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Athletic Injuries > Lecture 17 - Head and Face Injuries > Flashcards

Lecture 17 - Head and Face Injuries Flashcards

1
Q

what type of sport do face and head injuries occur in?

A
  • collision and contact sports
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2
Q

what is the best way to prevent injuries to the head and face?

A
  • education
  • protective equipment
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3
Q

what is the cause of facial lacerations?

A
  • penetrating/sharp object or blunt trauma causing direct or indirect compressive force
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4
Q

what are the signs of facial lacerations?

A
  • pain
  • substantial bleeding (especially overtop bones)
  • (skin cuts very easily)
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5
Q

how do you care for facial lacerations?

A
  • clean with sterile saline
  • assess for debris or damage to structures
  • apply pressure to control bleeding
  • rule out skull/brain trauma
  • refer to physician (preferably plastics) for stitches if necessary
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6
Q

what is the cause of scalp injuries?

A
  • blunt trauma or penetrating trauma (usually)
  • can occur in conjunction with serious head trauma
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7
Q

what are the signs of scalp injuries?

A
  • blow to the head
  • bleeding is extensive and difficult to pinpoint (highly vascular area)
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8
Q

how do you care for scalp injuries?

A
  • clean with antiseptic soap and water
  • remove debris
  • cut away hair (if necessary to expose area)
  • apply pressure to reduce/stop bleeding
  • use ice to reduce blood flow
  • refer wounds larger than 1/2 inch in length
  • treat smaller wounds with protective covering/gauze
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9
Q

when should you refer someone for stitches?

A
  • high tension location (elbow, knee, face, etc.)
  • wounds >4 cm in length
  • cut goes through all skin layers (showing fat, tendon, bone or vessels)
  • within 8-12 hours (ideally within 4-6 hours)
  • protect with non-medicated gauze if sending for sutures
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10
Q

how do you care for lacerations that do not require stitches?

A
  • steri-strips
  • butterfly bandage
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11
Q

what causes brain injuries?

A
  • a result of a direct blow
  • compressive force
  • tensile (negative pressure) force
  • shearing
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12
Q

what is the purpose of CSF?

A
  • (cerebral spinal fluid)
  • converts focal force into compressive stress
  • dissipates force over brains full surface
  • has minimal impact on shearing force (especially when combined with rotation)
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13
Q

what is battle’s sign? (aka periauricular ecchymosis)

A
  • bruising around the ear (behind the ear)
  • indicates a skull fracture
  • late finding (24-48 hours after incident)
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14
Q

what is raccoon eyes? (aka periorbital ecchymosis)

A
  • bruising around/under the eyes
  • indicates a skull fracture
  • late finding (24-48 hours after incident)
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15
Q

what is halo sign?

A
  • clear (yellowish/greenish) drainage that separates from bloody drainage from ears/nose
  • indicative of CSF leakage
  • indicates skull fracture
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16
Q

what is the PEARL test for vision?

A
  • Pupils Equal And Reactive to Light
  • indicates normal eye function
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17
Q

what do equal but dilated/unresponsive pupils indicate?

A
  • cardiac arrest
  • CNS injury
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18
Q

what do equal but constricted/unresponsive pupils indicate?

A
  • CNS injury or disease
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19
Q

what do unequal, one dilated/responsive pupils indicate?

A
  • CVA (cerebrovascular accident)
  • head injury
  • direct trauma to the eye
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20
Q

what is an Epidural Hematoma?

A
  • bleeding between the dura and skull
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21
Q

what is the cause of an epidural hematoma?

A
  • blow to the head
  • skull fracture
  • tearing of meningeal arteries
  • blood accumulation and pressure occur rapidly (minutes to hours)
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22
Q

what are the signs of an epidural hematoma?

A
  • possible brief loss of consciousness followed by lucidity
  • gradual progression of signs and symptoms
  • severe head pain
  • dizziness
  • nausea
  • dilation of one pupil (anisocoria), on side of the injury
  • determination of consciousness
  • slowing pulse and respiration (lethargic)
  • convulsion
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23
Q

what is the care for an epidural hematoma?

A
  • requires urgent neurosurgical care
  • relieve pressure to avoid disability or death
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24
Q

what is a subdural hematoma?

A
  • bleeding under the dura mater in the brain
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25
Q

what is the cause of a subdural hematoma?

A
  • the result of acceleration/deceleration forces
  • tearing of the vessels that bridge dura matter and brain
  • venous bleeding (little to no damage to the cerebellum, complicated bleeds can damage the cortex)
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26
Q

what are the acute signs of a subdural hematoma?

