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Prevention and Care Exam 2 > Chapter 9 - Head And Face > Flashcards

Chapter 9 - Head And Face Flashcards

0
Q

Three types of head injuries

A

Extra cranial - scalp
Scalp lesions
Intracranial - meninges

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1
Q

What are two types of scalp lesions?

A

Contusions and lacerations

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2
Q

Four intra-cranial tissues (meninges)

A

Dura mater
Arachnoid
Sub-arachnoid space
Pia-mater

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3
Q

Dura mater

A

Outer most layer, THICKEST, fibrous, highly vascular

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4
Q

Arachnoid layer

A

Middle layer, LESS DENSE, less vascular

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5
Q

Sub-arachnoid space

A

Contains cerebrospinal fluid (CSF) - cushions the CNS from external forces
** most important layer

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6
Q

Pia mater

A

Inter most layer, thin, DELICATE

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7
Q

Intra-cranial (brain tissue 3 areas)

A

Brain stem- base
Cerebellum- back
Cerebrum- cerebral cortex - lobes

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8
Q

Brain stem

A

Base, primitive function of body (metabolic,heart,breathing, hormone secretion)

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9
Q

Cerebellum

A

Back, connects directly to stem, motor coordination, fine motor, posture, balance, hand eye coordination

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10
Q

Cerebrum

A

Cerebral cortex– lobes and subcoritcal regions

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11
Q

Concussion - define clinically

A

Clinical syndrome characterized by immediate and transient impairment of neurological function secondary to mechanical forces

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12
Q

What is a cribiform plate fracture?

A

Wafer thin perforated bone and CSF leakage (rhinorrea)

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13
Q

Ethmoid

A

Through which the olfactory nerves pass on their journey from the nasal mucosa to the olfactory

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14
Q

Orbital blow out fracture

A

Blunt force causing increased pressure in socket or bottom rim

  • FX of the infra-orbital plate
  • contents drop into maxillary sinus
  • needs ct scan or X-ray to diagnose
  • loss of eye movement or fixed gaze (ocular muscle entrapment)
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15
Q

Periorbital ecchymyosis in blow out fracture

A

Raccoon eyes (black and blue around eye)

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16
Q

Zygomatic arch or tripod

A

Prominent bone - arch
Forms part of eye socket
Looks face collapses

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17
Q

Second most common facial fracture after nasal

A

Zygomatic or tripod

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18
Q

Moi (mechanism of injury) of tripod fracture

A

Direct blow

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19
Q

Face fracture (le fort)

A

I - horizontal
II - pyramidal
III - transverse

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20
Q

Tripod three segments

A
  1. Maxilla
  2. Arch
  3. Lateral orbital rim
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21
Q

Horizontal fracture

A

Across maxilla
Small bones
Least severe

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22
Q

Pyramidal fracture

A

Maxilla
Orbital rim
Nasal bridge
Looks like pyramid

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23
Q

Transverse fracture

A 
Most severe
Zygomatic arch
Eye socket
Nasal bridge 
More facial bones can be involved
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24
Q

Top sport for eye injuries

A

Basketball

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25
Q

Mandibular fx (fracture)

A 
Breaking jaw
Dental complication can occur
Tooth teeth involved in fracture
Body- 30-40% prevalence 
angle- 25-31% prevalence 
Usually on bottom side
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26
Q

Eye injuries (3 most common)

A

Conjunctiva
Cornea
Anterior chamber

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27
Q

Make up of the eye

A

Globe is filled with vitreous body
Post/infer eye is covered by retina
Abrasions and contusions

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28
Q

Extra ocular

A

Peri orbital ecchymyosis (contusion) – black eye

–> edema into tissue spaces

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29
Q

Intra ocular

A

Subconjuctive hemorrhage
Corneal abrasion (poke in eye)
Hyphema
*** must rule out intra ocular involvement to cancel out life threatening

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30
Q

Sub conjunctive hemorrhage

A

Hemorrhage of small vessels between conjunctive and sclera
Red eye
Rule out more serious
NOT VERY SERIOUS

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31
Q

Corneal abrasion

A 
Most common (poked eye)
Very painful
Foreign body, friction or rubbing of cornea 
Irritation of epithelial layer
Fluoresce dye
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32
Q

Hyphema

A

Damage to iris
Problematic
Hemorrhage into anterior chamber – lower portion
Accumulation of blood – increase intra ocular pressure
Loss of visual field – Diplopia (double vision)
Physician referral is warranted

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33
Q

Secondary bleeding

A

Bed rest prevents that
High blood pressure causes secondary bleeding in hyphema
Permanent vision loss

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34
Q

Ear injuries

A

Hematoma Auris
– cauliflower ear

Friction to outer ear (pinna or auricula)
Fluid In tissue spaces (under perichondrium)

