Chapter 33 Face and Neck Trauma
True or False: In the management of a foreign body impaled in the eye, the unaffected eye should be covered and bandaged as well.
True
True or False: Infants and toddlers are more likely to sustain face and scalp injuries than adults.
True
True or False: Open neck wounds should be sealed quickly to avoid entrained air.
True
True or False: Simple bruises and minor lacerations to the face and scalp can belie severe underlying trauma in older adult patients.
True
Because significant force is required to fracture the mandible:
it is often fractured in more than one place and is unstable to palpation
The third cranial nerve controls:
motion of the eyeballs and eyelids.
For a patient with a penetrating injury to the neck, which type of dressing should you apply?
occlusive dressing to prevent and air embolism
All of the following statements are true of cervical strains except:
Involves stretching or tearing of ligaments.
True or False: A soft cervical collar may be used to support the neck of a patient with a suspected cervical strain.
True
True or False: In the case of patient with possible facial fractures, it is critical to check eye movement in all planes.
True
What is the correct treatment for profuse bleeding of facial injuries?
apply direct pressure
When caring for a patient with fractured or avulsed teeth following an assault, you should:
assess the knuckles of the person who assaulted the patient.
Following blunt trauma to the face, a 30-year-old man presents with epistaxis, double vision, and an inability to look upward. You should suspect:
an orbital blowout fracture.
When managing the airway of an unresponsive patient with serious anterior neck trauma and shallow breathing, you should:
assist ventilations with a bag-mask device and prepare to intubate
Hyphema is defined as:
blood in the anterior chamber of the eye
Loss of function of the lower arms and hands following trauma to the anterior neck is indicative of damage to the:
brachial plexus
The ONLY indication for removing contact lenses in the prehospital setting is:
chemical eye burns
General care for an eye injury involves:
covering both eyes to minimize further injury.
You are dispatched to a high school where a 16-year-old female was stabbed in the eye with a pencil. The patient is conscious and in severe pain. A classmate removed the pencil prior to your arrival. The MOST appropriate care for this patients injury includes:
covering the affected eye with a sterile dressing and protective eye shield, covering the unaffected eye, and transporting promptly.
If a patient is unable to follow your finger above the midline following blunt trauma to the face, you should be MOST suspicious for a(n):
orbital skull fracture.
Bradycardia that occurs shortly after you have dressed and bandaged an open neck wound is MOST likely the result of:
parasympathetic nervous system stimulation due to excessive pressure on the carotid artery.
When caring for a patient with a seemingly isolated ear injury, you should:
perform a careful assessment to detect or rule out more serious injuries.
Which of the following is the MOST significant complication associated with a fractured nasal bone?
posterior epistaxis
When assessing a patient with maxillofacial trauma, it is MOST important to:
protect the cervical spine and monitor the patient's neurologic status.
Proper treatment for an open wound to the neck includes:
sealing the wound with an occlusive dressing
Alkali or strong acid burns to the eye should be irrigated continuously for at least ___ minutes.
20
What is the MOST significant complication associated with facial injuries?
airway compromise
You are providing care for an 8-year-old male patient who has a piece of plastic toy lodged in his left ear. There is some bleeding and the area appears inflamed. Based on this information, your most appropriate course of action should be to:
Cover the ear loosely with a clean dressing.
True or False: Avulsed teeth should be scrubbed thoroughly to ensure there are no bacteria present before being transported.
False
True or False: A ruptured tympanic membrane is a permanent injury that results in some level of hearing loss.
False.
You are providing care for an 18-year-old male patient involved in a motor vehicle collision. The patient has sustained soft-tissue trauma to his face but he is able to talk. In order to gain a better understanding of how the patient was injured all of the following questions are appropriate except:
How fast was the car traveling.
You are providing care for a 46-year-old female patient who sustained blunt trauma to her face during an industrial accident. On closer inspection of the right eye, you can see an accumulation of blood in the anterior chamber of the eye. Based on this information, the patient has most likely sustained a(n):
Hyphema
You are providing care to a 17-year-old male patient who sustained facial injuries as a result of a motor vehicle collision. The patient suffered a horizontal fracture separating the hard palate and inferior maxilla, separating them from the skull. Based on this information, the patient has sustained a:
Le Fort I Fracture.
If a patient had a foreign body impaled in the globe of the eye, which type of dressing would be applied?
Moist, sterile dressing and protective cup for the affected eye and bandage for the unaffected eye
What is anisocoria?
Naturally occurring uneven pupil size.
Which of the following cranial nerves innervates the muscles that cause motion of the eyeballs and upper eyelids?
Oculomotor
You are assessing a patient and note bright red blood in the anterior chamber of the eye. How should you transport this patient?
On a backboard with the head elevated 40 degrees.
You are providing care for a 38-year-old female patient who has sustained facial injuries as a result of motor vehicle collision. There is a laceration that extends from the right side of her mouth to her right cheek with significant bleeding. The patient is awake but unable to speak because of the blood. The patient has also sustained two fractured teeth. Based on this information, your most appropriate course of actions should be to:
Provide airway management as required, take spinal precautions, and rapid transport.
A 16-year-old male was struck in the face by a baseball bat during practice. He presents supine on the ground and is unresponsive with blood and broken teeth in the airway. What is your next step?
Roll the patient on the side and suction.
Which of the following anatomical structures are found in zone I of the neck?
Subclavian veins and Aortic arch
With respect to injuries to the anterior portion of the neck, the highest mortality rates are associated with injuries to the area between:
The cricoid cartilage and the clavicles and sternum.
You are assessing a patient who has suffered several facial lacerations during an automobile accident. As you examine her eyes with you penlight, you observe a circular shadow over the patient's left iris. What does this indicate?
The patient is wearing hard contact lenses.
Significant blunt injuries to the larynx or trachea pose an IMMEDIATE risk of:
airway compromise
What is subcutaneous emphysema?
a crackling sensation felt on palpation caused by the presents of air in the soft tissue.
If a knife is impaled in the neck:
a cricothyrotomy may be required to establish a patent airway
If you are unable to orotracheally intubate a patient due to massive maxillofacial trauma and severe oropharyngeal and nasopharyngeal bleeding, you would MOST likely have to perform:
a needle or surgical cricothyrotomy.
The primary risk associated with oral and dental injuries is:
airway compromise
Signs and symptoms of retinal detachment include:
flashing lights, specks, or floaters in the field of vision.
A patient with a dysconjugate gaze following an ocular injury:
has discoordination between the movements of both eyes.
The middle ear consists of the:
inner portion of the tympanic membrane and the ossicles.
A ruptured tympanic membrane:
is extremely painful but typically heals spontaneously
