Chapter 28 Face and Neck Injuries:
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
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
During the physical examination of a patient who has soft-tissue injuries to the face and neck, you should use both your eyes and hands. What are your hands looking for? A. Tenderness B. Discolorations C. Contusions D. Swelling
A
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
How many major bones comprise the face? A. 6 B. 10 C. 5 D. 4
A
Notify the receiving facility about any avulsed tooth because reimplantation is recommended within ___ minutes to 1 hour. A. 20 B. 10 C. 5 D. 30
A
The maxilla and zygoma are components of the ________. A. face B. skull C. spine D. extremities
A
The opening in the center of the iris, which allows light to move to the back of the eye, is called the: A. pupil. B. sclera. C. cornea. D. conjunctiva.
A
The skin and underlying tissues of the face: A. have a rich blood supply and bleed profusely B. swell minimally when exposed to blunt trauma. C. are well protected by the maxillae and mandible. D. contain a relatively small number of nerve fibers.
A
The term "hyphema" is defined as: A. blood in the anterior chamber of the eye. B. an acute rupture of the globe of the eye. C. inflammation of the iris, cornea, and lens. D. compression of one or both optic nerves.
A
When assessing a patient with facial trauma, you should be MOST concerned with A. threats to airway, breathing, or circulation B. spinal trauma C. Associated eye injuries D. severe external bleeding
A
When treating a chemical burn of the eye, it is important to flush: A. from the inner corner of the affected eye toward the outer corner B. from the outer corner of the affected eye toward the inner corner C. in a circular motion to encourage movement of chemical out of the eye D. both eyes simultaneously
A
Which muscles originate from the mastoid process of the cranium and insert into the medial border of each collarbone and the sternum at the base of the neck? A. sternocleidomastoid B. Lateral rectus C. Hypoglossus D. Scalenus medius
A
which of the following is the most posterior portion of the cranium? A. Occiput B. Temple C. Foramen magnum D. Maxillae
A
Which of the following is true about posterior epistaxis? A. More severe than anterior epistaxis B. Originates from the area of the septum C. Bleeds slowly D. Causes nausea and vomiting
A and D
What is an air embolism? A crackling sensation felt when palpating the neck resulting from air in the soft tissues A clinical situation in which a vein is punctured, and air is sucked into the heart A swelling or enlargement of the wall of a blood vessel that results from weakening of the vessel wall A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow
A clinical situation in which a vein is punctured, and air is sucked into the heart
What is a hematoma? A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissue A flap of skin that is separated from the underlying muscle and fascia A collection of blood within the tissues A rupture of the eye
A collection of blood within the tissues
Which of the following is true about posterior epistaxis? (2) A. More severe than anterior epistaxis B. Originates from the area of the septum C. Bleeds slowly D. Causes nausea and vomiting
A. More severe than anterior epistaxis D. Causes nausea and vomiting
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. a ruptured eyeball. C. optic vessel compression. D. a lacerated globe.
A. a blowout fracture.
Abnormal variations in pupil size and reaction would MOST likely be observed in a patient with: a A. a brain injury. B. contact lenses. C. conjunctivitis. D. retinitis.
A. 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. avoid applying pressure to the globe when you are covering the eye. B. carefully examine her eye and remove any foreign objects if needed. C. apply firm direct pressure to the injured eye and cover the opposite eye. D. ask her to move the injured eye to assess the integrity of the optic nerve.
A. avoid applying pressure to the globe when you are covering the eye.
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. has a history of eye surgeries. B. noticed the change during a meal. C. is allergic to any medications. D. regularly sees a family physician.
A. has a history of eye surgeries.
The superficial temporal artery can be palpated: A. just anterior to the tragus. B. over the mastoid process. C. slightly above the ear. D. at the angle of the jaw.
A. just anterior to the tragus.
The conjunctiva are kept moist by fluid produced by the: A. lacrimal gland. B. optic chiasma. C. posterior orbit. D. corneal duct.
A. lacrimal gland.
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. placing him supine and pinching his nostrils together. D. applying a gauze pad in between his lower lip and gum.