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35
Q

Fluid tissue spaces in ear

A 
Separates cartilage from perichondrium 
Cartilage dies and folds over into clumps (scars)
Ossification of a cartilage 
Hearing loss 
Ice and compression
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36
Q

Types of dental injuries

A

Fractured (chipped)
Avulsion (knocked out)
Displaced (subluxation)

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37
Q

What to do with dent injuries

A

Look out for soft tissue laceration (gum/lip)
First aid – avoid blood borne pathogens
Prevent – mouth guards

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38
Q

When is it painful and infectious with dent injuries

A

Exposure of pulp cavity

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39
Q

Fractured teeth

A

Broken (crown/neck)
Save broke tooth
Stabilize portion in mouth
Transport to dent facility

40
Q

Avulsed tooth

A

Entire tooth knocked out of root
Rupture of periodontal ligament and blood/vessel nerve
Re implant tooth in socket and don’t let it dry out
Protect exposed socket

41
Q

Displaced tooth

A

Tooth in socket but wrong position

Extruded or laterally displaced
— re position tooth and stabilize

Intruded
— DO NOT DO ANYTHING AND TRANSPORT TO FACILITY

42
Q

Mechanisms of injury (5)

A 
Contact and non contact 
Acceleration and deceleration of brain
Twisting of brain stem
Contre-coup
Threshold force force on brain to cause  concussion
43
Q

Contact and no contact mechanism

A

Blunt force

Whiplash

44
Q

Acceleration/deceleration of brain mechanism

A

Linear forces:

  • forceful impact against skull
  • compressive forces
45
Q

Twisting of brain stem

A

Rotational forces:

-shearing and tensile forces

46
Q

Contre-coup

A

Symptoms arise in side opposite of blow

47
Q

Threshold force of brain

A

Can it cause concussion?

  • 70Gs in brain w/o previous concussion
  • threshold drops with each subsequent concussion
48
Q

what regions of the brain are affected

A

Brain stem- RAS
cerebrum (cerebral cortex)
Cerebellum (little brain)

  • *sensory interaction impairments
    • visual and vestibular and auditory pathways
49
Q

Pathophysiology of injury

A

Mechanical damage to axons
Decrease cerebral BF
Diffuse axonal damage
Normal metabolic and cognitive functions in 7-10 days

50
Q

Decrease in cerebral BF

A

Ischemia and hypoxia

51
Q

Diffuse axon damage

A

Impaired signaling between brain centers

52
Q

Post concussion period

A

Residual or persistent signs and symptoms days, weeks, even months after concussion from unresolved brain tissue damage

** more likely to suffer repeat concussion if previous injury not completely healed

53
Q

Assessment of head injury

A

Cognitive function
Affective (behavioral)
Somatic (physical)

54
Q

Cognitive function in assessment

A

Concentration, focus and attention, memory and recall deficits

55
Q

Affective behavioral assessment

A

Emotional responses, anger and depression, lethargy, sleeping problems, irritability

56
Q

Somatic (physical) assessment

A

Headache, nausea, sensitivity to light/noise, visual impairments

  • psychomotor skills, balance deficits
  • exertional - symptoms stress tests –> provokes symptoms
57
Q

Primary signs and symptoms (hallmark)

A
  • loss of consciousness
  • post traumatic amnesia (retro and antegrade)
  • altered mental status (confusion, disorientation,
58
Q

Retrograde amnesia

A

Can’t remember things before incident

59
Q

Anterograde amnesia

A

Can’t form new memory

60
Q

Tools (subjective and objective) for S & S of concussions

A

-Cognitive (computerized or paper and pencil) for memory p, attention, and focus

Psychomotor (computerized or subjective) for balance

Symptom scale for somatic domain

61
Q

Secondary concussion S&S

A
  • persistent headache
  • emotional outburst (crying and laughing)
  • dizziness
  • blurred or double vision (pupillary response)
  • sensitivity to light and sound
  • psychomotor disturbances
  • abnormal vital signs
  • tinnitus (raining or buzzing in ears)
  • nausea
  • shock.
62
Q

Pupillary reaction

A

Anisocoria- oculomotor nerve

63
Q

Post concussion symptom scale

A
    • address somatic domain almost exclusively
    • headache and nausea
    • affective
    • sadness and nervousness
    • cognitive
    • difficulty remembering
64
Q

Cantu guidelines

A

Concussion grading scale based on loss consciousness and severity

65
Q

Grade I cantu

A

Post traumatic amnesia

  • less than 30 min
  • NO loss of consciousness
  • PCSS less than 24 hrs
66
Q

Grade II cantu

A

Loss of consciousness

  • less than 5 min or lasting amnesia 30 min - 24 hrs
  • PCSS greater than 24hrs less than 7 d
67
Q

Grade III cantu

A 
Loss of sconsciousness
Most severe
- greater than 5 min
- amnesia greater than 24 hrs 
- PCSS GREATER 7 d
68
Q

