Head, Face, and Neck Trauma

The bones include:

1) 5 nasal bones (nose) 2) 2 maxillary bones (upper jaw) 3) 2 lacrimal bones (inner eye) 4) 2 zygomatic bones (cheek) 5) 2 palatine bones (roof of the mouth) 6) 1 mandible (lower jaw)

Signs and symptoms of fractured orbits include:

1) A decrease in vision or double vision 2) Loss of feeling in the brows, cheeks, or upper lip 3) Bloody nasal discharge 4) Crepitus 5) Tenderness during palpation 6) Inability of the eye to look upward

Signs and Symptoms of neck trauma include:

1) Bruising, swelling, and bleeding in the neck 2) Difficulty speaking, swallowing, or breathing 3) Crepitus during speaking or breathing (due to a fractured larynx) 4) A "crackle" sound that occurs during palpation 5) Shift of the trachea to one side of the neck (which may also indicate a mediastinal shift and chest trauma)

Structures in the neck that are of particular concern to EMS professionals include:

1) Carotid arteries 2) Jugular veins 3) Larynx 4) Trachea 5) Esophagus 6) Cervical spine

Use a small penlight and evaluate the following items:

1) Check the orbits and the eyelids for bruising, swelling, and lacerations. 2) Check the conjunctiva for redness, puss, and foreign bodies. 3) Check the globe for redness, abnormal coloring, and lacerations. 4) Check the pupils for size, equality, roundness, and reactivity to light. The pupils in both eyes should be about the same size and should become smaller when light is shined into them. 5) Check for eye movement in all directions by asking the patient to follow the tip of your finger with his or her eyes.

Brain injuries that may result from head trauma include:

1) Concussion 2) Contusion 3) Increased intracranial pressure 4) Subdural hematoma 5) Epidural hematoma

Signs and symptoms of a concussion include:

1) Confusion that lasts for a few minutes 2) Inability to follow instructions 3) Inability to remember the accident 4) Retrograde and anterograde amnesia 5) Mild irritability or combativeness 6) Nausea and vomiting 7) Headache

Signs and symptoms of intracranial pressure include:

1) Decreasing mental awareness 2) Decreased pulse 3) Increased blood pressure 4) Abnormal or labored breathing 5) Headache 6) Vomiting 7) Seizures 8) Weakness or paralysis on one side of the body

Signs and symptoms of epidural hematoma include:

1) Decreasing mental awareness 2) Decreasing heart rate 3) Increasing blood pressure 4) Headache 5) Seizures 6) Vomiting 7) Dilated pupils 8) Abnormal breathing 9) Flexion posturing or extension posturing 10) Loss of consciousness followed by a return to consciousness, then quickly deteriorating and becoming unconscious again

signs and symptoms which may indicate a fractured facial bone includes:

1) Distorted facial features 2) Irregularity or asymmetry in the facial bones 3) Teeth do not align normally 4) Bruising and swelling 5) Bleeding from the mouth and nose 6) Crepitus 7) Limited jaw movement 8) Numbness or pain 9) Pain by the ears 10) Difficulty swallowing and speaking 11) Drooling

Signs and symptoms of chemical burns in the eye include:

1) Excruciating pain 2) Redness 3) Swelling 4) Diminished vision 5) Burned or irritated skin around the eyes

Types of Eye Trauma include:

1) Foreign bodies in the eye 2) Impaled objects in the eye 3) Extruding eyeball 4) Fractured orbits 5) Injured eyelids 6) Injured globes 7) Chemical in the eye

Types of Facial Trauma include:

1) Fractured facial bones, especially in the nose and jaw 2) Soft tissue injuries, including lacerations, penetrations, avulsions, and impaled objects 3) Broken or avulsed teeth 4) Foreign bodies, especially in the ears and nose of small children

Common causes of neck trauma include:

1) Hanging 2) Running into a stretched clothesline or wire 3) Knife or gunshot wounds 4) Impact with a steering wheel

Signs and symptoms of head trauma include:

1) Open wounds to the scalp, such as lacerations and avulsions 2) Penetrating wounds or fractures in the skull 3) Contusions, bruising, and swelling 4) Softness or tenderness during palpation 5) Skull deformity 6) Blood or cerebrospinal fluid draining from the nose and ears 7) Discoloration around the eyes (raccoon eyes) 8) Battle's sign 9) Altered mental status, confusion, and unresponsiveness 10) Irregular breathing 11) Decreased motor or sensory function 12) Double-vision 13) Unequal pupil size 14) Seizures 15) Nausea and vomiting 16) Retrograde amnesia and anterograde amnesia 17) Non-purposeful response to pain, including flexion posturing or extension posturing

Complications of Neck Trauma include:

1) Profuse bleeding can occur if the carotid arteries or jugular veins are damaged. 2) If air bubbles enter a lacerated blood vessel in the neck, a blockage may occur. This is known as an air embolism and is potentially fatal. 3) Some neck injuries will result in a fractured larynx or a collapsed trachea, both of which will have serious effects on a patient's ability to breathe. 4) Cervical spine injury is a common result of neck trauma.

