Chapter 27 Face and Neck Injuries

eustachian tube

A branch of the internal auditory canal that connects the middle ear to the oropharynx.

subcutaneous emphysema

A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissues.

optic nerve

A cranial nerve that transmits visual information to the brain.

What is a hematoma?

A hematoma is a collection of blood within the tissues.

Unequal pupils most likely indicate what type of injury?

Brain

Which of the following findings would be LEAST suggestive of a head injury?

Briskly constricting pupils when exposed to light

What is the most common type of facial fracture?

Nasal

anisocoria

Naturally occurring uneven pupil size.

Which area of the body are you palpating if you feel subcutaneous emphysema?

Neck

pupil

The circular opening in the middle of the iris that admits light to the back of the eye.

The head is divided into two parts

The cranium The face

conjunctiva

The delicate membrane that lines the eyelids and covers the exposed surface of the eye.

external auditory canal

The ear canal; leads to the tympanic membrane.

tympanic membrane

The eardrum; a thin, semitransparent membrane in the middle ear that transmits sound vibrations to the internal ear by means of auditory ossicles.

lacrimal glands

The glands that produce fluids to keep the eye moist; also called tear glands.

retina

The light-sensitive area of the eye where images are projected; a layer of cells at the back of the eye that changes the light image into electric impulses, which are carried by the optic nerve to the brain.

sternocleidomastoid muscles

The muscles on either side of the neck that allow movement of the head.

air embolism

The presence of air bubbles in the veins, which can lead to cardiac arrest if they enter the heart.

mastoid process

The prominent bony mass at the base of the skull about 1 inch posterior to the external opening of the ear.

tragus

The small, rounded, fleshy bulge that lies immediately anterior to the ear canal.

Following blunt trauma to the face, a 21-year-old male complains of a severe headache and decreased ability to move his eyes. This patient's clinical presentation is MOST consistent with:

a blowout fracture.

Which of the following is or are found in the middle ear?

anvil, hammer, and stirrup

A young female was involved in a motor vehicle crash. She complains of pain to her left eye, which appears to have a piece of glass impaled in it. Further assessment reveals a large laceration to her left forearm with active venous bleeding. As your partner manually stabilizes the patient's head, you should:

apply direct pressure to her arm wound.

Which of the following fractures is associated with bruising around the ears and blood coming from the nose?

basilar skull fracture,

You are assessing a patient who was hit in the face by a baseball bat. There are multiple contusions on his face, and he reports double vision. His left eye does not track with his right eye. What should you suspect?

blow-out fracture

What is an air embolism?

clinical situation in which a vein is punctured and air is sucked into the heart.

A 30-year-old female presents with redness, inflammation, and pain to her left eye. During your assessment, you note that she is having difficulty keeping her eyes open. You should suspect that she is experiencing:

conjunctivitis

Bleeding from soft-tissue injuries to the face is MOST effectively controlled with:

direct pressure using dry, sterile dressings.

The maxilla and zygoma are components of the ________.

face

A 52-year-old unrestrained female struck the steering wheel with her face when her truck collided with another vehicle. She has obvious swelling to her face and several dislodged teeth. A visual exam of her mouth reveals minimal bleeding. She is conscious and alert with a blood pressure of 130/80 mm Hg, a pulse of 110 beats/min, and respirations of 22 breaths/min with adequate tidal volume. You should:

fully immobilize her spine, attempt to locate the dislodged teeth, suction as needed, and transport.

You are assessing a 59-year-old male and note that his pupils are unequal. He is conscious and alert. When obtaining his medical history, it is MOST pertinent to ask him if he:

has a history of eye surgeries.

The skin and underlying tissues of the face:

have a rich blood supply and bleed profusely.

Controlling bleeding from a neck injury

if necessary, apply direct pressure to the bleeding site using a gloved fingertip to control bleeding Apply a sterile occlusive dressing to ensure that air does not enter a vein or artery

A factory worker was splashed in the eyes with a strong acid chemical. He complains of intense pain and blurred vision. Your ambulance does not carry bottles of sterile saline or water. You should:

irrigate both eyes continuously for 20 minutes with plain water.

A 22-year-old male was walking on the beach and had sand blown into his eyes. He complains of pain and decreased vision to his right eye. Treatment should include:

irrigating his right eye laterally.

Which of the following is true about posterior epistaxis?

is more serious than anterior epistaxis and often causes blood to drain into the patient's throat, causing nausea and vomiting.

When a light is shone into the pupil:

it should become smaller in size.

