transmitted through other structures

A
  • direct impact causes p phenomena to occur
  • local elements beneath site impact cause skull deformation
  • shock waves pass though skull to brain
  • mechanical failure in bone typically results from overload of tensile strength of site, not compression
  • fracture on tensile side of site or at distance from impact zone where skull is thinnest
  • protective equipment disperses force over larger area
24
Q

impact causes acceleration

A
  • head directly impacted or set into motion by forces elsewhere in body
  • acceleration causes shear, tensile, compression strain w/in brain substance
  • shear strain: most injury
  • contrecoup injury- axial rotation w/ rotation can lead to injuries away from actual injury site
25
Q

intracranial cerebral trauma - focal or diffuse

A
  • focal injuries: local damage, account over 2/3 all head injury deaths (epidural hematoma, subdural hematoma, subarachnoid, inter cerebral hemorrhage)
  • diffuse injuries: caused by sudden change velocity (acceleration/deceleration), involve widespread disruption to function/structure of brain (cerebral concussion)
26
Q

initial injury

A
  • extended by hypoxia, ischemia, cerebral edema

- important to recognize and treat immediately

27
Q

skull fracture

A
  • linear
  • comminuted (multiple pieces)
  • depressed (fragments driven inward toward brain)
  • basilar (involving base of skull)
  • closed (no break skin/meninges)
  • open (break in skin/meninges), risk infection
  • location shows different signs
  • around eyebrows: discoloration around eyes (raccoon eyes)
  • blood/cerebrospinal fluid leak from nose/ears
  • battles sign: discoloration around mastoid area
28
Q

hematoma

A
  • collection of blood w/in localized area
  • no room for expansion w/in cranial cavity
  • increased pressure w/in brain, increasing neurologic dysfunction
29
Q

epidural hematoma

A
  • outside dura mater
  • cause: direct blow to side head
  • associated w/ skull fracture
  • esp problematic if damage to middle meningeal artery
  • initially appear normal, show neurologic deterioration w/in10-20min
  • increased headache, drowsiness, nauseam vomiting, decreased LOC, dilated pupil on side of hematoma, muscular weakness on other side
30
Q

subdural hematoma

A
  • deep to dura mater
  • bleeding from cerebral vein
  • often rotational acceleration injury tears bridging veins
  • low pressure bleeding, hematoma forms slowly
  • symptoms may not eve become apparent for several hrs/days
31
Q

concussion

A

-result of immediate/transient impairment of neurologic function w/o anatomic structural damage
-information processing disorder
-must be able to document ability(cognitive, motor, balance) to process info w/o symptom recurrence prior to retiring to activity
-no LOC required for diagnosis
-slight alterations w/ dizziness, minimal unsteadiness, brief loss of judgement
-often symptoms completely resolve in 5-15 mins
-might return to play in elite setting but watch closely for any deterioration
-held from play if: unsteadiness, vertigo, nausea, headache, photophobia, mood swings, anxiety
-post-traumatic memory loss often develops in 5-15 min
-retrograde amnesia: can’t remember what happened prior to injury
-anterograde amnesia: can’t remember what happened after
hard neurologic signs: abnormal posturing, intracranial hemorrhage, nystagmus(involuntary eye movements)
-ongoing management:(RRESD) rest physical- rest mental - eat - sleep - drink fluids
-return to play(BRAIN) bike - run - agility - in protection/no contact - no restriction :24 hr period btwn each level, ensure no symptoms

32
Q

scalp injuries

A
  • scalp: outermost anatomic structure of head, first to receive contact (highly vascular)
  • primary concern: control bleeding, prevent contamination, assess presence skull fracture
  • apply direct pressure to control bleeding
  • inspect wound for foreign objects
33
Q

cranial injuries - immediate assessment

A
  • always assume concomitant cervical spine injury
  • not use ammonia capsules w/ unconscious
  • vital signs assessed early&often (pulse, respiration, blood pressure)
  • assess LOC, pupillary status
  • ask about headache, nausea, can talk
  • palpate: point tenderness, crepitus, depressions, elevations, swelling
  • assess neurologic function
  • 100-7 serial test: ability/concentration
  • finger to nose: (hold finger in front of subject, have them touch their nose with your finger with their finger alternating L/R) depth perception, ability to focus on object
  • romberg test: (subject stand with feet together arms at side and eyes closed while maintaining balance, holding arms out, standing on toes, touching nose with finger) body sway
  • stork stand test: put foot of one leg on other knee with eyes closed
  • heel and toe walking: walk on heels then walk on toes, swaying, inability walk in straight line
  • assess concussed patient every 5-7min until convinced they are stable
34
Q

jaw injuries

A
  • prevent injuries w/protective equipment
  • fractures occur in upper/lower jaw
  • careful when apply direct pressure over injury site w/bleeding
35
Q

mandible fractures

A
  • near angle of lower jaw
  • seldom isolated injury, usually double fracture/fracture-dislocation
  • malocclusion(change in bite, teeth don’t fit together when mouth closed) prominent symptom
  • have pain, swelling, discoloration
  • 3rd most common facial fracture
36
Q

dislocate TMJ

A
  • cause: excessive opening of mouth
  • condyle of mandible slips forward
  • painful bc muscle/lig stretching
37
Q

maxillary fracture

A
  • midface fracture
  • upper jaw & associated bony structures
  • face appear longer than usual if displaced
  • malocclusion indicates
  • gentle pressure indicate mobile upper jaw
38
Q

zygomatic fracture

A
  • 2nd most common fascial fracture
  • cheek bone depressed or flat
  • swelling, ecchymosis on affected side
  • eye on affected side appear sunken
  • may involve floor of orbit
39
Q

epistaxis(nosebleed)

A
  • occur: superficial blood vessels on anterior septum lacerated
  • usually bleeding stop spontaneously/easily w/application pressure
  • posterior bleeding more serious, may require physician
40
Q

nasal fracture

A
  • most common facial fracture
  • often lateral displacement
  • nose appear flattened/lose symmetry
  • crepitus over nasal bridge, ecchymosis under eye
41
Q

neck injuries

A
  • cervical fracture most concerning
  • any doubt, assume cervical
  • spine board
  • LOC, assume cervical
  • most concerning MOI: head down impact at top head(spearing, axial loading)
  • at ER, lateral cervical spine xray, start clearance
  • significant if difference in angulation 11deg from one level vertebrae to next, lack congruity anterior posterior curve vertebrae

upper body - ATP 2324 (3 decks)

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