Maxillofacial Trauma 1

Question 1

How can you control the airway?

Answer 1

Chin lift BUT not with head tilt Jaw thrust. Oropharyngeal suctioning. Manually move the tongue forward. Maintain cervical immobilization BUT not at the cost of the airway

Question 2

What are some considerations you should take into account when intubating?

Answer 2

•Avoid nasotracheal intubation:
–Nasocranial intubation
–Nasal hemorrhage
•Avoid Rapid Sequence Intubation:
–Failure to intubate or ventilate.
•Consider an awake intubation.
•Sedate with benzodiazepines.

• Consider fibre-optic intubation if available.
• Alternatives include percutaneous transtracheal ventilation and retrograde intubation.
• Be prepared for cricothyroidotomy.

Question 3

For a cricothyroidotomy what is the surgical anatomy you should be aware of?

Answer 3

Question 4

What are the different forms of breathing difficulties?

Answer 4

ATOMFC

–Airway Obstruction
–Tension Pneumothorax
–Open Pneumothorax
–Massive Haemothorax
–Flail Chest
–Cardiac Tamponade

Question 5

What is this breathing difficulty and how would you manage it?

Answer 5

Airway obstruction:

•Intubation/surgical airway

Question 6

What is this breathing difficulty and how would you manage it?

Answer 6

Tension pneumothorax:

•Needle thoracocentesis

Question 7

What is this breathing difficulty and how would you manage it?

Answer 7

Open pneumothorax:

•3 sided dressing/chest tube

Question 8

What is this breathing difficulty and how would you manage it?

Answer 8

Massive haemothorax:

•IV fluids/chest drain

Question 9

What is this breathing difficulty and how would you manage it?

Answer 9

•Flail chest

Question 10

What is this breathing difficulty and how would you manage it?

Answer 10

Cardiac tamponade: pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium).

The fluid around the heart must be drained as quickly as possible. Pericardiocentesis is a procedure that uses a needle to remove fluid from the tissue that surrounds the heart (pericardial sac).

Question 11

Where does the blood go following major trauma?

Answer 11

• abdomen
• pelvis
• femur
• chest cavity
• floor

Question 12

What is the management of acute blood loss?

Answer 12

Volume replace and ‘turn the tap off’

Acute blood loss is:
•Leading cause of disability amongst young adult males
•Costly in terms of both patients and health care
•Wide variety of presentations including altered behaviour, poor attention span, reduced concentration, headache

Question 13

What’s the management of acute injuries?

Answer 13

• Oxygen
• Assess GCS
• Pupillary responsiveness
• Posture
• Glucose
• GOOD MANAGEMENT OF HEAD INJURIES ACUTELY REDUCES LONG TERM PROBLEMS

•STICK WITH ABCDE APPROACH
•REMEMBER:
–CERVICAL SPINE
–OXYGEN
–GLUCOSE