Chapter 27 Face and Neck Injuries

The skin and underlying tissues of the face: A. have a rich blood supply and bleed heavily. B. swell minimally when exposed to blunt trauma. C. contain a relatively small number of nerve fibers. D. are well protected by the maxillae and mandible.

A. have a rich blood supply and bleed heavily.

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: A. irrigating his right eye laterally. B. flushing his eye starting laterally. C. irrigating both eyes simultaneously. D. covering both eyes and transporting.

A. irrigating his right eye laterally.

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: A. leaning him forward and pinching his nostrils together. B. packing the nasopharynx with moist, sterile dressings. C. applying a gauze pad in between his lower lip and gum. D. placing him supine and pinching his nostrils together.

A. leaning him forward and pinching his nostrils together.

Facial injuries should be identified and treated as soon as possible because: A. of the risk for airway problems. B. bleeding must be controlled early. C. the spine may be injured as well. D. swelling may mask hidden injuries.

A. of the risk for airway problems.

The Adam's apple is: A. the upper part of the larynx that is formed by the thyroid cartilage. B. the lower part of the larynx that is formed by the cricoid cartilage. C. the small indentation in between the thyroid and cricoid cartilages. D. below the thyroid cartilage and forms the upper part of the trachea.

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

What is the function of the sternocleidomastoid muscle?

Allows movement of the head

10.Which of the following mechanisms of injury would MOST likely cause a crushing injury of the larynx and/or trachea? A.Attempted suicide by hanging B.Gunshot wound to the lateral neck C.Car crash involving lateral impact D.Patient whose head hits the windshield

Answer: A Rationale: Any crushing injury of the upper part of the neck is likely to involve the larynx or trachea. Examples include the anterior neck impacting a steering wheel, hanging (distraction) mechanisms, and clothesline injuries.

Which of the following statements regarding the "Adam's apple" is FALSE? A.It is inferior to the cricoid cartilage. B.It is formed by the thyroid cartilage. C.It is the uppermost part of the larynx. It is more prominent in men than in women

Answer: A Rationale: The most obvious prominence in the center of the anterior neck is the Adam's apple. This prominence is the upper part of the larynx, formed by the thyroid cartilage. It is more prominent in men than in women. The other portion of the larynx is the cricoid cartilage, a firm ridge that is inferior to the thyroid cartilage.

When caring for a chemical burn to the eye, the EMT should: A.prevent contamination of the opposite eye. B.immediately cover the injured eye with a sterile dressing. C.avoid irrigating the eye, as this may cause further injury. D.irrigate both eyes simultaneously, even if only one eye is injured.

Answer: A Rationale: When irrigating a chemical burn to the eye, it is important to direct the stream away from the uninjured eye. If you do not, you will likely flush the chemical into the unaffected eye. After irrigating the eye for the appropriate amount of time, cover both eyes with a sterile dressing.

When caring for a patient with facial trauma, the EMT should be MOST concerned with: A.spinal trauma. B.airway compromise. C.associated eye injuries. D.severe external bleeding.

Answer: B Rationale: No airway, no patient! Injuries to the face often cause obstruction of the upper airway, either by clotted blood or associated swelling. Additionally, large amounts of blood can be swallowed, which increases the risks of vomiting and aspiration. Bleeding control, spinal trauma, and associated injuries are important factors and should be treated accordingly; however, the airway comes first.

Which of the following signs is LEAST indicative of a head injury? A.Asymmetrical pupils B.Pupillary constriction to bright light C.Both eyes moving in opposite directions D.Inability to look upward when instructed to

Answer: B Rationale: The pupils normally constrict in bright light and dilate in dim light. Suspect a head injury if the pupils do not react appropriately, are asymmetrical (unequal), do not move together, or if the patient is unable to look upward.

When a person is looking at an object up close, the pupils should: A.dilate. B.constrict. C.remain the same size. D.dilate, and then constrict.

Answer: B Rationale: The pupils, which allow light to move to the back of the eye, constrict in bright light and dilate in dim light. The pupils should also constrict when looking at an object up close and dilate when looking at an object farther away; this is called pupillary accommodation. These pupillary adjustments occur almost instantaneously.

The presence of subcutaneous emphysema following trauma to the face and throat is MOST suggestive of: A.esophageal injury. B.cervical spine fracture. C.crushing tracheal injury. D.carotid artery laceration.

Answer: C Rationale: Crushing injuries or fractures of the larynx or trachea can result in a leakage of air into the soft tissues of the neck. The presence of air in the soft tissues produces a characteristic crackling sensation called subcutaneous emphysema.

A 21-year-old male has a large laceration to his neck. When you assess him, you note that bright red blood is spurting from the left side of his neck. You should immediately: A.apply a pressure dressing to his neck. B.sit the patient up to slow the bleeding. C.place your gloved hand over the wound. apply 100% oxygen via nonrebreathing mask

Answer: C Rationale: Laceration of the carotid artery—as evidenced by bright red blood spurting from the wound—can cause profuse bleeding, profound shock, and death very quickly. You must immediately control the bleeding with the use of direct pressure. Cover the wound with your gloved hand initially and then apply a bulky pressure dressing. After the bleeding has been controlled, apply high-flow oxygen and transport promptly.