A. leaning him forward and pinching his nostrils together.
Which of the following are found in the middle ear? Pinna Tympanic membrane Eustachian tube Anvil, hammer, and stirrup
Anvil, hammer, and stirrup
Which of the following mechanisms of injury would MOST likely cause a crushing injury of the larynx and/or trachea? Attempted suicide by hanging Gunshot wound to the lateral neck Car crash involving lateral impact Patient whose head hits the windshield
Attempted suicide by hanging
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
Any time there is a suspected injury to the larynx, you should suspect possible A. hemorrhaging B. cervical spine injury C. all are correct D. tracheal rupture
B
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
How does the eyeball keep its global shape? A. From the shape of its bony orbit B. from the pressure of the fluid contained within its two chambers C. From the support of the superior oblique and inferior oblique D. all of these are correct
B
In which instance would you consider removing an impaled object? A. When the object is impaled in the eye and threatens vision B. When the object is impaled in the cheek and compromises the airway C. When the object is impaled in the ear and creates basilar trauma D. When the object is impaled in the neck into or near the carotid artery
B
Injuries about the face and neck can often lead to A. inflammation of the bronchi B. partial or complete obstruction of the upper airway C. tracheal or bronchial obstruction D. pneumothorax
B
Signs of a mandibular fracture include all the following, EXCEPT A. inability to open mouth B. bruising over the mastoid bone C. numbness of the chin D. loose or dislodged teeth
B
The clarity of the patient's vision in each eye is called A. visual acuteness B. visual acuity C. visual insight D. visual awareness
B
Unequal pupils most likely indicate what type of injury? A. Skull B. Brain C. Chest D. Spine
B
What is an air embolism? A. A crackling sensation felt when palpating the neck resulting from air in the soft tissues B. A clinical situation in which a vein is punctured and air is sucked into the heart C. A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow D. A swelling or enlargement of the wall of a blood vessel that results from weakening of the vessel wall
B
Which of the following fractures is associated with bruising around the ears and blood coming from the nose? A. Mandibular fracture B. Basilar skull fracture C. Orbit fracture D. Maxilla fracture
B
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
You are treating a patient with a facial injury that has displaced the eyeball from the socket. Which of the following actions are appropriate to take? A. Apply a pressure dressing and use roller gauze wrapped around the circumference of the head. B. Cover both eyes to decrease sympathetic eye movement. C. Carefully reposition it back in place. D. Cover the eye with a moist, sterile dressing.
B and D
Which of the following statements regarding anterior nosebleeds is correct? A. They are usually caused by a fracture of the basilar skull. B. They usually originate from the septum area and bleed slowly. C. They are usually severe and require aggressive treatment to control. D. They cause blood to drain into the posterior pharynx.
B. They usually originate from the septum area and bleed slowly.
The inner surface of the eyelids and the exposed surface of the eye itself are covered by a delicate membrane called the: A. retina. B. conjunctiva. C. sclera. D. cornea.
B. conjunctiva.
Bleeding from soft-tissue injuries to the face is MOST effectively controlled with: A. ice packs and elevation of the patient's head. B. direct pressure using dry, sterile dressings. C. digital pressure to an adjacent pulse point. D. pressure dressings and chemical ice packs.
B. direct pressure using dry, sterile dressings.
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. collapsed trachea. B. laryngeal fracture. C. esophageal tear. D. crushed cricoid.
B. laryngeal fracture.
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: b A. rapid facial swelling may mask hidden injuries. B. such injuries can affect the respiratory system. C. they lend credibility to your documentation. D. hospital staff require frequent patient updates.
B. such injuries can affect the respiratory system.
Which of the following fractures is associated with bruising around the ears and blood coming from the nose? Basilar skull fracture Orbit fracture Mandibular fracture Maxilla fracture
Basilar skull fracture
What is hyphema? Nosebleed Bleeding into the anterior chamber of the eye When air is sucked into the heart Pain or difficult swallowing
Bleeding into the anterior chamber of the eye
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 Corneal burn Retinal detachment Foreign object entrapment
Blow-out fracture
Unequal pupils most likely indicate what type of injury? Brain Skull Chest Spine
Brain
Which of the following findings would be LEAST suggestive of a head injury?
