Ch. 26 Face and Neck Injuries

What is the function of the sternocleidomastoid muscle? A. Allows movement of the head B. Allows flexion of the neck C. Connects the scapulae together D. Facilitates chest movement

A. Allows movement of the head

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

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

Retinal injuries that are caused by exposure to extremely bright light: A. are typically not painful, but may result in permanent damage to vision. B. are intensely painful, but usually only result in temporary blindness. C. usually do not immediate medical attention unless vision is impaired. D. damage the motor cells of the eye, resulting in reduced eye movement.

A. are typically not painful, but may result in permanent damage to vision

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 her eye. B. apply firm direct pressure to the injured eye and cover the opposite eye. C. carefully examine her eye and remove any foreign objects if needed. 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 her eye

The eyeball itself is called the: A. globe. B. sclera. C. orbit. D. cornea.

A. globe

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 factory worker was splashed in the eyes with a strong acid chemical. He complains of intense pain and blurred vision. If you do not have sterile saline or water, you should: A. irrigate both eyes continuously for 20 minutes with plain water. B. neutralize the acid chemical in his eye with an alkaline chemical. C. mix baking soda with water and irrigate his eyes with the solution. D. flush both eyes with an alcohol-based solution and transport.

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

The cricoid cartilage: A. is the only complete circular cartilage of the trachea. B. is easier to see and palpate than the thyroid cartilage. C. lies superior to the thyroid cartilage in the neck. D. lies superior to the cricothyroid membrane in the neck.

A. is the only complete circular cartilage of the trachea

The superficial temporal artery can be palpated: A. just anterior to the tragus. B. at the angle of the jaw. C. slightly above the ear. D. over the mastoid process.

A. just anterior to the tragus

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

A. padding between the ear and the scalp

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

A. such injuries can affect the respiratory system

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

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

A. tragus

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

A fracture involving the nasal bone and inferior maxilla, which separates the nasal bone and lower maxilla from the facial skull and remainder of the cranial bones describes: A. a Le Fort III fracture. B. a Le Fort II fracture. C. a Le Fort I fracture. D. craniofacial disjunction.

B. a Le Fort II fracture

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

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

You are assessing a 59-year-old male who complains of a headache and note that his pupils are asymmetrical. He is conscious and alert. When obtaining his medical history, it is MOST pertinent to ask him if he: A. regularly sees a family physician. B. has a history of eye surgeries. C. took any medication for his headache. D. is allergic to any medications.

B. has a history of eye surgeries

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

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

B. laryngeal fracture

When assessing a patient with a mandibular fracture, you would MOST likely encounter: A. pain directly over the chin. B. misalignment of the teeth. C. impaired ocular movement. D. lateral bulging of the jaw.

B. misalignment of the teeth

The AEMT should be MOST suspicious of a Le Fort fracture if a patient who experienced massive blunt force trauma to the face presents with: A. misalignment of the teeth. B. mobility of the facial bones. C. numbness of the chin. D. flattening of the cheekbones.

B. mobility of the facial bones

The opening in the center of the iris, which allows light to move to the back of the eye, is called the: A. sclera. B. pupil. C. cornea. D. conjunctiva.

B. pupil

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. requesting a paramedic ambulance. B. rapidly transporting her to the hospital. C. quickly immobilizing her spinal column. D. careful monitoring of her vital signs.

B. rapidly transporting her to the hospital

The optic nerve endings are located within the: A. cornea. B. retina. C. pupil. D. sclera.

B. retina

The mastoid process is located approximately: A. ½" anterior to the external opening of the ear. B. 1" inferior to the external opening of the ear. C. 1" posterior to the external opening of the ear. D. 1" posterior to the angle of the mandible.

C. 1" posterior to the external opening of the ear

Which of the following is the MOST significant complication associated with facial injuries? A. Cervical spine injury B. External hemorrhage C. Airway compromise D. Damage to the eyes

C. Airway compromise

Which of the following findings is 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

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

C. a specialist may be needed to manage the 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. circumferentially wrap a dressing around his neck. B. apply direct pressure below the lacerated vessel. C. apply direct pressure above and below the wound. D. apply pressure to the closest arterial pressure point.

