Maxillofacial trauma

Question 1

What are the ABCs of trauma management

Answer 1

A - secure airway
B - make sure pt is breathing and ventilating well
C - ensure adequate circulation (stop bleeding and fluid replacement)

Question 2

What is most common cause of airway obstruction in a patient with an altered level of consciousness? How can you treat this?

Answer 2

Tongue falling back into the throat

Jaw lift, oral airway, long nasal airway

Question 3

what are 2 reasons why an endoracheal intubation through the mouth not work?

Answer 3

1. Pt has cervical spine injury

2. Landmarks are distorted due to trauma

Question 4

If a pt has no C-spine fracture but all you can see is blood, how can you get an airway?

Answer 4

Cricothyrotomy

Question 5

What is the procedure of choice If there is concern over a fractured larynx (widened thyroid cartilage, subcutaneous air [crepitus], neck bruising, hoarseness, coughing up blood)

Answer 5

Tracheotomy

Question 6

When do you perform a fiberoptic nasotracheal intubation? Do you wait after inspiration or expiration to pplace the endoscope?

Answer 6

if you cannot do an oral intubation. This involves a tube through the nose into the hypopharynx.
l just after an expiration, because the ideal time to push the endoscope through is when the patient breaths in, opening the vocal cords

Question 7

What is the advantage of a fiberoptic nasotracheal intubation?

Answer 7

Neck is not manipulated and you still dont know if spine fracture is possible.

Question 8

Should the patient be awake during this procedure and what’s the best position for a fiberoptic nasotracheal intubation?

Answer 8

Awake and sitting upright (tissue collapse may make the procedure harder if you are supine)

Question 9

Which is not true?
A. You cannot perform an oral intubation (if the lateral C-spine film shows a broken neck)
B. You cannot perform a nasotracheal intubation (if the patient has profuse oral bleeding
C. indication for an emergent (“bedside”) surgical airway, is in a patient who is unable to be intubated and unable to be successfully ventilated with a mask
D. a patient w/severe laryngeal trauma should get an emergent “bedside” surgical airway

Answer 9

D. mask ventilation or intubation could worsen the syndrome

Question 10

Anyone who has sustained enough trauma to break a facial bone should be assumed to have a ___ fracture until this is ruled out

Answer 10

C-spine

Question 11

What are 3 rules of maxillofacial trauma management?

Answer 11

1. ABCs
2. Rule out C spine fracture
3. evaluate the pt completely

Question 12

When does swelling for a nasal fracture typically go down? Can be reduced up to how many days?

Answer 12

5-7

14

Question 13

If the nasal septum has been broken, you must rule out what?

Answer 13

septal hematoma—the formation of a blood clot between the perichondrium and cartilage that disrupts the nourishment of the cartilage –> septal necrosis

Question 14

grasping the maxilla area just above the front teeth and applying a gentle rocking motion helps you evaluate what?

Answer 14

The stability of the maxilla

If unstable this is a LeFort fracture

Question 15

A basal skull fracture or temporal bone fracture can leak ___ into the middle ear, which drains down into the eustachian tube and out the nose.

Answer 15

CSF. This is called CSF rhinorrhea

Question 16

CSF mixed with blood produces a ring sign on the sheets or on filter paper, and also that CSF has a measurable ____ concentration, while mere nasal secretions do not.
Where is the leak?

Answer 16

Glucose.

Cribiform plate

Question 17

What protein is only in CSF?

Answer 17

Beta2 transferrin.

Positive test = CSF leak