Chapter 27 face and neck injuries PDF

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Chapter 27: Face & Neck Injuries 1. The Head a. Vulnerable to injury b. Soft-tissue injuries and fractures are common. c. Injuries leave disfiguring scars d. LOTS of blood flow (highly vascular) e. Injuries and fractures can cause airway problems f. “What seems bad, may turn out well.” g. Head is divided into two parts: i. Cranium (aka skull) 1. Contains the brain 2. Most posterior part is the occiput 3. Lateral portions are the temporal regions (aka Temporals) 4. Forehead = Frontal region 5. Contains the superficial temporal artery; located anterior to the ear in the temporal region. Pulse can be felt. ii. Face 1. Soft tissues of the face: a. Eyes b. Ears c. Nose d. Mouth e. Cheeks f. Jowls 2. Bones of the face: a. Nasal bone: 1/3 is bone; 2/3 is cartilage b. Zygomas (two) c. Maxilla (two) d. Mandible h. “Le Fort Fractures”:

i. Unstable/Dangerous 2. The Eye a. Globe-shaped and approx. 1 inch in diameter; Keeps its shape as a result of the pressure of fluid contained within its two chambers:

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i. Vitreous humor: clear, jellylike fluid near the back of the eye. ii. Aqueous humor: clear fluid located in front of the lens. Named for its watery appearance. 80% of the eyeball is protected within the boney orbit. Orbit is composed of: i. lower edge of the frontal bone ii. the zygomas iii. maxilla iv. nasal bone The pigmented Iris allows the pupil to open and close. The pupil is the aperture (opening) of the eye. Behind the iris is the lens, which focuses the eye. At the very back of the eye lies the retina, the film that transmits impulses through the optic nerve. The inner surface of the eyelids and the exposed surface of the eye itself is a delicate membrane called the conjunctiva. The white part of the eye is the sclera; extends over the surface of the globe. The cornea is a clear transparent membrane that allows light to enter the eye. Eyes are kept moist by fluid produced by the lacrimal glands (aka tear ducts) The optic nerve lies within the retina and respond to light by transmitting nerve impulses to the brain. (impulses are interpreted as vision)

3. The Ear a. Entire exposed portion is Cartilage; Visible part is called the Pinna. b. Tragus is the small round, fleshy bulge immediately anterior to the ear canal. c. Vestibular System = apparatus in the inner ear involved in balance. 4. The Jaw a. The mastoid process is the boney mass at the base of the skull. b. Mandible for the jaw/chin c. TMJ (temporomandibular joint) provides motion. 5. The Neck a. Contains: i. Cervical vertebrae (c1-c7) ii. Larynx iii. Cricoid cartilage iv. Esophagus v. Trachea vi. Great Vessels vii. Large Muscle 6. Injuries to the FACE/NECK a. Partial or complete obstruction of the upper airway may be the result

b. Several factors may contribute to obstruction: i. Large blood clots in Upper airway due to heavy facial bleeding ii. Direct injuries to the nose and mouth, larynx, and trachea; source of significant bleeding/resp. compromise (suction airway if unable to control bleeding). iii. Dislodgement of teeth or dentures in the throat. iv. Swelling that accompanies direct and indirectly to soft tissue injuries in the face/neck. v. Airway may be affected when patients head is turned onto its side. vi. Possible injury to the brain and/or cervical spine. 7. Sof Tissue Injuries a. Very common b. Face and neck are extremely vascular i. Swelling may be more severe ii. Skin and tissues in this area are rich in blood supply; bleeding can be very heavy. iii. Blunt injuries can cause a hematoma. iv. Sometimes avulsed tissue can come from underlying muscles and fascia. 8. Dental Injuries a. Mandible fractures are common b. Most are a result of vehicle collisions and assaults. i. Mandibular fractures 1. Assume additional facial trauma and/or cervical injuries due to the force necessary to cause a mandibular fracture. 2. Signs of mandibular fracture: a. Misalignment of teeth b. Numbness of the chin c. Inability to open mouth ii. Maxillary Fractures 1. Maxillary fractures are usually found after blunt force, high-energy impacts. 2. Signs of maxillary fracture: a. Massive facial swelling b. Instability of the facial bones c. Misalignment of teeth d. Fractured/avulsed teeth are common following trauma. c. Always assess the pts mouth following a facial injury, especially if your examination reveals fractured or avulsed teeth. (can become a possible airway obstruction)

Emergency Medical Care for Specific Injuries 1. Injuries of the Eye a. Can produce severe, lifelong complications, including blindness. b. Pupil reaction or shape and eye movement are often disturbed in an injury; suspect an injury of the globe or its associated tissues. c. **Remember** Abnormal pupil reactions sometimes are a sign of brain injury rather than eye injury d. Foreign Objects

