Chapter 27 Face and Neck Injuries

Naturally occurring uneven pupil size

anisocoria

The ear canal is known as the external

auditory canal

Trauma to the face and skull that results in the posterior wall of the nasal cavity becoming unstable is caused by

basilar skull fracture

A fracture of the orbit or of the bones that support the floor of the orbit

blow-out fracture

Blunt trauma that causes fractures to the orbit are commonly called a

blowout fracture

Asymmetrical eyes could possibly indicate a

brain injury

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

lacrimal glands

You respond to a child who has placed a pebble in his ear. He is complaining that his ear hurts. You should

leave the pebble in the ear and transport

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

lens

The trachea connects the oropharynx and the larynx with the main air passages of the

lungs

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

mastoid process

The Adam's apple is more prominent in

men than in women

The tympanic membrane is the eardrum, which lies between the external and

middle ear

The lacrimal glands produce fluids to keep the eye

moist

The nasal cavity is divided into two chambers by the

nasal septum

The cervical vertebrae are in the

neck

Oxygen and airway management are important for all patients with face and

neck injuries

A cranial nerve that transmits visual information to the brain

optic nerve

Standard precautions for assessing face and throat injuries should include eye and

oral protection

The eustachian tube is a branch of the internal auditory canal that connects the meddle ear to the

oropharynx

The external visible part of the ear

pinna

The external, visible part of the ear

pinna

You are dispatched to a 37 year old man with a large laceration to the right side of his neck. Bleeding is dark and heavy. He is alert but weak. How would you best manage this patient?

Apply direct pressure to the bleeding site using gloved fingertips and a sterile occlusive dressing. Secure the dressing in place and apply pressure, if necessary. You may need to treat for shock. Provide prompt transport with the patient immobilized to a long backboard and apply high flow oxygen en route.

Describe bleeding control methods for facial injuries

Apply direct pressure with a dry dressing. Use roller gauze around the circumference of the head to hold the pressure dressing in place. Make sure you do not apply excessive pressure if there is a possibility of an underlying skull fracture

Injuries to the face can often lead to

airway problems

Describe bleeding control methods for lacerations to veins or arteries in the neck

1. Apply direct pressure to the bleeding site using a gloved fingertip if necessary to control bleeding 2. Apply a sterile occlusive dressing to ensure that air does not enter a vein or artery 3. Secure the dressing in place with roller gauze, adding more dressings if needed 4. Wrap the gauze around and under the patient's shoulder. To avoid possible airway and circulation problems, do not wrap the gauze around the neck.

List three important guidelines to use when treating an eye laceration

1. Never exert pressure on or manipulate the injured eye or globe in any way 2. If part of the eyeball is exposed, gently apply a moist, sterile dressing to prevent drying 3. Cover the injured eye with a protective metal eye shield, cup, or sterile dressing. Apply soft dressings to both eyes, and provide prompt transport to the hospital

List 5 eye indications that suggest a closed head injury

1. One pupil larger than the other 2. The eyes not moving together or pointing in different directions 3. Failure of the eyes to follow the movement of your finger as instructed 4. Bleeding under the conjunctiva, which obscures the sclera of the eye 5. Protrusion or bulging of one eye

Name 3 treatment of bleeding from a neck injury

1. apply pressure of the bleeding site using a gloved fingertip 2. apply a sterile occlusive dressing 3. use gauze to secure the dressing in place

List 3 signs of a possible facial fracture

1. bleeding in the mouth 2. absent or loose teeth 3. loose and or moveable bone fragments

You respond to a 68 year old man who was involved in a motor vehicle collision. He is unresponsive, and as you approach you notice he is not breathing. He was unrestrained and has massive facial injuries. When you check his airway, it is obstructed. List 3 things that could cause an upper airway obstruction in a patient with facial trauma.

1. heavy bleeding 2. loosened teeth or dentures 3. soft tissue swelling

List 3 signs or symptoms of a laryngeal injury

1. hoarseness 2. difficulty breathing 3. subcutaneous emphysema

List 3 objectives you have as an E.M.T. when treating patients with face and neck injuries

1. prevent further injury 2. manage any acute airway problems 3. control bleeding

When a patient has a chemical burn to the eye, you should irrigate the eye for at least 5 minutes, however, if the burn was caused by an alkali or strong acid, you should irrigate for

20 minutes

Care for facial injuries begins with standard precautions and

ABC's

Mastoid process

Bony mass at the base of the skull about 1 inch or 2.54 cm behind the opening to the ear

You respond to a 71 year old woman who is unresponsive. You try to het her to respond but have no success. Her airway is open, and she is breathing at a rate of 14 breaths per minute. You know you can check a pulse on either side of the neck. you know that the jugular veins and several nerves run through the neck next to the trachea. What structure are you trying to locate to take a pulse?

Carotid arteries

Pupil

Circular opening in the middle of the iris that admits light to the back of the eye

Eustachian tube

Connects the middle ear to the oropharynx

Optic nerve

Cranial nerve that transmits visual information to the brain

You are dispatched to assist a small child who was attacked by his family's dog. The dog bit the child's face and neck repeatedly, then grabbed him by the neck and shook him violently. The mother found the boy making funny breathing sounds and called for help. She has removed the dog from the area. How would you best manage this patient?