The purpose of the eustachian tube is to: A.move in response to sound waves. B.transmit impulses from the brain to the ear. C.equalize pressure in the middle ear when external pressure changes. D.house fluid within the inner chamber of the ear and support balance.

Answer: C Rationale: The middle ear is connected to the nasal cavity by the eustachian tube, which permits equalization of pressure in the middle ear when external atmospheric pressure changes.

The globe of the eye is also called the: A.lens. B.orbit. C.retina. D.eyeball.

Answer: D Rationale: The globe of the eye is also called the eyeball. The lens, which sits behind the iris, focuses images on the retina—the light-sensitive area at the back of the globe. The globe is located within a bony socket in the skull called the orbit.

The MOST significant complication associated with facial injuries is: A. damage to the eyes. B. airway compromise. C. cervical spine injury. D. mandibular immobility.

B. airway compromise.

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: A. is allergic to any medications. B. has a history of eye surgeries. C. regularly sees a family physician. D. noticed the change during a meal.

B. has a history of eye surgeries.

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: A. flush both eyes with an alcohol-based solution and transport. B. irrigate both eyes continuously for 20 minutes with plain water. C. neutralize the acid chemical in his eye with an alkaline chemical. D. mix baking soda with water and irrigate his eyes with the solution.

B. irrigate both eyes continuously for 20 minutes with plain water.

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: A. applying a tight pressure dressing. B. padding between the ear and the scalp. C. packing the ear with sterile gauze pads. D. covering the wound with a moist dressing.

B. padding between the ear and the scalp.

Frequent reassessments of the patient with face or neck injuries are MOST important because: A. they lend credibility to your documentation. B. such injuries can affect the respiratory system. C. hospital staff require frequent patient updates. D. rapid facial swelling may mask hidden injuries.

B. such injuries can affect the respiratory system.

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: A. they must make arrangements for an ICU bed. B. they may need to call a specialist to see the patient. C. it saves time on repeat assessments at the hospital. D. most patients with facial trauma will need surgery.

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

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: A. quickly suction his oropharynx. B. turn the backboard onto its side. C. reassess his breathing adequacy. D. alert the hospital of the situation.

B. turn the backboard onto its side.

If your patient swallows blood following facial trauma, there is an increased risk of ________. A. hypotension B. vomiting C. GI trauma D. altered LOC

B. vomiting

Which of the following findings would be LEAST suggestive of a head injury? A. One pupil larger in size than the other pupil B. Failure of the eyes to move in the same direction C. Briskly constricting pupils when exposed to light D. Failure of the eyes to follow movement of an object

C. Briskly constricting pupils when exposed to light

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: A. stabilize the impaled glass in her eye. B. administer 100% supplemental oxygen. C. apply direct pressure to her arm wound. D. carefully remove the glass from her eye.

C. apply direct pressure to her arm wound.

The small, rounded, fleshy bulge immediately anterior to the ear canal is called the: A. incus. B. pinna. C. tragus. D. stapes.

C. tragus.

A 4-year-old female has a peanut lodged in the external auditory canal of her right ear. You should: A. use tweezers to try to remove the object. B. remove the peanut with a cotton-tipped swab. C. transport her to the emergency department. D. thoroughly flush her ear with sterile saline.

C. transport her to the emergency department.

When caring for a patient with an open facial injury, the EMT's immediate priority should be to: A. closely assess the patient's airway. B. consider the mechanism of injury. C. wear gloves and facial protection. D. manually stabilize the patient's head.

C. wear gloves and facial protection.

Which of the following statements regarding anterior nosebleeds is correct? A. They cause blood to drain into the posterior pharynx. B. They are usually severe and require aggressive treatment to control. C. They are usually caused by a fracture of the basilar skull. D. They usually originate from the septum area and bleed slowly.

D. 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. retinitis. B. contact lenses. C. conjunctivitis. D. a brain injury.

D. a brain injury.

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: A. apply direct pressure below the lacerated vessel. B. circumferentially wrap a dressing around his neck. C. apply pressure to the closest arterial pressure point. D. apply direct pressure above and below the wound.

D. apply direct pressure above and below the wound.

The term "hyphema" is defined as: A. an acute rupture of the globe of the eye. B. inflammation of the iris, cornea, and lens. C. compression of one or both optic nerves. D. blood in the anterior chamber of the eye.

D. 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: A. leave the contact lenses in place and flush his eyes with sterile water. B. remove the contact lenses and cover his eyes with a dry, sterile dressing. C. leave the contact lenses in place and cover both eyes with a dry dressing. D. carefully remove the contact lenses and then irrigate his eyes with saline.

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

The conjunctiva are kept moist by fluid produced by the: A. corneal ducts. B. posterior orbit. C. optic chiasma. D. lacrimal glands.

D. 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): A. esophageal tear. B. crushed cricoid. C. collapsed trachea. D. laryngeal fracture.

D. laryngeal fracture.

Significant trauma to the face should increase the EMT's index of suspicion for a(n): A. airway obstruction. B. displaced mandible. C. basilar skull fracture. D. spinal column injury.

D. spinal column injury.

The maxilla and zygoma are components of the ________.

face

What is the most common type of facial fracture?

nasal

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

pupil