The major structures of the eye include:

1) Sclera 2) Choroid coat 3) Retina 4) Cornea 5) Aqueous humor 6) Iris 7) Pupil 8) Lens 9) Vitreous humor

Signs of a contusion include:

1) Swelling at the site of the injury 2) Decreasing mental awareness 3) Personality changes 4) Paralysis 5) Unequal pupils 6) Nausea and vomiting

Emergency Care guidelines include:

1) Take BSI precautions 2) Maintain spinal alignment 3) Assure an open airway and adequate breathing 4) Control bleeding 5) Monitor mental status 6) Leave impaled objects in the skull

Concerns for head, face, and neck trauma include:

1) The head, face, and neck are highly vascular. Trauma to these areas may bleed profusely. 2) Trauma, particularly to the front of the face and neck, are likely to affect the patient's ability to breathe. 3) Many injuries to the head, face, and neck are the result of violence, assault, and even attempted suicide. Rescuers must be aware of the emotional impact this may have on the patient.

You should suspect significant damage to the eyes if any of the following items is true:

1) The patient has full or partial loss of vision. 2) The patient has an unusual sensitivity to light. 3) The patient has double-vision. 4) The patient has serious pain in the eyes.

Signs and symptoms of subdural hematomas include:

1) Weakness or paralysis on one side of the body 2) Decreasing mental awareness 3) Decreasing pulse 4) Abnormal or labored respirations 5) Dilation of one pupil 6) Headache 7) Seizures 8) Vomiting

coup-contrecoup injury

another contusion may develop at the back of the brain, as a result of the brain being forced backward against the skull

extruding eyeball

A serious injury may cause the globe of the eye to be knocked out of the orbit

Contusions

are soft-tissue injuries that usually occur as a result of blunt-force trauma.

If crepitus is observed while a patient is speaking or breathing, the patient may have a fractured ____.

larynx

Closed head wounds

occur when the head is struck with a blunt force that does not break the skull.

Open head wounds

occur when the skull is broken.

Your patient Brandon has suffered some injuries as a result of a large piece of plywood falling on his head. He appears to have fractured orbits around his left eye. There does not appear to be any damage to the eyeball. Should you apply cold packs around the eye?

yes

You have responded to a call for a head injury as a result of a line-drive baseball hitting a Little League pitcher in the head. The pitcher has significant swelling on his forehead, and you detect blood and cerebrospinal fluid draining from his ear. How should you respond to the fluids draining from the ear?

Apply a loose dressing over the ear to absorb the blood.

Patients with epidural hematoma require immediate surgical care.

True

Soft contact lenses are larger and more flexible than hard lenses.

True

A concussion

is usually a mild injury that results from a blow to the head.

Subdural hematomas are most likely to occur in patients with vulnerable blood vessels in the brain.

True

Which of the following is of particular concern in trauma to the head, face, and neck?

all of the above

The brain #2

is part of the central nervous system

Trauma to the head, face, and neck may be emotional as well as physical.

True

The skull

is separated into two parts - the cranium and the facial bones.

These bones include:

1 frontal bone •2 parietal bones •2 temporal bones •1 occipital bone •1 ethmoid bone •1 sphenoid bone

What is an air embolism?

A bubble of air that creates a blockage in a blood vessel

When is a patient at the greatest risk of developing increased intracranial pressure?

After a closed head wound

Which of the following is a correct method for handling a tooth that has been knocked out of a patient's mouth?

All of the above

Which of the following is a source of protection for the brain?

All of the above

Which of the following may indicate a fractured facial bone?

All of the above

Which of the following signs or symptoms related to the eyes may indicate head trauma?

All of the above

What is the primary indication of a concussion?

Altered mental status or confusion

You are called to the scene of a stabbing incident. The scene has already been secured by the police. You and your partner approach the patient and see blood oozing from a wound on the neck. You immediately tend to the airway while your partner addresses the stab wound. The patient's airway is open, but ventilations are slow and shallow. The pulse is faint but steady. How should you proceed?

Begin artificial ventilation with a bag-valve mask

Where does blood collect in a subdural hematoma?

Between the dura mater and the arachnoid

Where does blood collect in an epidural hematoma?

Between the skull and the dura mater

What is a brain contusion?

Bruising or swelling of brain tissue

EMTs Deena and Troy are providing emergency care to Mr. Pinkerton, who appears to have several facial fractures. Mr. Pinkerton's airway is blocked, and Deena has not been able to establish a patent airway because of the facial damage. What should Deena and Troy do next?

Call for an advanced life support unit.

What is the best emergency treatment for a lacerated eyelid in which the globe of the eye is NOT damaged?

