head & neck Flashcards
1
Q
frequent site of injury
A
- head comprises 10% body surface area
- minor injuries: laceration, contusion, concussion
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
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
4
Q
TMJ (temporomandibular joint)
A
- movement allows mastication
- can become roughened, dislocated
- malocclusion - poor function of joint
5
Q
32 permanent teeth in upper & lower jaw
A
- upper teeth fixed - alveolar process (maxilla)
- lower teeth fixed - (mandible)
6
Q
teeth - each row 4 different types
A
- incisors (4) cutting
- canines/cuspids (2) tearing
- premolars/bicuspids (4) crushing
- molars (6) crushing/grinding
7
Q
tooth - 3 major areas
A
- root (anchored by cementum, small periodical lig)
- neck
- crown
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
9
Q
loosened tooth
A
- can be partially displaced, intruded extruded avulsed
- should try to return tooth to normal position & to dentist
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
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
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
13
Q
scalp - 3 layers
A
- skin, subcutaneous tissue, pericranium: protective, loose to deflect glancing blow
- scalp & face: extensive blood supply, bleed profusely
14
Q
brain - 4 main regions
A
- 2 cerebral hemispheres(R/L)
- diencephalon
- brain stem
- cerebellum
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)
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)
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
intracranial cerebral trauma - focal or diffuse
- 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
initial injury
- extended by hypoxia, ischemia, cerebral edema
| - important to recognize and treat immediately
27
skull fracture
- 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
hematoma
- collection of blood w/in localized area
- no room for expansion w/in cranial cavity
- increased pressure w/in brain, increasing neurologic dysfunction
29
epidural hematoma
- 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
subdural hematoma
- 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
concussion
-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
scalp injuries
- 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
cranial injuries - immediate assessment
- 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
jaw injuries
- prevent injuries w/protective equipment
- fractures occur in upper/lower jaw
- careful when apply direct pressure over injury site w/bleeding
35
mandible fractures
- 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
dislocate TMJ
- cause: excessive opening of mouth
- condyle of mandible slips forward
- painful bc muscle/lig stretching
37
maxillary fracture
- midface fracture
- upper jaw & associated bony structures
- face appear longer than usual if displaced
- malocclusion indicates
- gentle pressure indicate mobile upper jaw
38
zygomatic fracture
- 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
epistaxis(nosebleed)
- occur: superficial blood vessels on anterior septum lacerated
- usually bleeding stop spontaneously/easily w/application pressure
- posterior bleeding more serious, may require physician
40
nasal fracture
- most common facial fracture
- often lateral displacement
- nose appear flattened/lose symmetry
- crepitus over nasal bridge, ecchymosis under eye
41
neck injuries
- 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
