MOD E Tech 32 Head & Maxillofacial injuries

Question 1

Head Anatomy

Intracranial Contents:

Answer 1

Intracranial Contents:

•

• Brain – 80%
• Blood – 12%

CSF – 8%

Question 2

Head Trauma - Types

Answer 2

Open

•Skull compromised
and brain exposed

Closed

•Skull not compromised
and brain not exposed

•Contra Coup injury

Question 3

Head Injuries – Scalp Wounds

Answer 3

Scalp wounds

• Highly vascular, bleeds briskly
• May be difficult to pinpoint the source
• Patient may suffer concussion

Question 4

Base of Skull Fracture

signs

Answer 4

Question 5

Brain Injury

Answer 5

Primary brain injury

•Immediate damage
due to force

• Coup and contracoup
• Fixed at time of injury
• Localised
• Diffuse

Management

•Directed at prevention

Question 6

Brain Injury

Secondary brain injury

Answer 6

Secondary brain injury

•Results from hypoxia, hypercarbia
or decreased perfusion

• Response to primary injury
• Develops over hours

Management

•Good prehospital care can help prevent

Question 7

Brain Injury

Response to injury

Answer 7

Response to injury

• Swelling of brain
• Vasodilatation with increased blood volume
• Increased ICP
• Decreased blood flow to brain
• Perfusion decreases
• Cerebral ischemia (hypoxia)

Question 8

Early efforts
to maintain brain perfusion
can be life-saving.

Answer 8

Question 9

Brain Injury - Contusion

Answer 9

Cerebral contusion

• Bruising of brain tissue
• Swelling may be rapid and severe
• Level of consciousness

•Prolonged unconsciousness,
profound confusion or amnesia

• Associated symptoms
• Focal neurological signs
• May have personality changes

Question 10

Brain Injuries – Vascular Damage

Answer 10

Intracranial haemorrhage

• Epidural / Extradural
• Between skull and dura
• Subdural
• Between dura and arachnoid
• Intracerebral
• Directly into brain tissue

Question 11

Intracranial Haemorrhage

Answer 11

Question 12

Intracranial Haemorrhage

Acute epidural haematoma

Answer 12

Question 13

Intracranial Haemorrhage

Acute subdural haematoma

Answer 13

Question 14

Consequences & Complications of Head Injuries

Answer 14

Question 15

Consequences & Complications of Head Injuries

Answer 15

Compression

• Extradural and sudural haematomas can cause a sudden or gradual increase in ICP
• Large pressure changes can result in shifting of the brain and “coning” of the brain stem
• A deterioration in level of consciousness is an important indicator of an increasing ICP
• Deterioration in LOC
• Noisy, slow breathing (Cheyne-Stokes in terminal stages)
• Slow, full pulse
• Raised temperature
• Hot, flushed face
• Unequal pupils – dilated and fixed on side of injury
• Unilateral facial or body weakness / paralysis
• Intense headache
• Convulsions

Question 16

Question 17

Assessment

Answer 17

Question 18

Pupil Reaction

Answer 18

Question 19

Answer 19

Question 20

Question 21

Maxillofacial Injuries

Answer 21

• Maxillofacial injuries are often associated with head and neck injury
• Therefore they present a unique range of problems in terms of patient positioning and airway management

Question 22

Maxillo Facial Injuries

Special Problems

Answer 22

• Facial distortion, bruising & swelling may mask a fracture
• CSF leakage
• Damage to teeth
• Loss of cough reflex
• Sense of taste & smell affected
• Double vision
• Inability to close jaw

Question 23

Airway & Breathing issues to think about

Answer 23

• What may obstruct the airway?
• Consider use of “unusual” airway maintenance, especially in facial fractures
• Masks may not fit properly
• Because the face is very vascular, profuse bleeding may be present, necessitating constant suction

Question 24

CSF Leakage

Answer 24

• CSF may be identified as a pale/colourless liquid leaking (normally) from the nose or ears
• Where is CSF normally contained?
• What does CSF leakage imply?
• What are the consequences of this for the patient?

Question 25

Management Maxillo Facial Injuries

Answer 25

* Ensure open airway – may require suction * Consider cervical spine damage * Postural drainage * Control bleeding * Take broken dentures / avulsed teeth to hospital * Encourage patient not to speak

Question 26

Eye Injuries Eye Injuries - Types

Answer 26

Question 27

Question 28

Eye Injuries - Management Chemical contamination:

Answer 28

Chemical contamination: * Flush the eye with copious amounts of water * If safe to do so – retain a sample of the chemical for the hospital * Reduce eye movement – cover both eyes * Do not apply direct pressure to the eye itself * Consider removal to specialist department

Question 29

Eye Injuries - Management Embedded Objects or Injuries

Answer 29

Embedded Objects or Injuries * Do not remove embedded foreign bodies * Cover both eyes * Do not apply direct pressure to the eye itself * Consider removal to a specialist department * Reassurance * Constant communication * Be aware of displaced contact lenses * Avoid unnecessarily tampering with eye injuries * Reassurance * Constant communication * Be aware of displaced contact lenses * Avoid unnecessarily tampering with eye injuries