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athletic injuries 2036 > Lecture 17: Head and Face injuries > Flashcards

Lecture 17: Head and Face injuries Flashcards

1
Q

cause of injuries for facial lacerations

A
  • may be a penetrating (sharp object) or blunt trauma causing direct or indirect compressive force
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2
Q

signs of facial lacerations

A
  • pain
  • substantial bleeding
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3
Q

care for facial lacerations

A
  • facial lacerations should be cleaned with sterile saline and assessed for the presence of debris or damage to underlying structures.
  • apply pressure to control the bleeding
  • rule out skull/ brain traumas
  • referral to a physician may be necessary for stitches
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4
Q

cause of injury for scalp injuries

A
  • highly vascular area
  • blunt trauma or penetrating trauma tends to be the cause
  • can occur in conjunction with serious head trauma
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5
Q

care for scalp injuries:

A
  • clean with antispetic soap and water (remove debris)
  • cut away hair if necessary to expose area
  • apply firm pressure to reduce bleeding
  • wounds larger than 1/2 inch in length should be referred to hospital
  • smaller wounds can be covered with protective covering and gauze (use extra adherent)
    (can use pressure and ice to help stop the pain and bleeding)
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5
Q

signs of scalp injuries

A
  • athlete complains of blow to the head
  • bleeding is often extensive and difficult to pinpoint exact site
    (can be difficult to pin point because the athlete has so much hair)
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6
Q

how to know when to send someone for stitches?

A
  • tissue adhesive generally is recommended for closure of simple lacerations less than 4 cm in length that are not at points of high skin tension
  • for wounds over 4cm in length or at points of high skin tension
  • if it is through all skin layers and/or showing exposed fat, tendons, bones, or vessels
  • place a non-medicated gauze pad over the lesion if patient is to be sent for sutures
  • within 8-12 hours max
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7
Q

what are other options for instead of stitches?

A

1: steri-strips
2: butterfly bandage

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8
Q

what are the steps for assessing cuts?

A

1: identify the area
2: get the bleeding to stop
3: then you can assessing for fractures

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9
Q

the dura mater is on the –
the subarachnoid space is on the –

A

1: outside
2: inside

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10
Q

head injuries

A
  • occur as a result of direct blow causing compressive force, tensile (negative pressure force) or shearing.
  • CSF
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11
Q

what does CSF do?

A
  • it acts to convert focal force into compressive stress that is dissipated over the brains full surface
  • has minimal impact on shearing force, especially when combined with rotations
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12
Q

what are signs of head injuries?

A

1: halo signs
2: battle signs
3: raccoon eyes

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13
Q

battle sign

A
  • when there is per auricular ecchymosis (bruising around the ear)
  • late findings, usually 24-48 hours!
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14
Q

racoon eyes

A
  • periorbital ecchymosis
  • bleeding under the skin around the eyes
  • also late findings 24-48 hours
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15
Q

halo sign

A
  • clear drainage that separates from bloody drainage suggests the presence of cerebrospinal fluid
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16
Q

pupil reactions and possible causes

A

1: pupils equal and reactive to light
- normal

2: equal but dilated/unresponsive
- cardiac arrest, CNS injury

3: equal but constricted/unresponsive
- CNS injury or disease

4: unequal, one dilated/unresponsive
- cerebrovascular accident (CVA)
- head injury
- direct trauma to the eye

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17
Q

epidural hematoma

A

cause of injury
- blow to head or a skull fracture which tears meningeal arteries
- blood accumulation and creation of hematoma and pressure occur rapidly (minutes to hours)
- blood accumulates on the outside.
- slowly, have the tear, then bruise forming, then it starts to put pressure on the brain

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18
Q

signs of epidural hematoma

A
  • may or may not have brief loss of consciousness followed by a period of lucidity. During this period they may not display clear signs and symptoms of a serious head injury
  • gradual progression of signs and symptoms
  • severe head pain, dizziness, nausea, dilation of one pupil (anisocoria), occurring on same side as injury, deterioration of consciousness, depression of pulse and respiration, and convulsion

they basically get hit, feel fine, then you start to see a gradual decline over the course of the next couple of hours