A
  • LOC in seconds to minutes
  • pupillary asymmetry
  • headache
  • dizziness
  • nausea
  • sleepiness (if not unconscious)
  • falling in and out of consciousness quickly
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27
Q

what is the care for a subdural hematoma?

A
  • immediate emergency medical attention
  • CT or MRI to determine extent of injury
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28
Q

how long should you monitor an athlete following head trauma?

A
  • 4-6 hours
  • don’t send them home alone
  • if in doubt, check it out
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29
Q

what are the steps to recognizing and managing facial injuries?

A
  1. assess (ABC’s)
  2. manage significant bleeding
  3. check nose and ears for CSF
  4. take a top-down approach to assess
  5. evaluation criteria
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30
Q

what are the ABC’s of assessment for facial trauma?

A

A = airway
B = breathing
C = consciousness (aka mental status)

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31
Q

why do you need to manage significant bleeding in the face?

A
  • to better assess all structures (for better visibility)
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32
Q

how can you check the nose and ears for CSF?

A
  • halo test with a gauze wad (in the nose or ears, wherever there is bloody drainage)
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33
Q

what is the top-down approach to assess facial injuries?

A
  • look for facial asymmetry
  • forehead and orbits
  • maxilla and nose
  • cheekbones (zygoma)
  • oral cavity and mandible
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34
Q

what are the evaluation criteria for facial injuries?

A
  • asymmetry
  • bony steps
  • bony mobility
  • bruising
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35
Q

what is the cause of a forehead fracture?

A
  • blunt trauma
  • fairly resistant to fractures
  • superior portion of the weaker orbital structures reside here
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36
Q

what are the signs of a forehead fracture?

A
  • severe headache and nausea
  • possible defect on palpation
  • blood in ear, ear canal, and nose
  • possible ecchymosis around eyes or behind ear
  • halo sign may be seen
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37
Q

what is the cause of an orbital fracture?

A
  • direct trauma to the eyeball
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38
Q

what are the signs of an orbital fracture?

A
  • possible displacement of the eye (enophthalmos)
  • diplopia
  • restricted upward gaze
  • downward displacement of the eye
  • soft-tissue swelling and hemorrhaging
  • subconjunctival hemorrhaging (red in the white of the eye)
  • periorbital ecchymosis
  • unilateral epistaxis (nosebleed on the injured side because of sinuses)
  • numbness of the cheek, side of nose, upper lip or ipsilateral teeth (because of injury to the infraorbital nerve)
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39
Q

how do you care for an orbital fracture?

A
  • ice
  • no blowing nose
  • no Valsalva maneuver (keep head upright and limit movement)
  • *the risk of infection is high
  • x-ray/CT to confirm fracture
  • treated surgically or will resolve spontaneously
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40
Q

what are the signs of a midface (maxillary) fracture?

A

-*must also assess the airway and eyes (especially around the nose)
- visible lengthening and flattening of face
- mobile maxilla
- nasal bleeding
- ecchymosis of cheek
- malocclusion (alteration of bite) –> teeth won’t go together

41
Q

how do you palpate to confirm a maxillary fracture?

A
  • along maxilla (for major deformities)
  • forehead stabilization with one hand, gently pull maxillary incisors (to see if face moves)
42
Q

what are the 3 levels of maxillary fracture?

A
  • Le Fort I = only under nose
  • Le Fort II = up cheek bones and top of nose
  • Le Fort III = up to top of eye sockets
43
Q

what is the cause of a zygomatic complex fracture?

A
  • direct blow to the cheek
44
Q

what are the signs of a zygomatic complex fracture?

A
  • deformity/ bony discrepancy
  • palpable step-offs in the upper lateral orbital rim and inferior orbital rim
  • numbness in cheek, side of nose, upper lip and ipsilateral teeth (due to infra-orbital nerve)
  • nosebleed (on injured side, sinus fills with blood)
  • double vision (diplopia)
  • possible restricted eye movements
  • possible subconjunctival hemorrhage and periorbital ecchymosis
45
Q

how can you measure step-offs for a zygomatic complex fracture?

A
  • place a ruler or pencil on the side of the head, should stick relatively straight down
  • positive test is if the bottom of the ruler deviates
46
Q

how do you care for a maxillary and zygomatic complex fracture?

A
  • secure airway
  • if conscious, keep upright for blood and saliva drainage (not down the throat)
  • transport to emergency for diagnosis and imaging
47
Q

what is the cause of a mandible fracture?

A
  • direct blow
  • often occurs at the angle or condyle (angle = sharp corner, condyle = where it connects to skull)
48
Q

what are the signs of a mandible fracture?

