Chapter 28: Face and Neck Injuries

The ____ joint is a prominent bony mass at the base of the skull 1 inch posterior to the external opening of the ear - mastoid process - sternocleidomastoid muscle - sclera - temporomandibular

mastoid process

Which of the following mechanisms of injury would MOST likely cause a crushing injury of the larynx and/or trachea? A. Attempted suicide by hanging B. Gunshot wound to the lateral neck C. Car crash involving lateral impact D. Patient whose head hits the windshield

A. Attempted suicide by hanging

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 signs is LEAST indicative of a head injury? A. Asymmetric pupils B. Pupillary constriction to bright light C. Both eyes moving in opposite directions D. Inability to look upward when instructed to

B. Pupillary constriction to bright light The pupils normally constrict in bright light and dilate in dim light. Suspect a head injury if the pupils do not react appropriately, are asymmetric (unequal), do not move together, or if the patient is unable to look upward.

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? - Carefully reposition the globe back in place. - Cover the eye with a moist, sterile dressing. - Apply a pressure dressing and use roller gauze wrapped around the circumference of the head. - Cover both eyes to decrease sympathetic eye movement.

-Cover the eye with a moist, sterile dressing. -Cover both eyes to decrease sympathetic eye movement.

Which of the following is true about posterior epistaxis? - Originates from the area of the septum - Bleeds slowly - Causes nausea and vomiting - More severe than anterior epistaxis

-More severe than anterior epistaxis -Causes nausea and vomiting

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 subcutaneous emphysema? - 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 crackling sensation felt when palpating the neck resulting from air in the soft tissues

Which of the following statements regarding the "Adam's apple" is FALSE? A. It is inferior to the cricoid cartilage. B. It is formed by the thyroid cartilage. C. It is the uppermost part of the larynx. D. It is more prominent in men than in women.

A. It is inferior to the cricoid cartilage. The most obvious prominence in the center of the anterior neck is the Adam's apple. This prominence is the upper part of the larynx, formed by the thyroid cartilage. It is more prominent in men than in women. The other portion of the larynx is the cricoid cartilage, a firm ridge that is inferior to the thyroid cartilage.

When caring for a chemical burn to the eye, the EMT should: A. prevent contamination of the opposite eye. B. immediately cover the injured eye with a sterile dressing. C. avoid irrigating the eye, as this may cause further injury. D. irrigate both eyes simultaneously, even if only one eye is injured.

A. prevent contamination of the opposite eye. When irrigating a chemical burn to the eye, it is important to direct the stream away from the uninjured eye. If you do not, you will likely flush the chemical into the unaffected eye. After irrigating the eye for the appropriate amount of time, cover both eyes with a sterile dressing.

When caring for a patient with facial trauma, the EMT should be MOST concerned with: A. spinal trauma. B. airway compromise. C. associated eye injuries. D. severe external bleeding.

B. airway compromise. No airway, no patient! Injuries to the face often cause obstruction of the upper airway, either by clotted blood or associated swelling. Additionally, large amounts of blood can be swallowed, which increases the risks of vomiting and aspiration. Bleeding control, spinal trauma, and associated injuries are important factors and should be treated accordingly; however, the airway comes first.

What is the purpose of the sternocleidomastoid muscle? A. provides respiration B. allows movement of the head C. connects the scapulae together D. allows flexion of the neck

B. allows movement of the head

When a person is looking at an object up close, the pupils should: A. dilate. B. constrict. C. remain the same size. D. dilate, and then constrict.

B. constrict. The pupils, which allow light to move to the back of the eye, constrict in bright light and dilate in dim light. The pupils should also constrict when looking at an object up close and dilate when looking at an object farther away; this is called pupillary accommodation. These pupillary adjustments occur almost instantaneously.