The superficial temporal artery can be palpated:

just anterior to the tragus.

The conjunctiva are kept moist by fluid produced by the:

lacrimal glands.

Following direct trauma to the upper part of the anterior neck, a young male presents with labored breathing, loss of voice, and subcutaneous emphysema in the soft tissues around his neck. You should suspect a(n):

laryngeal fracture.

A 29-year-old male has an anterior nosebleed after he was accidentally elbowed in the nose. He is conscious and alert with adequate breathing. The MOST appropriate care for this patient includes:

leaning him forward and pinching his nostrils together.

The upper jawbones are called the:

maxillae.

Facial injuries should be identified and treated as soon as possible because:

of the risk for airway problems.

A 44-year-old male sustained a laceration to his left ear during a minor car accident. Your assessment reveals minimal bleeding. Appropriate care for this injury includes:

padding between the ear and the scalp.

The opening in the center of the iris, which allows light to move to the back of the eye, is called the:

pupil.

A 6-year-old female was riding her bicycle and struck a clothesline with her throat. She is breathing, but with obvious difficulty. Your assessment reveals a crackling sensation in the soft tissues of her neck and facial cyanosis. In addition to the appropriate airway management, the intervention that will MOST likely improve her chance of survival is:

rapidly transporting her to the hospital.

Significant trauma to the face should increase the EMT's index of suspicion for a(n):

spinal column injury.

Motion of the mandible occurs at the __________, which lies just in front of the ear on either side of the face.

temporomandibular joint

The Adam's apple is:

the upper part of the larynx that is formed by the thyroid cartilage.

When transporting a patient with a facial injury, it is MOST important to be as descriptive as possible with the hospital regarding the patient's injuries because:

they may need to call a specialist to see the patient.

A 4-year-old female has a peanut lodged in the external auditory canal of her right ear. You should:

transport her to the emergency department.

You are transporting an immobilized patient with severe facial trauma. As you are preparing to give your radio report to the hospital, the patient begins vomiting large amounts of blood. You should:

turn the backboard onto its side.

If your patient swallows blood following facial trauma, there is an increased risk of ________.

vomiting

When caring for a patient with an open facial injury, the EMT's immediate priority should be to:

wear gloves and facial protection.

What is the function of the sternocleidomastoid muscle?

Allows movement of the head

When performing a full body scan, you should assess for ________.

DCAP-BTLS

conjunctivitis

Inflammation of the conjunctiva.

Which of the following statements regarding the vitreous humor is correct?

It is a clear, jellylike fluid near the back of the eye that cannot be replaced if it is lost.

turbinates

Layers of bone within the nasal cavity.

retinal detachment

Separation of the retina from its attachments at the back of the eye.

The ________ is a prominent bony mass at the base of the skull 1 inch posterior to the external opening of the ear.

The mastoid process

iris

The muscle and surrounding tissue behind the cornea that dilate and constrict the pupil, regulating the amount of light that enters the eye; pigment in this tissue gives the eye its color.

sclera

The tough, fibrous, white portion of the eye that protects the more delicate inner structures.

lens

The transparent part of the eye through which images are focused on the retina.

cornea

The transparent tissue layer in front of the pupil and iris of the eye.

Which of the following statements regarding anterior nosebleeds is correct?

They usually originate from the septum area and bleed slowly.

Abnormal variations in pupil size and reaction would MOST likely be observed in a patient with:

a brain injury.

The MOST significant complication associated with facial injuries is:

airway compromise.

You are dispatched to a convenience store where the clerk sustained a laceration to the side of his neck during a robbery attempt. During your assessment, you note bright red blood spurting from the laceration. You should:

apply direct pressure above and below the wound.

What is hyphema?

bleeding into the anterior chamber of the eye

The term "hyphema" is defined as:

blood in the anterior chamber of the eye.

A 50-year-old male was splashed in the eyes with radiator fluid when he was working on his car. During your assessment, he tells you that he wears soft contact lenses. You should:

carefully remove the contact lenses and then irrigate his eyes with saline.

You are treating a patient with significant bruising to her face and a broken nose. She is conscious, but her LOC is significantly altered and her breathing is labored. What should you do to manage this patient's airway?

insert an oropharyngeal airway.

The pinna

is the external, visible part of the ear

Frequent reassessments of the patient with face or neck injuries are MOST important because:

such injuries can affect the respiratory system.

The small, rounded, fleshy bulge immediately anterior to the ear canal is called the:

tragus.

In which instance would you consider removing an impaled object?

when the object is impaled in the cheek and compromises the airway.