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19
Q

care for epidural hematoma

A
  • requires urgent neurosurgical care
  • must relieve pressure to avoid disability or death
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20
Q

subdural hematoma

A
  • result of acceleration/deceleration forces that tear vessels that bridge dura matter and brain
  • venous bleeding (simple hematoma may result in little to no damage to cerebellum while more complicated bleed can damage the cortex)
  • this happens inside the dura
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21
Q

signs of subdural hematoma

A
  • athlete may experience loss of consciousness in seconds to minutes
  • pupillary asymmetry
  • signs of headache, dizziness, nausea or sleepiness if not unconscious (all immediate sings)
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22
Q

care for subdural hematoma

A
  • immediate emergency medical attention
  • CT or MRI is necessary to determine extent of injury
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23
Q

recognition and management of specific facial injuries

A

1: assess:
- mental status (conscious or unconscious, if un conscious send them to hospital right away)
- airway and breathing

2: manage significant bleeding
- can better assess all structures

3: check nose and eats for CSF

4: take a top-down approach to assess
- get an idea of facial asymmetry ASAP these injuries will swell quickly
- forehead and orbits
- maxilla and nose
- cheekbones (zygoma)
- oral cavity and mandible

5: evaluation criteria
- symptoms
- asymmetry, bony steps, bruising and mobility

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24
Q

cause of injury for forehead fractures

A
  • most common cause is blunt trauma
  • usually fairly resistant to fractures
  • most superior portions of the weaker orbital structures reside within the bounds of the forehead
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25
Q

signs of injury for forehead fractures

A
  • severe headache and nausea
  • palpation may reveal defect in skill
  • may be blood in the middle ear, ear canal, nose, ecchymosis around the eyes (raccoon eyes) or behind the ear (battle signs)
  • cerebrospinal fluid may also appear in ear and nose (halo sign seen on gauze)
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26
Q

orbital fracture cause of injury

A
  • direct trauma to the eyeball
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27
Q

orbital fracture signs of injury

A
  • possible posterior displacement of the eye
  • diplopia (double vision, immediate referral to the hospital)
  • restricted upward gaze
  • downward displacement of the eye
  • soft-tissue swelling and hemorrhaging
  • subconjunctival hemorrhaging
  • periorbital ecchymosis (raccoon eyes)
  • unilateral epistaxis
  • numbness
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28
Q

orbital fracture care

A
  • ice, no blowing nose and valsalva maneuver (risk of infection (due to proximity of maxillary sinus and bacteria)
  • x-ray/CT will be necessary to confirm fracture
  • treated surgically or allow to resolve spontaneously
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29
Q

signs of midface (maxillary) fracture

A
  • must also assess airway and eyes
  • visible lengthening and flattening of face
  • mobile maxilla
  • nasal bleeding
  • ecchymosis of cheek
  • malocclusion (alteration of bite)

palpation of facial bones
-palpation along maxilla for major deformities
- identify by forehead stabilization with one hand, while gently pulling maxillary incisors

30
Q

causes of zygomatic complex fracture

A
  • direct blow to the cheek.
  • on the fractures side its going to droop down a little
31
Q

signs of zygomatic complex fracture

A
  • deformity, or bony discrepancy
  • palpable step-offs in the upper lateral orbital rim and inferior orbital rim
  • cheek numbness
    (due to injury to infra orbital nerve-cheek, side of nose, upper lip and ipsilateral teeth)
  • nosebleed (on injured side due to sinus filling with blood)
  • diplopia and possible restricted eye movements
  • subconjunctival hemorrhage and periorbital ecchymosis are seen in as many as 50% of patients
32
Q

midface (maxillary) and zygomatic complex care

A
  • secure airway
  • if conscious, keep in upright sitting position to aid blood and saliva drainage
  • transport to emergency for definitive diagnosis/imaging
33
Q

cause of injury for mandible fractures

A

direct blow
- often occur at the angle or the condyle

34
Q

sings of injury mandible fractures

A
  • pain with biting
  • positive tongue blade test

deformity
- palpate inferior border and mandibular condyle
- loss of occulation
- bleeding around teeth
- lower lip anesthesia

35
Q

care for mandible fractures

A
  • secure airway
  • temporary immobilization with elastic wrap followed by reduction and fixation
  • emergency medical referral
36
Q

prevention of dental injuries

A
  • when engaged in contact/collision sports, mouth guards should be worn
  • greatly reduces the incidence of oral injuries
37
Q

what are the different types of mouth gaurds?