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 heavy 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

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. cornea. C. conjunctiva. D. sclera.

C. conjunctiva

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. remove the object with a cotton-tipped applicator. B. scrape the splinter away with moist, sterile gauze. C. cover both of his eyes and transport to the hospital. D. cover his right eye and flush the left eye with saline.

C. cover both of his eyes and transport to the hospital

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

C. lacrimal glands

The lower jawbone is called the: A. maxillae. B. zygoma. C. mandible. D. mastoid.

C. mandible

The upper jawbones are called the: A. mastoid. B. mandible. C. maxillae. D. zygoma.

C. maxillae

The white portion of the eye is called the: A. iris. B. retina. C. sclera. D. cornea.

C. sclera

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

C. turn the backboard onto its side

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

C. wear gloves and facial protection

Which of the following statements regarding scalp lacerations is correct? A. Because the scalp is highly vascular, you should always apply a tight pressure dressing to control bleeding B. Patients who take antihypertensive medications bleed more severely from scalp lacerations C. Although deep scalp lacerations bleed profusely, they are rarely associated with skull fractures D. Blood loss from a scalp laceration may result in hypovolemic shock, especially in children

D. Blood loss from a scalp laceration may result in hypovolemic shock, especially in children

Abnormal variations in pupil size and reaction would MOST likely be observed in a patient with: A. conjunctivitis. B. contact lenses. C. retinitis. D. a brain injury.

D. a brain injury

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 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. secure her eyes open so you can reassess her pupils. B. inspect her eyes and gently remove impaled objects. C. irrigate her eyes with water to prevent mucosal drying. D. close her eyes and cover them with a moist dressing.

D. close her eyes and cover them with a moist dressing

Bleeding from soft-tissue injuries to the face is MOST effectively controlled with: A. digital pressure to an adjacent pulse point. B. ice packs and elevation of the patient's head. C. pressure dressings and chemical ice packs. D. direct pressure using dry, sterile dressings.

D. direct pressure using dry, sterile dressings

Clinical findings associated with a laryngeal injury include: A. hematemesis, bulging eyes, and jugular venous distention. B. pallor, a mediastinal shift, and tracheal deviation. C. posterior neck deformity, Battle's sign, and a dry cough. D. hemoptysis, subcutaneous emphysema, and cyanosis.

D. hemoptysis, subcutaneous emphysema, and cyanosis

A 58-year-old woman fell and landed face-first on a concrete sidewalk. She is conscious, but confused. Her skin is pale, cool, and clammy; her radial pulses are weak and rapid; and her blood pressure is 72/54 mm Hg. Further assessment reveals crepitus to her left cheekbone. After administering high-flow oxygen, you should: A. perform a detailed secondary assessment, immobilize her entire spine, and establish IV access. B. place her in a sitting position on the stretcher, insert a saline lock, and reassess her blood pressure. C. apply a cervical collar only, establish two large-bore IV lines, and administer 2 liters of normal saline. D. immobilize her entire spine, establish at least one large-bore IV line, and give a 20-mL/kg crystalloid bolus.

D. immobilize her entire spine, establish at least one large-bore IV line, and give a 20-mL/kg crystalloid bolus

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. applying a gauze pad in between his lower lip and gum. B. packing the nasopharynx with moist, sterile dressings. 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 must be identified and treated as soon as possible because: A. bleeding must be controlled early. B. swelling may mask hidden injuries. C. the spine may be injured as well. D. of the risk for airway problems.

D. of the risk for airway problems

Significant trauma to the face should increase the AEMT's index of suspicion for a/an: A. displaced mandible. B. airway obstruction. C. basilar skull fracture. D. spinal cord injury.

D. spinal cord injury

A 30-year-old female was 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. visualize her mouth for obvious wounds. C. begin immediate ventilatory assistance. D. suction her oropharynx for 15 seconds.

D. suction her oropharynx for 15 seconds

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

D. transport her to the emergency department