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CEN > Maxillo-Facial And Ocular Emergencies > Flashcards

Maxillo-Facial And Ocular Emergencies Flashcards

1
Q

Causes of Facial Trauma:

A
  • MVC
  • Assaults/ Personal Altercations
  • Domestic Violence
  • Handguns
  • Falls
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2
Q

General Information for Maxillo-Facial and Ocular emergencies:

A
  • Always care for life threatening emergencies first.
  • C-spine and head injuries must be ruled out with significant facial trauma.
  • Injury to vision considered after life/limb threatening injuries.
  • Fractures of the facial plane may injure growth centers with can result in growth problems and functional derangement.
  • Consider facial nerves involved. (“3,4,6 make my eyes do tricks”)
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3
Q

Facial Nerve (VII) controls these:

A
  • Facial expression
  • Taste
  • Branches
  • Zygomatic (close eyes)
  • Temporal (wrinkle forehead)
  • Buccal (elevate upper lip)
  • Cervical
  • Mandibular (purse lips)
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4
Q

Oculomotor Nerve (III) controls this:

A
  • Pupil Response
  • Ocular Movement
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5
Q

Trochlear Nerve (IV) controls this:

A
  • Ocular Movement
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6
Q

Abducens Nerve (VI) controls this:

A
  • Ocular Movement
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7
Q

Trigeminal Nerve (V) controls this:

A
  • Facial sensation
  • Jaw movement
  • Bite
  • Opening against resistance.
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8
Q

What are some Assessment tips with regard to Maxillo-facial and Ocular Emergencies?

A
  • Raccoon Eyes
  • Nasal/ear drainage may be CSF
  • Deep lacerations of cheek (check for underlying damaged structures.
  • Tear-drop shaped pupil
  • Numbness of upper lip
  • Numbness of lower lip
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9
Q

What can raccoon eyes signify?

A
  • Basilar Skull fracture
  • LeFort Fracture
  • Naso-Ethmoid injury
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10
Q

General Treatment Considerations for Maxillo-facial and Ocular Emergencies:

A
  • Elevate head of bed but clear C-spine first)
  • suction
  • no intranasal tubes
  • Cold packs
  • Antibiotics
  • Tetanus Prophylaxis
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11
Q

Laceration considerations with regard to Maxillo-facial and ocular emergencies:

A
  • repair within 24 hours
  • Human and animal bites can be very dirty and may or may not be sutured (use mnemonic RATS = Rabies, Antibiotics, Tetanus, Soap)
  • Permanent tattooing can occur from road rash and gunpowder.
  • Must be careful with Vermilon border.
  • No epinephrine on ears, nose, fingers, or toes.
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12
Q

Important things too note with nasal fractures:

A
  • Septal hematoma must be noted early for drainage, to prevent airway obstruction.
  • Involvement of nasal mucosa and lacrimal system can result in subcutaneous emphysema.
  • Always check for CSF rhinorrhea.
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13
Q

What are some general manifestations of Maxillary fractures?

A
  • Severe facial pain.
  • visual disturbances
  • swelling/ecchymosis
  • Peri-orbital/orbital swelling
  • subconjunctival hemorrhage
  • facial asymmetry
  • elongation of face
  • Epistaxis
  • Malocclusion
  • Anesthesia/ Paresthesia of upper lip
  • CSF leakage
  • Airway obstruction
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14
Q

What are the 3 categories of Maxillary fractures?

A
  • LeFort I
  • LeFort II
  • LeFort III
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15
Q

What is a LeFort I fracture?

A

Where the body of the maxilla is separated from the base of the skull.

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16
Q

What is a LeFort II fracture?

A

Fracture involves the central maxilla, nasal area, and the ethmoid bones.

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17
Q

What is a LeFort III fracture?

A
  • Complete craniotomy-facial separation.
  • Involves Maxilla, zygoma, Mandible, nasal bones, ethmoids, vomer, orbits, all lesser bones of cranium.
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18
Q

What is the treatment for Maxillary fractures?

A
  • aggressive airway management
  • suctioning to prevent aspiration.
  • Fowler’s position
  • Antibiotics
  • Tetanus
  • Surgery for internal fixation.
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19
Q

What are the types of Zygomatic fractures?

A
  • Zygomatic arch
  • Tripod
    • Zygomatic arch
    • Posterior 1/2 of infra-orbital rim
    • Frontozygomatic suture
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20
Q

What are some manifestations of a zygomatic fracture?