A
  • 1: stock mouthpieces
    2: “boil and bite” mouth guards
    3: custom guard

(all work the same its more about how comfortable they are)

38
Q

tooth fractures causes of injury

A
  • impact to the jaw
  • direct dental trauma
39
Q

signs of tooth fractures

A

1:uncomplicated fractures produce fragments without bleeding

2: complicated fractures produce bleeding, with the tooth changer being exposed with a great deal of pain and sensitivity to thermal changes, air exposure and touch

3: root fractures are difficult to determine and require follow-up with x-ray

40
Q

care for tooth fractures

A
  • uncomplicated and complicated crown fractures do not require immediate attention
  • fractured pieces can be placed in a bag, milk, or save-a-tooth solution
  • DO NOT place the avulsed tooth portion in ice (it will kill it)
  • if not sensitive to air or cold, follow-up can be within 24 hours
  • bleeding can be controlled via gauze
  • in instances of root fractures, the athlete can continue to play but must follow-up immediately following competition
41
Q

cause of injury for tooth subluxation, luxation, avulsion and intrusion

A
  • direct blow
42
Q

signs of tooth subluxation

A
  • tooth may be slightly loosened or dislodged
  • with luxations, no fracture has occurred however, there is displacement
43
Q

signs of intrusion (tooth injury)

A

with an intrusion, the tooth is driven back into the socket
- do not try to reposition. refer to dentist immediately

44
Q

signs of extrusion (tooth injury)

A

with extrusion it is partially outward dislodged
- attempt repositioning and hold in place by biting-down

45
Q

signs of a laterally displaced tooth

A

laterally displaced tooth (forward, back, or side to side)
- do not attempt to reposition. refer to dentist immediately

46
Q

signs of an avulsion (tooth injury)

A

with an avulsion, the tooth is completely removed from the oral cavity

47
Q

tooth avulsion

A

time dependent injury
- prognosis is 90% with replacement within 30 minutes
- after 2 hours, results in a 95% failure rate

48
Q

management of a tooth avulsion

A
  • locate and protect the tooth
  • if solied, rinse lightly with milk or saline
  • do not rub, use tap or drinking water, as this may injure the periodontal ligament cells and compromise implantation

reposition tooth if athlete is conscious ASAP
- minutes matter, try to get it in within 5 - 10 minutes
- do not worry about getting it in perfectly, it can be repositioned by the dentist
- splint with hand or wad of paper towel to hold in place
- refer fore immediate dental evolution

if unable to replace
- stored in “save-a-tooth” , cold milk, cold saline, saline gauze on ice or athletes cheek

49
Q

nasal fractures cause of injury and examination

A

cause of injury
- direct trauma

examination
- observe for and palpate gently for crepitus (want to know if it is cracking or creaking) or bony asymmetries
- depression of the nasal dorsum
- deviation of the septum

examine for septal hematoma
- can they breath through each nostril

50
Q

care for nasal fracture

A
  • secure airway if needed
  • control bleeding by external pressure or if needed, internal packing
  • protect and transport for x-ray, examination and reduction
  • un complicated and simple fractures will post little problem for the athletes quick return
51
Q

septal hematoma: cause of injury and signs

A

cause of injury
- hemorrhage between the two layers of mucosa covering the septum

signs of injury
- blueish or dull red bulge on the septum
- athlete will complain of nasal pain and may have difficulty breathing out of one nostril

52
Q

care for septal hematoma

A
  • this may complicate a trivial nosebleed
    (a neglected hematoma will reuslt in formation of an abscess along with bone and cartilage loss and deformity)
  • at the site of the hematoma, compression will be required (and if MD present, drained immediately)
  • following drainage, a wick is inserted to allow for further drainage
  • packing will be necessary to prevent a return of the hematoma
53
Q

nosebleed (epistaxis)
cause of injury

A
  • result of a direct blow in sport situations
  • a foreign body or some other serious facial injury
54
Q

nosebleed (epistaxis) signs of injury

A
  • generally bleeding from the anterior aspect of the septum (little’s/ kiesselbach’s area)
  • usually presents with minimal bleeding and resolves spontaneously
  • more severe bleeding may require more medical attention
55
Q

care for nosebleed

A
  • have athlete blow each nostril to clear clots
  • sit upright in the head-forward position to avoid blood from pooling in the posterior pharynx.
  • with a cold compress over the nose, compress vessels of the nasal septum
  • if bleeding does not cease in 5 minutes, an stringent or stypic may need to be applied along with gauze/cotton nose plug to encourage clotting
  • ice to back of head/neck can also help decrease vagal tone, thereby allowing bleeding to slow and help the clotting process
  • after bleeding has ceased, the athlete can return to play but should be reminded not to blow the nose under any circumstances for at least 2 hours after the initial insult
56
Q