A
  • pain with biting
  • +ve tongue blade test
  • deformity
  • loss of occlusion
  • bleeding around teeth
  • lower lip numbness
49
Q

what is the tongue blade test?

A
  • insert a wooden tongue depressor into patients molars
  • tell them to bite down
  • if you can twist the tongue depressor and it breaks, they likely didn’t fracture their mandible
  • broken mandible will be weak, painful and likely unable to keep strength in bite
50
Q

how do you care for a mandible fracture?

A
  • secure airway
  • immobilize with elastic wrap (around head to keep jaw closed) –> easy to remove in case of vomiting
  • emergency medical referral
51
Q

what is the best way to prevent dental injuries?

A
  • wear a mouthguard - PROPERLY
  • any type of mouthguard is effective
52
Q

what are the three types of mouthguards?

A
  • “boil and bite” mouthguards
  • stock mouthpieces
  • custom guards
53
Q

what is the cause of tooth fractures?

A
  • impact to the jaw
  • direct dental trauma
54
Q

what are the signs of the three types of tooth fractures?

A
  • uncomplicated = fragments without bleeding
  • complicated = bleeding, tooth chamber exposed, pain and sensitivity with air exposure, touch and temperature
  • root fractures = requires an x-ray, may feel loose and have bleeding
55
Q

how do you care for tooth fractures?

A
  • uncomplicated and complicated do not require immediate attention (just within 24 hours)
  • place broken off pieces into milk or save-a-tooth solution (NOT ON ICE)
  • control bleeding with gauze
  • for root fractures, follow-up immediately following the game
56
Q

what is the cause of injury for tooth subluxation, luxation, avulsion and intrusion?

A
  • direct blow
57
Q

what are the signs of tooth subluxation?

A
  • tooth may be loose within the socket
58
Q

what are the signs of tooth luxation?

A
  • displacement of the tooth, no fracture present
59
Q

what are the 3 types of tooth luxation?

A
  • intrusion
  • extrusion
  • lateral displacement
60
Q

what are the signs of a tooth intrusion?

A
  • tooth is driven back into the socket
  • do not try to reposition
  • refer to dentist immediately
61
Q

what are the signs of a tooth extrusion?

A
  • partially downwardly dislodged
  • attempt to reposition
  • hold in place by biting down
62
Q

what are the signs of a laterally displaced tooth?

A
  • forward, back or side to side
  • do not attempt to reposition
  • refer to a dentist immediately
63
Q

what are the signs of tooth avulsion?

A
  • tooth is completely removed from the oral cavity
64
Q

how do you manage a tooth avulsion injury?

A
  • locate and protect the tooth
  • rinse lightly with milk (if soiled)
  • do not rub or rinse with tap water (injures periodontal ligament cells and compromises implantation)
  • try to reposition tooth if athlete is conscious (any position is fine, just want to keep viable)
  • splint with hand or paper towel to hold in place
  • immediate dental evaluation
  • if unable to replace, put in milk or save-a-tooth
65
Q

what is the cause of nasal fracture injuries?

A
  • direct trauma
66
Q

how do you examine nasal fracture injuries?

A
  • palpate for crepitus or bony asymmetries
  • palpate for depression of the nasal dorsum or deviation of the septum
  • examine for septal hematoma (if deviated septum) (make athlete breath through each nostril individually)
67
Q

how do you care for nasal fractures?

A
  • secure airway if needed
  • control bleeding by external pressure if needed
  • internal packing (nose plugs, etc.)
  • protect and transport for x-ray, exam and reduction
  • will have little problem for return, may fix with surgery (depending on severity and athlete)
68
Q

what is the cause of septal hematoma injuries?

A
  • hemorrhage between the two layers of mucose covering the septum
69
Q

what are the signs of a septal hematoma?

A
  • blueish or dull red bulge on the septum
  • nasal pain and difficulty breathing out of one nostril
70
Q

how do you care for a septal hematoma?

A
  • *untreated will lead to abscess and bone cartilage loss and deformity
  • compression
  • drain ASAP
  • insert wick to allow for further drainage
  • pack to prevent the return of hematoma (needs pressure)
71
Q

what is the cause of injury of epistaxis?

A
  • *aka nosebleed
  • direct blow
  • foreign body or other facial injuries
72
Q

what are the signs of an epistaxis injury?

A
  • bleeding from the anterior aspect of the septum
  • presents minimal bleeding and resolves spontaneously
  • may require medical attention is severe
73
Q

how do you care for an epistaxis injury?

A
  • blow nose (to clear clots)
  • sit upright with head forward
  • cold compress over nose and on back of neck
  • after 5 minutes, may need septic or astringent
  • after bleeding has stopped, player may return to play –> don’t let them blow their nose for 2 hours (may remove clots and cause rebleeding)
74
Q

what is the mindset as a clinician caring for sport-related ocular injuries?