A
  • Flattened cheek.
  • Step off deformity
  • Asymmetry
  • Peri-orbital swelling
  • Ecchymosis
  • Subconjunctival hemorrhage
  • Pain with movement of jaw.
  • TIDES ( Trismus, Infraorbital anesthesia, Diplopia, Epistaxis, Symmetry absence.)
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21
Q

What is Trismus?

A

Tonic contraction of muscles of mastication.

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22
Q

What is an Orbital Blow-Out fracture?

A

Fracture of orbital floor from blunt trauma.

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23
Q

What can become entrapped in an orbital blow-out fracture?

A
  • Inferior rectus muscle
  • Inferior oblique muscle
  • Infraorbital nerve
  • Orbital fat
  • Connective tissue
  • globe
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24
Q

What are some manifestations of an Orbital blow-out fracture?

A
  • Inability to gaze upward.
  • Diplopia
  • Bulging eye (may also see exopthalamus).
  • Epistaxis
  • Infraorbital paresthesia
  • Periorbital edema/ecchymosis
  • Subconjunctival hemorrhage.
  • Subcutaneous Emphysema when blowing nose.
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25
Q

What should you advise the patient to be care with when they have an orbital blow-out fracture?

A
  • Nose blowing
  • coughing
  • sneezing
  • vomiting
  • straining
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26
Q

What are some manifestations of Mandibular fracture?

A
  • point tenderness
  • crepitus
  • step off deformity
  • malocclusion
  • decreased range of motion
  • asymmetry
  • Paresthsia of lower lip/chin
  • Trismus
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27
Q

What is the treatment for a Mandibular fracture?

A
  • Airway management
  • Cold packs
  • Surgery for intermaxillary fixation/wiring.
  • antibiotics
  • Dental growth can complicate fracture.
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28
Q

What are the classifications of Mandibular fractures (by location)?

A
  • Condyle (growth center which occurs downward and forward.
  • Angle
  • Body
  • Dentoalveolar
  • Symphysis (less common)
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29
Q

What is a Hyphema?

A

Bleeding into anterior chamber from blood vessels in the iris.

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30
Q

What comorbities increase the rate of complications associated with a Hyphema?

A
  • Bleeding disorders
  • Anticoagulant therapy
  • Kidney disease
  • Liver disease
  • Sickle cell disease
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31
Q

What are some complications that can occur due to a Hyphema?

A
  • Secondary glaucoma
  • Corneal blood staining
  • Loss of vision
  • Loss of eye
    (If there is any rebleeding within 2-5 days they need to come back)
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32
Q

What is the treatment for a Hyphema?

A
  • strict bed rest vs. mild activity.
  • elevate head of bed 30 degrees.
  • Beta blockers
  • Mydriatics for comfort (to dilate pupil)
  • Steroids
  • Antifibrinolytics
  • Analgesics
  • Anti-emetics
  • Patch both eyes
  • Diuretics
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33
Q

What causes a globe rupture of the eye?

A
  • Blunt or penetrating trauma.
  • Most common area of rupture is under recuts muscles because it is very thin.
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34
Q

What are manifestions of Globe rupture?

A
  • Decreased IOP <10.
  • Decreased vision
  • Assymetry
  • Globe protrusion
  • Irregular Pupil boarders
  • Altered Light Perception
  • Pupil Herniation
  • Nausea
  • Tear-drop shaped pupil (tip of the drop is point of perforation).
  • Extrusion of aqueous/vitreous humor.
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35
Q

What are the Interventions for a Globe Rupture?

A
  • No manipulation
  • Leave impaled object in place.
  • Patch both eyes
  • Semi-fowler’s
  • No eye drops
  • Pain management
  • Tetanus
  • Anti-emetics
  • Surgery
  • Antibiotics
  • Rigid eye shield
  • Send to ophthalmology.
36
Q

What are the types of Ocular Burns?

A
  • Chemical
  • Thermal
  • Radiation
37
Q

What is important to know about Chemical Ocular Burns?

A
  • These are the most urgent.
  • Acids cause damage immediately by immediate desaturation of tissue proteins, then act as a barrier against further damage.
  • Alkalis are the worst because they continue to damage by combining with cellular lipids producing coagulation necrosis.
  • Top priority is irrigation until pH neutral (7-8). This may take 30 minutes of irrigation with 2L of NS/LR.
38
Q

What is important to know about Thermal Ocular burns?

A
  • Rarely involves globe.
  • May cause lid contracture.
39
Q

What is important to know about Radiation Ocular burns?

