Blunt Trauma to Head and Neck -- SD

Question 1

If we have an injury in “zone 1”, what do we worry about?

Answer 1

Subclavian, aortic arch, trachea, c-spine roots

Question 2

If we have an injury in “zone 2”, what injuries do we worry about?

Answer 2

Carotid/vertebral arteries, jugular vein, larynx, c-spine

Question 3

If we have an injury in “zone 3”, what injuries do we worry about?

Answer 3

Trachea, vertebral bodies, carotids, jugular, CN 9-12

Question 4

95% of penetrating neck wounds are caused by?

Answer 4

Knife/guns

Question 5

If someone has a penetrating wound from a knife, what’s important to know about the knife?

Answer 5

How big is it

Question 6

Must common cause of blunt trauma to the neck?

Answer 6

MVA

Question 7

In reference to neck injuries, symptoms are a good or poor predictor of underlying damage?

Answer 7

Poor!

Question 8

On PE we must know if the ________ has been violated. If it hasn’t, it’s very unlikely we have a penetrating injury.

Answer 8

Platysma

Question 9

What are some signs of underlying injury from blunt trauma?

Answer 9

Hematemesis, odynophagia, voice changes, subQ emphysema

Question 10

True or False:

If we know the platysma has been violated we should send them to CT immediately?

Answer 10

False – skip imaging, go the OR immediately

Question 11

Shock, expanding hematoma, impending airway obstruction, bruit, or blood in aerodigistive tract are all indicators for?

Answer 11

Surgical exploration

Question 12

If a neurologic deficit is found on contralateral side, we must consider what type of injury?

Answer 12

Carotid/vertebral artery injury

Question 13

Should we remove foreign bodies in the ED? like knives and such?

Answer 13

no – many be only thing holding carotids together

Question 14

True or False

It takes a lot of force to break the frontal bone

Answer 14

True! High velocity injuries

Question 15

What will you find on exam of a frontal bone fracture?

Answer 15

Well feel a divot, depression of forehead

Question 16

What type of fracture can be isolated or occur with medical wall fracture?

Answer 16

Orbital floor fracture

Question 17

What do we need to worry about with orbital floor fractures?

Answer 17

Fracture can herniate orbital contents into sinus and can cause entrapment of the inferior rectus muscle

Question 18

How do diagnose a orbital floor fracture?

Answer 18

Non-contrast maxillofacial CT scan

Question 19

What can we not miss with a nasal bridge fracture?

Answer 19

Do not miss a septal hemaotma

Question 20

This type of fracture may present with CSF rhinorrhea and constant tearing after trauma

Answer 20

Nasoethmoidal fracture

Question 21

Nasoethmoidal fractures risk damage to what other structures?

Answer 21

Medial canthus, lacrimal gland, nasofrontal duct, and cribiform plate

Question 22

How do we diagnose a nasoethmoidal fracture?

Answer 22

CT scan

Question 23

This type of fracture usually occurs from a direct blow and is typically isolated

Answer 23

Zygomatic arch fracture

Question 24

what kind of x-ray do we get to diagnose a zygomatic arch fracture?

Answer 24

X-ray of head tilted back to isolate the zygomatic arch

Question 25

For what types of fractures do we use the LeFort classification?

Answer 25

Maxillary

Question 26

Facial edema, mobility of palate and teeth is which type of classification?

Answer 26

LeFort 1

Question 27

Telecanthus, mobility of maxilla, epistaxis, CSF rhinorrhea is what type of classification?

Answer 27

LeFort 2

Question 28

Facial elongation/flattening, movement of all facial bones with respect to cranial base, CSF rhinorrhea is what type of classification?

Answer 28

LeFort 3

Question 29

How do we treat maxillary fractures?

Answer 29

Surgery

Question 30

What type of mandible fracture is most commonly overlooked?

Answer 30

Condyle fracture

Question 31

What test on physical exam can we do to diagnose a mandible fracture?

Answer 31

Tongue blade test -- bite on tongue depressor and twist it. With a broken jaw it will slide right out

Question 32

What should you do if you have a broken tooth?

Answer 32

Store avulsed tooth in whole milk and give the the patient a temporary filling/dental block

Question 33

Battle's sign, raccoon eyes, and hemotympanum are symptoms of?

Answer 33

Basilar skull fracture

Question 34

How do you know if a patient has CSF coming out of their ear/nose?

Answer 34

Grab a piece of gauze and if there is CSF you will see a separation of the CSF from blood -- halo sign

Question 35

What is hallmark of a Basilar skull fracture?

Answer 35

CN1 deficit with or without CN 7, 8

Question 36

If someone has an orbital blowout fracture, who must be consult with?

Answer 36

Ophthalmologist +/- ENT

Question 37

Nasoethmoidal fracture -- who must be consult with?

Answer 37

Neurosurgery