A
  • salvage the remaining vision (once it’s gone, it’s gone)
  • eye injuries have a very high likelihood of being severe
75
Q

what is a subconjunctival hemorrhage?

A
  • bright red area in the white conjunctiva
  • popped blood vessels in the eye
76
Q

what is the cause of a subconjunctival hemorrhage?

A
  • occur spontaneously
  • minor eye trauma or zygomatic fracture
  • Valsalva maneuvers, coughing, sneezing, straining
77
Q

how do you care for a subconjunctival hemorrhage?

A
  • assess for vision issues
  • if severe and blocking entire sclera, refer
  • resolves in 2-3 weeks
78
Q

what is a corneal abrasion?

A
  • injury to the anterior layer of the eye
79
Q

what is the cause of a corneal abrasion?

A
  • poke to the eye
  • attempt to remove foreign object by rubbing
80
Q

what are the signs of a corneal abrasion?

A
  • mild to severe pain
  • watering of the eye
  • photophobia (sensitive to bright light)
  • pain with blinking
  • decreased focus ability
  • spasm of orbicular muscle of eyelid
81
Q

how do you care for corneal abrasion?

A
  • refer to the physician
  • heal within 24-72 hours
  • patch for younger athletes to avoid rubbing
  • return to play once their vision is back and symptoms are gone (may require short-term eye protection)
82
Q

what is hyphema?

A
  • bleeding within the lens or retina of the eye (not present in the white of the eye)
83
Q

what is the cause of hyphema?

A
  • anterior chamber of eye injured due to blunt trauma
  • high force injury! –> rule out penetrating trauma, orbital fracture, abrasion and retinal injury
  • (will look like blood in the iris)
84
Q

what are the signs of hyphema?

A
  • visible reddish tinge (or pea green) in the anterior chamber of the eye
  • vision is partially or completely blocked
85
Q

how do you care for hyphema?

A
  • immediate referral to an ophthalmologist
  • bed rest (4 days) and elevation (30-40 degrees)
  • patch both eyes (restrict strain)
  • discontinue NSAIDs
  • irreversible vision damage if not managed properly
86
Q

what is periorbital ecchymosis?

A
  • black eye
87
Q

what is the cause of periorbital ecchymosis?

A
  • blow to the area surrounding the eye
88
Q

what are the signs of periorbital ecchymosis?

A
  • swelling and discolouration
  • subconjunctival hemorrhage may be a sign of a more serious condition
89
Q

how do you care for periorbital ecchymosis?

A
  • cold application for at least 30 minutes
  • do not blow nose (may increase hemorrhaging)
90
Q

what are the 4 steps for a basic eye assessment?

A
  1. history (determine force and direction of force)
  2. check vision (before any manipulation)
  3. pupil/cornea/conjunctiva
  4. eye movements
91
Q

how do you check vision in step 2 of an eye assessment?

A
  • get them to read a chart or newspaper (~ size 12 font)
  • diplopia suggests serious injury
92
Q

how do you examine the pupil/cornea/conjunctiva in step 3 of an eye assessment?

A
  • penlight exam (PEARL)
  • foreign bodies
  • hyphema or subconjunctival hemorrhaging
93
Q

how do you examine eye movements in step 4 of an eye assessment?

A
  • full mobility (up, down, all around)
94
Q

if a chemical injury is present in the eye, how long do you have to flush the eye for?

A
  • flush immediately for 30 minutes
95
Q

what is an airway injury?

A
  • most dangerous maxillofacial injuries
  • airway is compromised
96
Q

what is the cause of an airway injury?

A
  • blow to the anterior neck
97
Q

what is laryngospasm?

A
  • closure of the larynx caused by a spasm (may occur within 4-6 hours)
  • causes athlete to panic
98
Q

how do you treat a laryngospasm?

A
  • move the chin forward and place strong anterior pressure behind the angle of the jaw
  • hold for 45-60 seconds until you hear inspiration
  • the best case scenario, the athlete passes out (this causes them to relax and therefore breathe normally)
99
Q

what are the signs and symptoms of larynx injury (following trauma) –> aka cartilaginous fracture to thyroid/coricoid cartilage (6)

A
  1. speechlessness or hoarse, breathy voice
  2. loss of prominence (adams apple)
  3. difficulty breathing
  4. pain/tenderness when swallowing
  5. crepitation (crackly sound) on palpation of anterior neck (subcutaneous emphysema)
  6. hematoma/hemoptysis
    * this is a medical emergency, pack and go ASAP

Athletic Injuries (13 decks)

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