A

Ultraviolet
- These burns are very painful and can cause keratitis (corneal inflammation) and conjunctivitis.
Infrared
- Permanent loss of vision from absorption of rays via the iris and an increased temperature in the lens.
- Complications include cataracts, focal retinitis, and x-ray burns.

40
Q

What are some types of Lid infections?

A
  • Hordeleum
  • Chalazion
  • Blepharitis
41
Q

What is a Hordeleum?

A
  • stye
  • Infection of eyelash oil gland.
  • Use a warm compress
  • May need I&D.
42
Q

What is a Chalazion?

A
  • Internal Hordeoleum.
  • Inflammation of meibomian gland (sebaceous gland).
  • causes dryness, burning, and irritation.
43
Q

What is Blepharitis?

A
  • inflammation of the eyelid.
  • Causes ulceration.
  • Usually caused by Staph Aureus.
  • Red scales on lashes.
44
Q

What is Keratitits?

A

Inflammation of the cornea.

45
Q

What can cause Keratitis?

A
  • Ulcer
  • Bacteria
  • Fungus
46
Q

What are the manifestations of Keratitis?

A
  • Light sensitivity
  • Redness
  • Painful
  • Profuse tearing
  • Hypopyon (condition involving inflammatory cells in the anterior chamber of the eye)
47
Q

What is the treatment for Keratitis?

A
  • Cultures
  • Antibiotics
  • Fungal drops
  • Cyclopegics drugs (used to dilate the pupil)
  • No Patching
48
Q

What is Uveitis/ Iritis?

A

Inflammation of the uveal tract.

49
Q

What are some manifestations of Uveitis/ Iritis?

A
  • Unilateral
  • Blurred vision
  • Photophobia
  • Constricted pupil
  • Tearing
  • Headache
  • Pain
  • Pain in affected eye when light is shone in opposite eye.
50
Q

What is the treatment for Uveitis/ Iritis?

A
  • Analgesia
  • Antibiotic Opthalamic
  • Topical Steroids
  • Mydriatic Drugs
51
Q

What is Orbital Cellulitis?

A
  • Can be life threatening.
  • Associated with infected sinus/throat
    • Also known as Cavernous Sinus Thrombosis.
52
Q

What are the usual etiologies of Orbital Cellulitis?

A
  • Pneumococcal
  • Staphylococcal
  • Streptococcal
53
Q

What are the manifestations of Orbital Cellulitis?

A
  • Chills
  • Headache
  • Fever
  • Lethargy
  • Nausea/ Vomiting
  • Decreased Vision
  • Facial/Globe Edema
  • Vascular congestion of eyelids
  • Exopthalamus
  • Decreased pupil reflexes
  • Papilledema
  • Paralysis of extra-ocular muscles
54
Q

What is the treatment for orbital cellulitis?

A
  • Antibiotic (Opthalamic)
  • Parenteral Antibiotics
  • Bed rest
  • Hospitalization
  • Warm compresses
55
Q

What is Central Retinal Artery Occlusion?

A
  • A true ocular emergency (only have 60-90 minutes to get to surgery).
  • Painless loss of vision.
56
Q

What are the etiologies of Central Retinal Artery Occlusion?

A
  • Embolus
  • Thrombus
  • Giant Cell Arteritis
  • Angiospasms
57
Q

What is the treatment for Central Retinal Artery Occlusion?

A
  • Must re-establish circulation.
  • Ocular Massage
  • IOP lowering drugs
  • Vasodilation techniques
58
Q

What is Retinal Detachment?

A

A retinal tear with seepage of vitreous humor between retina and choroid which causes loss of blood supply.

59
Q

What are the manifestations of Retinal Detachment?

A
  • see flashing lights.
  • see floaters
  • “veil” over eyes
60
Q

What is the treatment for Retinal Detachment?

A
  • Bedrest
  • bilateral eye patches
  • laser repair
61
Q

What is Glaucoma?

A
  • Two types : Open Angle and Closed Angle.
  • Aqueous Humor which is produced by the ciliary body is blocked and cannot exit through the Schlemm’s canal.
62
Q

What are the manifestations of Glaucoma?

A
  • Severe eye pain
  • Hard globe
  • severe headache
  • decreased peripheral vision
  • fixed, dilated pupil
  • foggy cornea
  • halos around lights
  • nausea/vomiting
63
Q

What is the treatment for Glaucoma?

A
  • Decrease IOP
  • Pilocarpine 2% q 15 minutes until constriction- causes pupillary constriction (miotic).
  • Timolol 0.5% to decrease IOP.
  • Antiemetics
  • Narcotics
  • Ophthalmology consult
  • diuretics
64
Q

What are the etiologies of a Ruptured Tympanic Membrane?