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

B. direct pressure using dry, sterile dressings.

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

B. just anterior to the tragus.

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, obscuring the iris -When air is sucked into the heart -Pain or difficult swallowing

Bleeding into the anterior chamber of the eye, obscuring the iris

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

You are dispatched to a motor vehicle crash on a rural road where a single vehicle is up on an embankment. The vehicle has front-end damage and a starred windshield. The unrestrained driver is lying supine in the road; the police report that they found the patient outside of the vehicle. He is unconscious and has obvious facial bleeding. Examination reveals a hematoma and depression of the left temporal area, both eyes are black and blue, and one pupil is dilated, whereas the other is normal. The patient has blood coming from the nose and mouth, and palpation reveals subcutaneous emphysema around the clavicles and chest area. The patient's breathing is labored, and the pulse is rapid and thready. How should you manage this patient's airway? A. Give oxygen via a nasal cannula at 4 L/min. B. Give oxygen via a nonrebreathing mask at 15 L/min. C. Suction the airway and assist with ventilations with a bag-mask device. D. Suction the airway and give 100% oxygen via a nonrebreathing mask.

C. Suction the airway and assist with ventilations with a bag-mask device.

The presence of subcutaneous emphysema following trauma to the face and throat is MOST suggestive of: A. esophageal injury. B. cervical spine fracture. C. crushing tracheal injury. D. carotid artery laceration.

C. crushing tracheal injury. Crushing injuries or fractures of the larynx or trachea can result in a leakage of air into the soft tissues of the neck. The presence of air in the soft tissues produces a characteristic crackling sensation called subcutaneous emphysema. Esophageal injury will produce bleeding, which may be observed in the patient's mouth or through difficulty swallowing. Carotid artery laceration could be assessed by excessive swelling or the presence of a large hematoma in the neck area.

The purpose of the eustachian tube is to: A. move in response to sound waves. B. transmit impulses from the brain to the ear. C. equalize pressure in the middle ear when external pressure changes. D. house fluid within the inner chamber of the ear and support balance.

C. equalize pressure in the middle ear when external pressure changes. Impulses are transmitted from the brain to the ear, and the bony chambers of the inner ear support balance. The tympanic membrane moves in response to sound waves. The middle ear is connected to the nasal cavity by the eustachian tube, which permits equalization of pressure in the middle ear when external atmospheric pressure changes.

The cricoid cartilage: Select one: 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.

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: A. apply a pressure dressing to his neck. B.sit the patient up to slow the bleeding. C. place your gloved hand over the wound. D. apply 100% oxygen via nonrebreathing mask.

C. place your gloved hand over the wound. Laceration of the carotid artery—as evidenced by bright red blood spurting from the wound—can cause profuse bleeding, profound shock, and death very quickly. You must immediately control the bleeding with the use of direct pressure. Cover the wound with your gloved hand initially and then apply a bulky pressure dressing. After the bleeding has been controlled, apply high-flow oxygen and transport promptly.

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. they may need to call a specialist to see the patient. D. it saves time on repeat assessments at the hospital.

C. they may need to call a specialist to see the patient.

You are dispatched to a motor vehicle crash on a rural road where a single vehicle is up on an embankment. The vehicle has front-end damage and a starred windshield. The unrestrained driver is lying supine in the road; the police report that they found the patient outside of the vehicle. He is unconscious and has obvious facial bleeding. Examination reveals a hematoma and depression of the left temporal area, both eyes are black and blue, and one pupil is dilated, whereas the other is normal. The patient has blood coming from the nose and mouth, and palpation reveals subcutaneous emphysema around the clavicles and chest area. The patient's breathing is labored, and the pulse is rapid and thready. What is the priority for this patient? A. Initiate spinal motion restriction precautions. B. Assess the vital signs. C. Provide rapid transport. D. Assess for exsanguinating hemorrhage and then airway, breathing, and circulation

D. Assess for exsanguinating hemorrhage and then airway, breathing, and circulation

The globe of the eye is also called the: A. lens. B. orbit. C. retina. D. eyeball.

D. eyeball. The globe of the eye is also called the eyeball. The lens, which sits behind the iris, focuses images on the retina—the light-sensitive area at the back of the globe. The globe is located within a bony socket in the skull called the orbit.

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. Because the patient's breathing is labored and her level of consciousness is altered, you should insert an oropharyngeal airway.

Which of the following fractures is associated with misalignment of the teeth, numbness of the chin, an inability to open the mouth, swelling, bruising, and loosened or missing teeth? - Basilar skull fracture - Orbit fracture - Mandibular fracture - Maxilla fracture

Mandibular fracture

Which area of the body are you palpating if you feel subcutaneous emphysema? - Chest - Neck - Abdomen - Spine

Neck

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