Uppers Face and Eyes Flashcards
nasal fracture
fracture to nasal bones most common fracture of the face and skull S/S -bleeding -deformity -ecchymosis -tenderness to palpation check for -deviated septum -septal hematoma
nose inspection
nose
-alignment - have athlete view in mirror if unsure
-epistaxis
-septum and mucosa
–otoscope or penlight - asymmetry or angulation
eyes and face
-raccoon eyes - periorbital ecchymosis
auricular hematoma
- what
- S/S
- Tx
- RTP
- cauliflower ear
buildup of fluid between the skin and cartilage
-commonly seen in wrestling
S/S
-observable and palpable collected fluid between the pinnae
Tx
-refer for draining
RTP
-wear headgear
cauliflower ear
-scarring that results from repetitive hematomas
ruptured tympanic membrane
- causes
- S/S
- Tx
- RTP
causes -direct trauma -direct puncture -changes in pressure - URI S/S -pain -hearing loss -tinnitus -hear the ocean (echoey) Tx -refer for drops RTP -ear protection if ear comes into contact with another surface (swimming, wrestling)
inner ear exam
pars tensa
-inferior half - transparent/translucent
mandibular fracture
- MOI
- most commonly effects
- S/S
- Tx
MOI -direct blow most commonly effects the ramus or mental protuberance (chin) S/S -swelling or deformity -malocclusion of the teeth -intraoral or extraoral ecchymosis -pain with movement - + tongue blade test Tx -refer
zygoma fracture
Russell Westbrook
maxillary fracture
can occur with a tooth fracture
LeFort fractures
midface fractures uncommon in athletics type 1: maxillary bone type 2: maxillary + nasal bones type 3: orbit and zygomatic bones common with airbags/punch
temporomandibular joint dysfunction (TMJD)
-MOI
MOI
-lateral blow
teeth malaligned
decreased jaw ROM
tooth fractures
class 1 -chip -lack of pain class 2 -when dentin is exposed class 3 -dentin and pulp are exposed class 4 -dentin and pulp are exposed -full separation of top and bottom of tooth
tooth luxations
partial displacement -rotational force intrusion -tooth compressed into alveolar process extrusion -tooth is partially withdrawn total avulsion -whole tooth comes out of place -save the tooth --Save-a-tooth -milk -in something wet (damp gauze)
oral cavity
lips
- vermilion border (between lips and skin) laceration
- -referral
- teeth
- -obvious or subtle fractures
- tongue
- lingual frenulum (membrane below tongue)
- gums
- -gingivitis - inflammation of the gums
throat injury
respiratory distress
inability to speak/change in voice
loss of consciousness (trauma to carotid sinus)
bruising around the larynx
examine inside of mouth
-bloody sputum
don’t correct deviations - refer immediately
eye history
prior visual assessment
general health
prior visual assessment
prior visual acuity corrective lenses nystagmus previous injuries preexisting conditions
general health
chronic illness -ex: diabetes - retinopathy location and description of Sx -photophobia -"something in my eye" --foreign body --displaced lens --corneal abrasion -"itchy" --conjunctivitis injury mechanism
eye inspection
trauma to external structures may mask underlying pathology
a normal external eye may still have internal damage
periorbital area
general appearance
eyelids
cornea
globe
periorbital area
discoloration -hematoma gross deformity -gross bony deformity -skin surrounding eye swells easily -lacerations
general appearance
enophthalmos
-eye is sunken back
exophthalmos
-eye protruding out - displacement of globe
eyelids
swelling ecchymosis lacerations stye -inflammation of tear duct
cornea
normally clear
-cloudiness –> intraocular pressure
hyphema
globe
conjunctiva -foreign body -subconjunctival hematoma sclera iris pupil shape and size -anisocoria -"teardrop" pupil --corneal laceration --ruptured globe
eye functional assessment
visual acuity
pupillary reaction to light
eye motility
visual acuity
devices -Snellen eye chart -near-vision card -newspaper -game program -fingers monocularly (one eye) binocularly (both eyes) wear corrective lenses at the time of assessment
pupillary reaction to light
dysfunction
- includes
- -dilation
- -diminished PEARL
- indicates
- -head trauma
eye motility
smooth, symmetrical ROM
referral of eye injuries from history
loss of all or part of the visual field persistent blurred vision diplopia photophobia throbbing or penetrating pain around or within the eye pain when blowing nose -pain with orbit fracture
referral eye injuries from inspection
foreign body protruding into the eye laceration of the eyelid margin deep laceration of the lid inability to open the eyelid because of swelling protrusion of the globe loss of corneal clarity hyphema pupillary distortion unilateral pupillary dilation or constriction
referral from palpation and function
crepitus or deformity of the orbital rim
restricted eye movement
diplopia occurring with eye movement
neurological tests
numbness or paresthesia over the lateral nose and cheek
abnormal pupillary reaction
“I feel I have something in my eye”
don't rub the eye locate the object -pull the upper eyelid out and ask the patient to look up, down, left, and right -use a pen light -evert the eyelid flush the object -flush away from the uninvolved eye
orbital fracture
- blowout
- S/S
- Tx
- RTP
blowout -direct blow to the eye S/S -may appear sunken back -bruising -can't look up --fractured floor -diplopia -pain with blowing nose Tx -refer -some will resolve on own -may need surgery RTP -as soon as 2-4 weeks -wear protective eyewear for up to 6 months
corneal abrasions
- MOI
- S/S
- Tx
MOI -scrape across the eye --rock/sand flies into eye and you move the eye around S/S -feels like something is in eye -photophobia -teary Tx -refer --will prescribe antibacterial and/or numbing drops -will self-resolve --minor: 1-2 days --more major: around a week
corneal lacerations
direct trauma to the globe -usually from sharp object S/S -irregularly shaped pupil --tear-drop --elliptical -decreased vision -potential blood in tears Tx -surgically repair -antibiotics
subconjunctival hemorrhage
- MOI
- S/S
- Tx
MOI -allergies -straining (lifting) -trauma S/S -redness Tx -no trauma - self-resolve -trauma/other Sx - refer
hyphema
- what
- MOI
- S/S
- Tx
- RTP
blood in anterior chamber of eye MOI -blunt trauma directly to the eye S/S -pain --from initial blow and intraocular pressure -blurred vision Tx -refer --upright or semi-reclined -eyepatch RTP -protective eyewear -high risk for re-bleed
detached retina
- problem
- MOI
- S/S
- Tx
disrupts nerve pulses going to eye (optic nerve) MOI -jarring force to head -sneeze S/S -visual disturbances --halos --flashes of light --curtain over field of vision Tx -refer -surgical repair
traumatic iritis
- secondary to
- S/S
- DDx
- Tx
secondary to blunt trauma S/S -photophobia -red ring around cornea DDx -corneal abrasion -hyphema -retinal detachment Tx -anti-inflammatories -refer
ruptured globe
- MOI
- what happens
- S/S
- Tx
worst possible MOI -severe blunt trauma directly to eye rupture of cornea or sclera -internal contents come out S/S -vision loss -globe displaced -swelling -hyphema Tx -shield the eye -refer