A
  • slap over the ears
  • driving injury
  • aircraft/ altitude injury
  • blast injury
  • self-instrumentation
65
Q

What are the manifestations of a Ruptured Tympanic Membrane?

A
  • Pain
  • Bleeding
  • Hearing impairment
66
Q

What is the treatment for Ruptured Tympanic Membrane?

A
  • May heal spontaneously
  • Antibiotics
  • May need surgical repair
67
Q

What is Otitis Media?

A

Middle ear infection

68
Q

What are the manifestations of Otitis Media?

A
  • Pain
  • fullness in ear
  • decreased hearing
  • N/V
  • Fever
  • Pulling at ear
69
Q

What is the treatment for Otitis Media?

A
  • Decongestants
  • Antibiotics
  • Analgesics
  • Myringotomy
70
Q

What is Otitis Externa?

A

An inflammatory reaction that causes swelling and maceration in the external ear canal. Can get cellulitis from this.

71
Q

What are the etiologies of Otitis Externa?

A
  • Swimmer’s ear
  • Cleaning canal with object
  • Chemical irritant
  • Earphones/ earmuffs/ earplugs
  • Perforated Tympanic Membrane
72
Q

What is Labyrinthitis?

A

Inner ear infection that can mimic cardio-vascular concerns.

73
Q

What are the manifestations of Labyrinthitis?

A
  • severe dizziness
  • nystagmus
  • N/V
  • Hearing loss
  • Difficulty standing/ walking
74
Q

What is the treatment for Labyrinthitis?

A
  • bed rest
  • IV hydration
  • antiemetics
  • Diazepam (IV)
  • Meclizine
75
Q

What is Meniere’s Disease?

A

A disorder of vestibular system of the inner ear that usually affects individuals aged 40’2 to 60’s.

76
Q

What are the symptoms of Meniere’s Disease?

A
  • Rotational Vertigo
  • Diaphoresis
  • Sensitivity to sound
  • Ataxia
  • Tinnitus
  • Headache
  • Feeling of spinning
  • Hearing loss
  • Blurred vision
  • N/V
  • Pressure in ear
  • Nystagmus
  • Can have vagal symptoms (abdominal pain, diaphoresis, Bradycardia, pallor)
77
Q

What is the treatment for Meniere’s Disease?

A
  • Vasodilating agents
  • Meclizine
  • Diuretics
  • Steroids
  • Anticholinergics
  • Benzodiazepines
  • Bed rest
  • Position changes slowly
  • Avoid alcohol/ caffeine
  • ENT referral
78
Q

What is Ludwig’s Angina?

A
  • board-like swelling (submandibular, sublingual, submental).
  • can be caused by the spread of existing untreated dental infection or cellulitis.
  • Need to be concerned with airway compromise.
79
Q

What is the treatment for Ludwig’s Angina?

A
  • ABC’s
  • Pain relief
  • Antibiotics
  • Elevate head of bed
  • Oxygen
  • Continuous Pulse-Oximetry
  • Monitor vital signs and mental status
  • IV fluids
80
Q

What is a Peri-Tonsillar Abscess?

A

Collection of pus that penetrates the tonsillar capsule and may invade the muscle in surrounding tissue.

81
Q

What are the manifestations of a Peri-Tonsillar Abscess?

A
  • Difficulty speaking
  • Trismus
  • Dysphagia
  • Drooling
  • Deviation of uvula
82
Q

What is the treatment for Peri-Tonsillar Abscess?

A
  • Airway management
  • Antibiotics
  • Possible I&D
83
Q

What are the 2 types of Epistaxis?

A

Anterior and Posterior

84
Q

What are the etiologies of epistaxis?

A
  • Infection
  • Trauma
  • Foreign bodies
  • Anticoagulant therapy
  • Hypertension
  • Coagulation disorders
  • Tumor
85
Q

What labs need to be performed on an Epistaxis patient?

A
  • CBC
  • Protime (if patient is on Coumadin)
86
Q

What is the treatment for Epistaxis?

A
  • Cocaine
  • Balloon/foley (for posterior bleeds)
  • Packing
  • Silver Nitrate (for anterior bleeds)
  • Nasal tampon
87
Q

What are some complications to be concerned with regarding Epistaxis?

A
  • Syncope
  • Hypoxia
  • Dislodged nasal packing
  • hypovolemia
  • Sinusitis
  • Toxic Shock
  • Cardiac Dysrhythmias
  • Respiratory/ Cardiac Arrest

CEN (6 decks)

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