Briskly constricting pupils when exposed to light
A 21 year-old male has a large laceration to his neck. When you assess him, you note that the bright red blood is spurting from the left side of his neck. You should immediately A. apply 100% oxygen via a nonrebreathing mask B. apply a pressure dressing to his neck C. place your gloved hand over the wound D. sit the patient up to slow the bleeding
C
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
Normally, the pupils in both eyes are equal in size. What is the word for pupils that are not equal in size? A. Conjunctivitis B. Exotropia C. Anisocoria D. Turbinates
C
The small, rounded, fleshy bulge immediately anterior to the ear canal is called the: A. incus. B. pinna. C. tragus. D. stapes.
C
What is a hematoma? A. A flap of skin that is separated from the underlying muscle and fascia B. A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissue C. A collection of blood within the tissues D. A rupture of the eye
C
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
Which of the following is or are found in the middle ear? A. Eustachian tube B. Pinna C. Anvil, hammer, and stirrup D. Tympanic membrane
C
Which of the following would you NOT do when treating a patient with a piece of avulsed skin? A. wrap the skin in sterile dressing B. If still attached, place it back in normal position if possible C. place the tissue directly on ice to keep the cells from necrotizing D. place skin in a plastic bag, label it, and bring to ED
C
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? A. Apply high-flow oxygen via a non-rebreathing mask. B. Insert a nasopharyngeal airway. C. Insert an oropharyngeal airway. D. Give oxygen via a nasal cannula at 4 L/min.
C
the ______ is a prominent bony mass at the base of the skull 1 inch posterior to the external opening of the ear A. Sclera B. Sternocleidomastoid muscle C. Mastoid process D. Temporomandibular joint
C
What should you do for a patient that reports pain, double vision, or decreased vision following a blunt injury about the eye? A. cover lids with moist gauze or hold them closed with clear tape and transport B. cover eyes with moist, sterile dressing and transport C. cover the injured eye with metal shield, cover the other eye, and transport D. none of these
C.
The skin and underlying tissues of the face: A. contain a relatively small number of nerve fibers. B. are well protected by the maxillae and mandible. C. have a rich blood supply and bleed profusely. D. swell minimally when exposed to blunt trauma.
C. have a rich blood supply and bleed profusely.
The _______is a prominent bony mass at the base of the skull 1 inch posterior to the external opening of the ear. A. temporomandibular joint B. sclera C. mastoid process D. sternocleidomastoid
C. mastoid process
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. use tweezers to try to remove the object. C. transport her to the emergency department. D. thoroughly flush her ear with sterile saline.
C. transport her to the emergency department.
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
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
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
How should an injury that exposes the brain, eye, or other structures be managed? A. apply direct manual pressure with a dry, sterile dressing B. Do not cover the exposed parts or tissues C. Apply a dry sterile pressure bandage D. cover exposed parts with a moist, sterile dressing
D
The conjunctiva are kept moist by fluid produced by the: A. corneal ducts. B. posterior orbit. C. optic chiasma. D. lacrimal glands.
D
What is the function of the sternocleidomastoid muscle? A. Allows flexion of the neck B. Provides respiration C. Connects the scapulae together D. Allows movement of the head
D
What is the most common type of facial fracture? A. Orbit B. Mandible C. Maxilla D. Nasal
D
Which area of the body are you palpating if you feel subcutaneous emphysema? A. Spine B. Abdomen C. Chest D. Neck
D
Which of the following can cause anisocoria? A. brain injury B. nerve disease C. OTC eye drops D. all of these are correct
D
With eye injuries, in some situations, surgery and/or restoration of circulation to the eye needs to be accomplished within ___ minutes or blindness could result A. 15 B. 90 C. 45 D. 30
D
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? A. Foreign object entrapment B. Retinal detachment C. Corneal burn D. Blow-out fracture
D
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
what is hyphema? A. nosebleed B. pain or difficulty swallowing C. When air is sucked into the heart D. bleeding into the anterior chamber of the eye
D
The term "hyphema" is defined as: A. compression of one or both optic nerves. B. an acute rupture of the globe of the eye. C. inflammation of the iris, cornea, and lens. D. blood in the anterior chamber of the eye.
