Chapter 27 - Face and Neck Injuries

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-a blowout fracture. b-optic vessel compression. c-a ruptured eyeball. d-a lacerated globe.

a-a blowout fracture.

The MOST significant complication associated with facial injuries is: a-airway compromise. b-cervical spine injury. c-mandibular immobility. d-damage to the eyes.

a-airway compromise.

A 40-year-old male was in his woodworking shop when he felt a sudden, sharp pain in his left eye. Your assessment reveals a small splinter of wood embedded in his cornea. You should: a-cover both of his eyes and transport to the hospital. b-cover his right eye and flush the left eye with saline. c-scrape the splinter away with moist, sterile gauze. d-remove the object with a cotton-tipped applicator.

a-cover both of his eyes and transport to the hospital.

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.

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-laryngeal fracture. b-collapsed trachea. c-crushed cricoid. d-esophageal tear.

a-laryngeal fracture.

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: a-rapidly transporting her to the hospital. b-quickly immobilizing her spinal column. c-requesting a paramedic ambulance. d-careful monitoring her vital signs.

a-rapidly transporting her to the hospital.

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: a-fully immobilize her spine, attempt to locate the dislodged teeth, tilt the backboard to the left side, and transport. b-apply supplemental oxygen, immobilize her spine, attempt to locate the dislodged teeth, suction as needed, and transport. c-apply oxygen via a nonrebreathing mask, suction her airway as needed, disregard the dislodged teeth, and transport. d-assist ventilations with a bag-mask device, immobilize her spine, suction her oropharynx for 30 seconds, and transport.

b-apply supplemental oxygen, immobilize her spine, attempt to locate the dislodged teeth, suction as needed, and transport.

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-carefully remove the contact lenses and then irrigate his eyes with saline. c-remove the contact lenses and cover his eyes with a dry, sterile dressing. d-leave the contact lenses in place and cover both eyes with a dry dressing.

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

The eyeball itself is referred to as the: a-orbit. b-globe. c-cornea. d-sclera.

b-globe.

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-noticed the change during a meal. d-regularly sees a family physician.

b-has a history of eye surgeries.

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

b-such injuries can affect the respiratory system.

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

b-transport her to the emergency department.

A patient who is complaining of seeing flashing lights, specks, or "floaters" in his or her field of vision has MOST likely experienced: a-acute hyphema. b-a blowout fracture. c-a detached retina. d-conjunctivitis.

c-a detached retina.

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-most patients with facial trauma will need surgery. b-they must make arrangements for an ICU bed. c-a specialist may need to be called. d-it saves time on repeat assessments at the hospital.

c-a specialist may need to be called.

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-circumferentially wrap a dressing around his neck. b-apply pressure to the closest arterial pressure point. c-apply direct pressure above and below the wound. d-apply direct pressure below the lacerated vessel.

c-apply direct pressure above and below the wound.

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-administer 100% supplemental oxygen. b-stabilize the impaled glass in her eye. c-apply direct pressure to her arm wound. d-carefully remove the glass from her eye.

c-apply direct pressure to her arm wound.

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: a-a detached retina. b-a corneal abrasion. c-conjunctivitis. d-acute retinitis.

c-conjunctivitis.

The cricoid cartilage: a-is easier to see and palpate than the thyroid cartilage. b-lies superior to the thyroid cartilage in the neck. c-is the only complete circular cartilage of the trachea. d-lies superior to the cricothyroid membrane in the neck.

c-is the only complete circular cartilage of the trachea.

The conjunctiva are kept moist by fluid produced by the: a-optic chiasma. b-posterior orbit. c-lacrimal gland. d-corneal duct.

c-lacrimal gland.

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-packing the ear with sterile gauze pads. b-applying a tight pressure dressing. c-padding between the ear and the scalp. d-covering the wound with a moist dressing.

c-padding between the ear and the scalp.

A 30-year-old female was robbed and assaulted by a gang as she was leaving a nightclub. She has massive facial trauma and slow, gurgling respirations. As your partner manually stabilizes her head, you should: a-apply oxygen via a nonrebreathing mask. b-begin immediate ventilatory assistance. c-suction her oropharynx for 15 seconds. d-visualize her mouth for obvious wounds.

c-suction her oropharynx for 15 seconds.

The Adam's apple is: a-below the thyroid cartilage and forms the upper part of the trachea. b-the small indentation in between the thyroid and cricoid cartilages. c-the upper part of the larynx that is formed by the thyroid cartilage. d-the lower part of the larynx that is formed by the cricoid cartilage.

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

Abnormal variations in pupil size and reaction would MOST likely be observed in a patient with: a-contact lenses. b-conjunctivitis. c-retinitis. d-a brain injury.

d-a brain injury.

A young female experienced a laceration to her left eyeball from flying glass when her boyfriend broke a soda bottle against a wall. There is moderate bleeding and the patient states that she cannot see out of the injured eye. You should: a-carefully examine her eye and remove any foreign objects if needed. b-ask her to move the injured eye to assess the integrity of the optic nerve. c-apply firm direct pressure to the injured eye and cover the opposite eye. d-avoid applying pressure to the globe when you are covering the eye.

d-avoid applying pressure to the globe when you are covering the eye.

A 39-year-old female experienced a severe closed head injury. She is unconscious with her eyes slightly open; her pupils are bilaterally dilated and slow to react. In addition to managing problems with airway, breathing, and circulation, you should: a-irrigate her eyes with water to prevent mucosal drying. b-inspect her eyes and gently remove impaled objects. c-secure her eyes open so you can reassess her pupils. d-close her eyes and cover them with a moist dressing.

d-close her eyes and cover them with a moist dressing.

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-mix baking soda with water and irrigate his eyes with the solution. b-flush both eyes with an alcohol-based solution and transport. c-neutralize the acid chemical in his eye with an alkaline chemical. d-irrigate both eyes continuously for 20 minutes with plain water.

d-irrigate both eyes continuously for 20 minutes with plain water.

A 29-year-old male has an anterior nosebleed after he was accidentally elbowed in the nose. His is conscious and alert with adequate breathing. The MOST appropriate care for this patient includes: a-packing the nasopharynx with moist, sterile dressings. b-applying a gauze pad in between his lower lip and gum. c-placing him supine and pinching his nostrils together. d-leaning him forward and pinching his nostrils together.

d-leaning him forward and pinching his nostrils together.

Facial injuries should be identified and treated as soon as possible because: a-swelling may mask hidden injuries. b-the spine may be injured as well. c-bleeding must be controlled early. d-of the risk for airway problems.

d-of the risk for airway problems.

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 cord injury.

d-spinal cord injury.

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-reassess his breathing adequacy. c-alert the hospital of the situation. d-turn the backboard onto its side.

d-turn the backboard onto its side.