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