D. blood in the anterior chamber of the eye.
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. lies superior to the cricothyroid membrane in the neck. D. is the only complete circular cartilage of the trachea.
D. is the only complete circular cartilage of the trachea.
The lower jawbone is called the: A. maxillae. B. mastoid. C. zygoma. D. mandible.
D. mandible.
The upper jawbones are called the: A. mandible. B. zygoma. C. mastoid. D. maxillae.
D. maxillae.
A 30-year-old female was robbed and assaulted 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. visualize her mouth for obvious wounds. D. suction her oropharynx for 15 seconds.
D. suction her oropharynx for 15 seconds.
You are treating a patient with significant bruising to her face and a broken nose. She is conscious but her level of consciousness is significantly altered, and her breathing is labored. What should you do to manage this patient's airway? Give oxygen via a nasal cannula at 4 L/min. Insert a nasopharyngeal airway. Insert an oropharyngeal airway. Apply high-flow oxygen via a nonrebreathing mask.
Insert an oropharyngeal airway.
All of the following statements regarding the "Adam's apple" is true EXCEPT? It is inferior to the cricoid cartilage. It is formed by the thyroid cartilage. It is the uppermost part of the larynx. It is more prominent in men than in women.
It is inferior to the cricoid cartilage.
Which area of the body are you palpating if you feel subcutaneous emphysema? Chest Neck Abdomen Spine
Neck
Which of the following signs is LEAST indicative of a head injury? Asymmetric pupils Pupillary constriction to bright light Both eyes moving in opposite directions Inability to look upward when instructed to
Pupillary constriction to bright light
In which instance would you consider removing an impaled object? When the object is impaled in the eye and threatens vision When the object is impaled in the ear and creates basilar trauma When the object is impaled in the cheek and compromises the airway When the object is impaled in the neck into or near the carotid artery
When the object is impaled in the cheek and compromises the airway
When caring for a patient with facial trauma, the EMT should be MOST concerned with: spinal trauma. airway compromise. associated eye injuries. severe external bleeding.
airway compromise.
What is the function of the sternocleidomastoid muscle?
allows movement of the head
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.
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.
The term "hyphema" is defined as:
blood in the anterior chamber of the eye.
Abnormal variations in pupil size and reaction would MOST likely be observed in a patient with:
brain injury.
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.
When a person is looking at an object up close, the pupils should: dilate. constrict. remain the same size. dilate, and then constrict.
constrict
The presence of subcutaneous emphysema following trauma to the face and throat is MOST suggestive of: esophageal injury. cervical spine fracture. crushing tracheal injury. carotid artery laceration.
crushing tracheal injury.
The purpose of the eustachian tube is to: move in response to sound waves. transmit impulses from the brain to the ear. equalize pressure in the middle ear when external pressure changes. house fluid within the inner chamber of the ear and support balance.
equalize pressure in the middle ear when external pressure changes.
The globe of the eye is also called the: lens. orbit. retina. eyeball.
eyeball.
The maxilla and zygoma are components of the ________.
face
The skin and underlying tissues of the face:
have a rich blood supply and bleed profusely.
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.
The conjunctiva are kept moist by fluid produced by the:
lacrimal gland.
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.
What is the most common type of facial fracture?
nasal
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.
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: apply a pressure dressing to his neck. sit the patient up to slow the bleeding. place your gloved hand over the wound. apply 100% oxygen via nonrebreathing mask.
place your gloved hand over the wound.
When caring for a chemical burn to the eye, the EMT should: prevent contamination of the opposite eye. immediately cover the injured eye with a sterile dressing. avoid irrigating the eye, as this may cause further injury. irrigate both eyes simultaneously, even if only one eye is injured.
prevent contamination of the opposite eye.
The opening in the center of the iris, which allows light to move to the back of the eye, is called the:
pupil
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.
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.