RTP guidelines

A

Changes made to address PTA and PC symptoms

- less emphasis on LOC

69
Q

Concussion: primary survey assessment

A
  • on field or court
  • CNS involvement (primary signs)
  • vital signs
  • lye down, sit up , kneel, and the stand to walk off
70
Q

Concussion: secondary survey assessment

A
  • sidelines or court side
  • HOPS
  • re-assess in training room or clinic
  • F/U daily to monitor progress
71
Q

Types of psychomotor tests

A

Romberg test

Finger to nose

72
Q

Best treatment for head injury

A

Sleep and rest for brain

73
Q

General treatment for head injury

A

Monitor for deterioration of symptoms

    • headache, LOC, dizziness, amnesia
    • have someone check periodically thru night

Tylenol for headache (no NSAIDS)

Need a recovery period cessation of symptoms and healing of neural tissue

RTP guidelines

74
Q

Recovery for head injury

A
  • track PCSS
  • need cognitive test
  • allow additional period of time (1 week) for healing and damage to neural tissue
  • use RTP
75
Q

Second impact syndrome

A
  • loss of auto regulatory function if CNS
  • very RARE (secondary blow to head before recovery from first)
  • impingement of brain stem can cause respiratory arrest and can lead to cardiac arrest
76
Q

Secondary impact syndrome S&S

A
  • collapse with in seconds
  • semi to unconsciousness
  • rapid pupillary dilation, loss of eye movement
  • respiratory failure
77
Q

Amnesia vs LOC

A

Amnesia is more predictive of deficits and poor recovery

78
Q

Over stimulation to injured brain

A

Longer lasting deficits

79
Q

Many athletes have neither LOC or amnesia but rather

A

Temporary confusion

80
Q

Repeat concussion

A

Have a lower threshold for damage

Defer action of brain tissue

81
Q

Dementia pugilistica

A

Irreversible Brian damage (memory loss and motor tremors)

  • early onset of Alzheimer’s and Parkinson’s disease
  • clinical depression
82
Q

PCSS determines

A

Course of recovery

83
Q

Cumulative effects of secondary concussion

A

Brain tissue degeneration

84
Q

Hallmark signs

A

Only secondary signs may be present

85
Q

Microscopic damage

A

Axonal pathways disrupted

- tensile and shear forces

86
Q

Cerebral contusion

A
  • bruising of brain tissue w/ or w/o intracranial hemorrhage
      • often delayed effect (gradual onset of symptoms)
  • effusion/hemorrhage within cranial cavity
      • bleeding into finite space
  • expanding intracranial lesion (EIL)
87
Q

Subdural hematoma

A

Effusion

- capillaries

88
Q

Epidural hematoma

A

Rapid hemorrhage

- artery/arterioles (middle meningeal artery)

89
Q

Second degree fracture to skull

A

expanding of intracranial lesion in cerebral contusion

90
Q

Lucid interval

A

Temporary improvement in patients condition after concussion, after which condition deteriorates
– time period between concussive episode and onset of symptoms of SDH (Subdural hematoma)

91
Q

Subdural hematoma (SDH)

A
  • forceful blows to the head cause damage to bridging veins and capillaries
  • effusion between dura mater and arachnoid
  • increases intracranial pressure (ICP) and produces symptoms (gradual) –> lucid interval
  • progressive headache, deterioration of mental status and psychomotor function
92
Q

Battles signs

A

Ecchymosis at base of skull (mastoid process)

93
Q

Ecchymosis

A

Discoloration because of bruising

94
Q

Cranio facial fractures

A 
Cribiform plate
Nose
Eye orbit
Zygomatic arch (cheek)
Mandible 
Maxilla
Proximity of brain
95
Q

Sinus involvement with face injuries

A
  • para nasal
  • connected to nasal cavity via Ostia
  • lined by mucus membrane
  • susceptible to infection and trauma
96
Q

Cribiform plate fracture

A
  • wafer thin sheet of perforated bone (ethmoid) thru which olfactory nerves pass thru from mucosa to olfactory
  • CSF leakage (rhinorrea)
  • sense of smell
  • sinusitis, mengititis
97
Q

Orbital blow out fracture

A
  • blunt force causing increased pressure in socket or bottom rim
  • Fx of infra orbital plate
  • contents drop into maxillary sinus
  • loss of eye movement or fixed gaze!!!!!!!*****
    • -> ocular muscular entrapment
  • Periorbital ecchymyosis (raccoon eyes)
  • need stray or ct scan to diagnose
98
Q

Zygomatic arch (tripod)

A
  • prominent bone (arch)
  • forms part of eye socket
  • MOI: direct blow
  • second most common facial fracture after nasal
  • facial collapse

Prevention and Care Exam 2 (4 decks)

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