i. Always flush from the nose side of the eye to the outside to avoid contamination into the other eye. ii. A foreign body will leave a small abrasion on the surface of the eye. iii. Irrigation may not wash out a foreign body stuck to the cornea or lying under the eyelid. iv. NEVER attempt to remove a foreign body that is stuck to the cornea, must be removed by a physician; stabilize object and prepare pt. for transport) e. Burns of the eye i. Role is to stop the burn and prevent further damage. ii. Chemical burns 1. Usually caused by acid or alkaline solutions 2. Flush the eye with water or saline 3. Direct the greatest amount of irrigating solution or water into the eye as gently as possible. 4. May have to force the lids open. 5. For chemical burns Irrigate the eye for AT LEAST 5 MINUTES 6. If the burn was caused by an alkaline or a strong acid, irrigate for AT LEAST 20 MINUTES. 7. After irrigation, apply a clean, dry dressing, then cover the eye and transport. a. Contact lenses/Artificial eyes i. DO NOT attempt to remove contact lens UNLESS there is a chemical burn. ii. To remove a hard contact lens, use a small suction cup iii. To remove a soft contact, place one to two drops saline into eye, use thumb & index finger to pinch and lift. iii. Thermal Burns 1. During heat, eyes will close to protect eye from the heat, but eyelids will burn. 2. Transport promptly without further examination 3. Cover both eyes with sterile dressing moistened with sterile solution. 4. Apply eye shield over dressing. iv. Light burns 1. Inferred rays, eclipse light, and laser beams all can cause significant damage. 2. Retinal injuries caused by exposer to light are generally not painful but may result in perm. Damage. 3. Severe conjunctivitis usually develops w/redness, swelling, and excessive tears. 4. Ease pain by covering each eye with a sterile, moist pad and eye shield. v. Lacerations 1. Require vary careful repair to restore function and appearance when functioning. 2. Bleeding may be heavy, can usually be controlled by gentle, manual pressure. 3. If there is a laceration to the globe of the eye itself, DO NOT apply pressure. 4. NEVER exert pressure or manipulate the injured eye in any way!

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5. If part of the eye is exposed, gently apply a moist, sterile dressing to prevent drying. 6. Cover the injured eye with/ protective metal eye shield, or sterile dressing. vi. Blunt Trauma 1. Injuries range from “black eye” to severely damaged globe 2. Hyphema is bleeding into the anterior chamber of the eye, that obscures part or all of the iris. 3. Blow-out fracture: fracture of the orbital bone, particularly of the bones that form its floor and support the globe. 4. Retinal detachment is often seen in sports. vii. Eye Injuries following Head Injury 1. Following findings should alert you to possible head injury: a. One pupil larger than the other b. Eyes not moving together c. Failure of the eyes to follow your finger d. Bleeding under conjunctiva e. Protection or bulging of the eye. Injuries to the nose a. Nose bleeds (epistaxis) are a common problem i. One of the most common causes is digital trauma (picking nose) ii. Anterior bleeds usually originate from the area of the septum and bleed slowly. iii. Psterior bleeds are usually more severe and often cause blood to drain into the throat. b. CSF (cerebrospinal fluid) may escape down through the nose following a fracture at the base of the skull. c. Control bleeding by applying a sterile dressing. Injuries to the Ear a. Ears are often injured but do not bleed much i. In case of an ear avulsion, wrap the avulsed part in a moist, sterile dressing and put in a plastic bag. ii. Children place foreign objects in the outer ear. iii. CSF coming from ear may indicate a possible skull fracture. Facial Fractures a. Typically result from blunt trauma b. Assume a direct blow to the mouth or nose has caused the facial fracture c. Other clues include i. Bleeding in the mouth ii. Inability to swallow or talk iii. Absent or loose teeth iv. Loose or movable bone fragments d. Facial Fractures alone are not acute emergencies unless there is serious bleeding. e. Plastic surgeons can repair the damage to the face and mouth is the injuries are treated in 7 to 10 days of the injury f. Swelling can be extreme within the first 24 hours after injury. Dental Injuries a. Can be traumatic to the pt. b. Bleeding will occur whenever a tooth is violently displaced from its socket.

i. Apply direct pressure to stop the bleeding ii. Perform suctioning if needed iii. Cracked or loose teeth are possible airway obstructions c. Save and transport avulsed tooth/teeth i. Handle by the crown of the tooth rather than the root ii. Place tooth in cold milk or sterile saline iii. Notify the hospital iv. Reimplantation is recommended within 20min to 1 hour after trauma 6. Injuries of the Neck a. An injury to the neck is serious and should be considered life threatening until proven otherwise in the ER i. Blunt Trauma 1. Any crushing injury of the upper part of the neck is likely to involve the larynx or trachea 2. Once the cartilage of the upper airway and larynx are fractured, they do not spring back to their normal position. 3. Can lead to loss of voice, difficultly swallowing, severe and sometimes fatal airway obstruction, and leakage of air into the soft tissues of the neck 4. Subcutaneous emphysema is characteristic crackling sensation produced by the presence of air. ii. Penetrating injuries 1. Can profusely bleed from laceration of the great vessels in the neck. 2. Injuries to the carotid and jugular veins can cause the body to bleed out (exsanguination). 3. Injuries may lead to an Air embolism: A large amount of air in the right atrium and right ventricle of the heart and can lead to cardiac arrest. 7. Laryngeal Injuries a. Blunt force trauma to the larynx can occur when: i. Unrestrained driver strikes steering wheel ii. Snowmobile rider strikes a clothesline b. The larynx becomes crushed against the cervical spine, resulting in soft-tissue injury, fractures, and/or separation of the fascia. c. Penetrating or impaled objects in the larynx should not be removed unless they interference with CPR i. Stabilize all impaled objects if they are not obstructing the airway. d. Signs and symptoms of larynx injuries: i. Respiratory distress ii. Hoarseness iii. Pain iv. Difficulty swallowing (dysphagia) v. Cyanosis vi. Pale skin vii. Sputum in the wound. viii. Subcutaneous emphysema ix. Bruising on the neck x. Hematoma xi. Bleeding

e. To manage a laryngeal injury i. Provide oxygen and ventilation ii. Apply cervical immobilization- avoid rigid collars. 8. Injuries to the cheek a. You may encounter and object impaled in the pts cheek i. If you are unable to control bleeding, consider removing the object ii. Then provide direct pressure on the outside and inside of the cheek. iii. The amount of dressing should not occlude the mouth....