Depending on where the dog's teeth have punctured the skin, you may have a variety of soft tissue injuries and swelling. If you notice the presence of subcutaneous emphysema, the dog punctured or perforated the child's trachea. You must also assume the presence of cervical spine injuries and take appropriate precautions. Assess his level of consciousness, airway, breathing, and circulation. control any bleeding and apply other dressings, as needed, after airway management is accomplished and while en route to the hospital. Always follow local protocols.

Tympanic membrane

Eardrum

Pinna

External visible part of the ear

Globe

Eyeball

Turbinates

Layers of bone within the nasal cavity

Retina

Light sensitive area of the eye where images are projected

Iris

Muscle and surrounding tissue behind the cornea that dilate and constrict the pupil

Anisocoria

Naturally occurring unequal pupils

You are called to the home of a 48 year old woman who has a history of high blood pressure and now has a major nose bleed. She is alert and oriented and converses freely with you. Her respirations and pulse are within normal limits. Her blood pressure is 194/108 mm Hg. You have been able to rule out trauma. How would you manage the nose bleed>

Pinch the nostrils together

Tragus

Small, rounded, fleshy bulge that lies immediately anterior to the ear canal

Explain the physical exam process for evaluation of the eye

Start

Sclera

Tough, fibrous, white portion of the eye

Lens

Transparent part of the eye through which images are focused on the retina

Cornea

Transparent tissue layer in front of the pupil and iris

You are despatched to a residential neighborhood for a 6 year old girl who was bitten by the family pet. The mother meets you at the door with the girl, who is crying uncontrollably and has blood covering the right side of her head. You look at the child and notice that her lower right ear has been completely avulsed. You control the bleeding with direct pressure and bandage the injury. You follow the blood trail back to where the incident occurred and find the avulsed part. How do you manage the avulsed tissue?

Wrap the skin in a moist, sterile dressing, place it in a plastic bag, and keep it cool.

You are dispatched to a Little League baseball game to assist an assault victim. Apparently, emotions were running high when two parents began to argue. You arrive to find a 40 year old man with a bloody nose. How would you best manage this patient?

You should determine what objects were used to cause injury to this man's face. Baseball bats would be readily available and would increase your index os suspicion. You should determine the presence of head and neck pain. If the area of injury is limited to his nose, and the need for spinal precautions is not indicated, you can instruct the patient in controlling his bleeding by ensuring that he pushes on the cartilage of his nose and does not lean his head backward. Swallowing blood will cause nausea. Do not allow the patient to blow his nose, and consider using ice, as needed, to reduce swelling and pain.. Transport according to local protocols.

The presence of air in the veins, which can lead to cardiac arrest if it enters the heart

air embolism

Pulsations in the neck are felt in the

carotid vessels

Approximately one third of the nose is composed of bone. The remainder is composed of

cartilage

The rings of the trachea are made of

cartilage

What is the main purpose of eye blinking?

clean the eye

Soft tissue injuries to the face are

common

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

conjunctiva

Inflammation of the conjunctiva

conjunctivitis

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

cornea

When stabilizing a large foreign object in the eye, you should first cover the eye with a moist dressing, then surround the object with a

doughnut shaped collar made from gauze

The mastoid process is the prominent bony mass at the base of the skull about 1 inch posterior to the external opening of the

ear

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

eustachian tube

The middle ear is connected to the nasal cavity by the

eustachian tube

For the patient described id the above question, how often would you reassess is vitals during your ongoing assessment?

every 5 minutes

The ear canal; leads to the tympanic membrane

external auditory canal

You should never exert pressure on or manipulate an injured

eye in any way

When flushing as eye with saline to remove a foreign object, it is important to remember to flush from the nose side of the

eye toward the outside

The head is divided into two parts, the cranium and the

face

Stabilization and maintenance of an airway can be difficult in patients with

facial injuries

The brain connects to the spinal cord through a large opening at the vase of the skull known as the

foramen magnum

The eyeball

globe

The temporal regions of the cranium are located on the lateral portion of the

head

An air embolism results when an open vein sucks sir into it and travels to the

heart

You have a patient who has had a tooth knocked out. You find the tooth. How would you transport it to the hospital?

in saline

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

iris

The muscle and surrounding tissue behind the cornea that dilates and constricts the pupil, regulating the amount of light that enters the eye

iris

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

pupil

The light sensitive area of the eye where images are projected

retina

When dealing with an avulsed tooth, handle it by its crown and not by the

root

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

sclera

You have a patient who has severe epistaxis. You have been able to rule out trauma. How would you position this patient to help control the bleeding

sitting leaning forward

The foramen magnum is a large opening at the base of the

skull

Open injuries to the larynx can occur as the result of a

stabbing

A characteristic crackling sensation felt on palpation of the skin is known as

subcutaneous emphysema

The presence of air in the soft tissues of the neck that produces a crackling sensation is called

subcutaneous emphysema

You have responded to a motor vehicle collision and find a 21 year old man who has massive facial trauma. He is bleeding heavily and is unconscious. The first thing that you do in ;your treatment of this patient is to

take standard precautions

Motion of the mandible occurs at the

temporomandibular joint

The cricothyroid membrane connects the cricoid cartilage and

thyroid cartilage

Any crushing injury of the upper part of the neck likely involves the larynx or the

trachea

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

tragus