Control bleeding with light pressure, then apply a moist dressing

Which of the following is the best emergency treatment for a patient with an extruding eyeball?

Cover the eyeball with a moist dressing and a protective shield.

Why should direct pressure be used with caution when controlling bleeding on the skull?

Direct pressure may damage the brain if the skull is fractured.

Which of the following is true about examining swollen eyes?

Do not force open swollen eyes.

What is the best treatment for an ear that is bleeding from the outer cartilage?

Dress and bandage as a soft tissue injury

Which of the following is a non-purposeful response to pain that may indicate head trauma?

Extension posturing

In addition to protecting the spine, what is a benefit of immobilizing the c-spine during facial trauma?

Facial bones are immobilized.

A concussion is usually caused by penetrating trauma to the head.

False

If the eye is bleeding, you should apply direct pressure over the globe to slow blood flow.

False

The symptoms of subdural hematoma always appear immediately.

False

What is the best treatment for chemical in the eye?

Flush the eye with water or saline

intracranial pressure

If a contusion occurs as a result of a closed head wound

At this point, it is unclear if Brandon has suffered any spinal damage. How should he be transported to the hospital?

Immobilized in the supine position

When bandaging an open wound on the neck, how should the roller gauze be applied?

In a figure-eight wrap around the neck and armpit

Why is the neck considered a high-risk area for multi-system injuries?

It is a small area that contains structures for several body systems.

When managing a bleeding neck wound, why is it important NOT to apply direct pressure to both sides of the neck at the same time?

It will cut off the blood supply to the brain.

Which method should be used to open the airway of a patient with a serious head injury?

Jaw-thrust maneuver

What is the best emergency treatment for a lacerated eyelid in which the globe of the eye has also been lacerated?

Lay gauze over the eye, but do not apply any pressure.

You are responding to a call in which the patient, Mr. Tyson, fell down the stairs and landed on his face. Mr. Tyson appears to have several fractured facial bones. When you examine Mr. Tyson's mouth, you notice that he is wearing dentures, which appear to be intact. How should you proceed?

Leave the dentures in place because they will help to support the facial structures.

What is the name of the nerve that transmits information from the eyeballs to the brain?

Optic nerve

Which of the following best describes the bleeding in epidural hematoma?

Quick and profuse

What is the best way to determine if a patient is wearing contact lenses?

Shine a penlight into the eyes.

What may clear fluid draining from the nose indicate?

Skull fracture

Why is it important for your partner to prevent air from entering the stab wound in the neck?

So that an air embolism does not form in or close to the heart

What is the proper treatment for an impaled object in the skull in the pre-hospital setting?

Stabilize the object with bulky dressings

Which of the following is the best emergency treatment for a patient with a pencil impaled in her eye?

Stabilize the pencil with gauze and a cup.

Which of the following may occur as a result of increased intracranial pressure?

The brain is compressed downward onto the brain stem.

Damage from a chemical burn in the eye can occur within seconds of exposure.

True

Most head wounds should be treated as a high priority.

True

Which of the following may indicate that something is wrong with the eyes?

The eyes do not react to light

What is the primary reason that an impaled object should be removed from the cheek in the pre-hospital setting?

The object may obstruct the airway

Which of the following best describes an open head wound?

The skull is broken

the optic nerve

The visual information that is detected through the eyes is transmitted to the brain

The facial bones

There are 14 that guard and support the eyes, nose, mouth, and ears.

Why is it important to bandage both eyes, even if only one eye has been injured?

To prevent simultaneous eye movement

In the pre-hospital setting, what is the best response to a child with a foreign body in the nostril?

Transport the child to the hospital where the object can be removed

Any patient with a suspected brain injury must be transported immediately.

True

Emergency rescuers are only permitted to remove foreign bodies from the eye if the foreign body is lodged in the ____.

conjunctiva

Patients with head trauma tend to deteriorate quickly. For this reason, it is particularly important for rescuers to ____.

continually assess vital signs and level of consciousness

Subdural hematoma

is the most common type of severe head injury. It occurs when blood collects between the dura mater and the arachnoid layers of the brain.

cerebrospinal fluid (CSF)

flows throughout the brain to protect it against impact

Face Trauma

involves injuries to the mouth, jaw, cheeks, nose, and ears.

The cranium

is made of 8 bones, which surround and protect the brain.

Epidural hematoma

is much rarer than subdural hematoma, and it is significantly more serious. Epidural hematoma occurs when blood collects between the dura mater and the skull.

The eyeballs (also called globes)

rest in the orbital bones of the skull

Open wounds to the scalp typically result in bleeding that is ____.

severe

The three layers of tissue include:

the dura mater, the arachnoid, and the pia mater

Structures that may be injured from a head injury include:

the scalp, the skull, and the brain.

meninges

three layers of tissue that provide additional protection