aspects associated with sport-related occular injuries

A
  • high likelihood of being a severe injury
  • treatment often limited to salvaging the remaining vision
  • high-risk sports include, basketball, baseball, soccer, lacrosse, tennis, racquetball, hockey
  • very high-risk sports include boxing, martial arts, and wrestling
57
Q

subconjunctival hemorrhage

A

appears as a bright red area in the white conjunctiva
cause:
- can occur spontaneously
- due to minor eye trauma or obrital/zygomatic fractures
- valsalva maneuvers, such as coughing, sneezing, or straining are the usual causes

58
Q

care for subconjunctival hemorrhage

A
  • assess eye for any vision issues
  • if this covers the entire sclera, it may be obscuring a perforation in the eye. patient should be referred immediate
  • otherwise, usually resolved in 2-3 weeks
59
Q

corneal abrasions causes of injury

A
  • an injury that occurs to the most anterior layer of the eye
  • poke to the eye
  • attempt to remove foreign object from eye by rubbing
60
Q

sings of corneal abrasions

A
  • mid to severe pain
  • watering of the eye
  • phtophobia
  • pain with blinking
  • decreased focusing ability
  • spasm of the orbicular muscle of the eyelid
61
Q

care for corneal abrasions

A
  • refer to a physician (may need to patch until assessed)
  • usually heal within 24 to 72 hours
  • a patch may be necessary with younger patients to avoid rubbing
  • return to play is guided by a decrease in symptoms and may require short-term eye protection
62
Q

hyphema: cause of injury

A
  • this is a serious injury that leads to serious problems with the lens or retina
  • anterior chamber injured due to blunt trauma
  • high force injury so you must rule out penetrating trauma, orbital fracture, abrasion, and/or retinal injury
63
Q

signs of injury for hyphema

A
  • visible reddish tinge (occasionally pea green) in the anterior chamber of the eye
  • vision is partially or completely blocked
64
Q

care for hyphema

A
  • IMMEDIATE referral to an ophthalmologist
  • bed rest (4 days) and elevation (30-40 degrees); both eyes patched
  • discontinue use of NSAIDs
  • irreversible vision damage if not managed properly!!!
65
Q

periorbital ecchymosis (black eye): cause of injury

A
  • blow to the area surrounding the eye
66
Q

sings of periorbital ecchymosis (black eye)

A
  • swelling and discolouration
  • signs of a more serious condition if accompanied by a subconjunctival hemorrhage
67
Q

care for periorbital ecchymosis (black eye)

A
  • cold application for at least 30 minutes
  • do not blow nose after acute eye injury - may increase hemorrhaging
68
Q

if chemical injury (field marking) - flush immediately for – minutes

A

30

69
Q

basic eye assessment

A

1: history- determine force and direction of force
2: check vision - before any manipulation
- chart or newpaper 16’ away
- diplopia suggest serious injury
3: pupil/ cornea/conjunctiva
- penlight exam (PEARL)
- foreign bodies
- hyphema or subconjunctival hemorrhaging
4: eye movements
- full mobility.. up ,down, all around

70
Q

airway injuries

A
  • most dangerous of all maxillofacial injuries
  • airway compromise secondary to laryngotracheal trauma are second most common cause of death
  • any blow to the anterior neck can cause significant airway obstruction
  • minor injuries to larynx can worsen due to laryngospasm
71
Q

laryngospasm

A
  • closure to the larynx caused by spasm
  • athlete becomes agitated and panic stricken
  • to teat, move chin forward and place strong anterior pressure behind the angle of the jaw. hold for 45-60 seconds until you can hear inspiration
72
Q

sings and symptoms of larynx injury following trauma

A
  • cartilaginous fracture to the Thyroid/Cricoid cartilages

1: athlete initially may be speechless or have hoarse (muffled, breathy, changed) voice

2: loss of prominence in anterior neck (fractured thyroid/cricoid cartilage)

3: difficulty breathing
- feeling of impeding doom

4: pain/tenderness with swollowing

5: crepitation on palpation of the anterior neck
- subcutaneous emphysema-critical!!!!

6: hematoma/hemoptysis
- this is a medical emergency - load and go!

(blood is going to be frothy when they split it up)

athletic injuries 2036 (20 decks)

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