ch:20 head and facial cond

Question 1

vital signs

Answer 1

pulse
respiratory rate
bp
body temp

Question 2

pulse in head trauma

Answer 2

slow,bounding pulse= inc intracranial pressure

accelerated pulse= pressure at the base of the brain

Question 3

respiration and head trauma

Answer 3

slow breathing= inc intracranial pressure

cheyne-stock (alternating periods of breathing and apnea)= brain damage

ataxic(unpredictable)= respiratory depression and brain damage typically at the medullary level

apneustic (pronlonged inhlae no exhale)= trauma to pons

Question 4

bp and head trauma

Answer 4

inc systolic or dec diastoli = rising intracranial pressure

Question 5

anterograde vs retrograde memory

Answer 5

anterograde= amnesia of event after point of injury

retrograde = amnesia before the point of injury

Question 6

raccoon eyes

Answer 6

skull fx
- fracture of the eyebrow level that travels into the ant cranial fossa and sinuses

Question 7

battle sign

Answer 7

basilar fx above and behind the ear

Question 8

epidural hematoma

Answer 8

focal injury
- direct blow to the side of the head almost always associated w/ skull fx
s/s
- LOC and then regained feeling normal
- gradual decline in mental status
- h/a
- drowsiness
- nausea/vomiting
- ipsilateral dilated pupils

Question 9

subdural hematoma

Answer 9

• more common the epidural
• hemorrhage occurs when the bridging vein btw the brain and the dura mater is torn
• caused by acceleration forces of the head
• either simple or complicated
  complicated = deadly

Question 10

s/s of inc intracranial pressure

Answer 10

• pupillary dilation and retinal change on affected side
• irreg eye tracking/ mvt
• severe h/a
• nausea/vomiting
• confusion/emotional
• progressive or sudden LOC
• rising bp
• failing pulse
• irreg respiration
• inc body temp

Question 11

what are concussion defined as

Answer 11

a brain injury and is a complex pathophysiological process affecting the brain, induced by biomechanical forces

Question 12

external provocative tests for head traumas

Answer 12

• 40yard sprint
• five jumping jacks
• ffive sit-ups
• five push-ups
• five kn bends

Question 13

five motion tested in VOMS

Answer 13

• smooth pursuit
• hz and verticle saccades
• convergence
• hz vestibular ocular reflex
• visual motion sensitivity

Question 14

posttraumatic h/a

Answer 14

• vascular h/a is a result od vas-plasm normally dev shortly after impact
• localised area of blindness
• refer to physician

Question 15

postconcussion syndrome

Answer 15

length of sysptom persistence after concussion
- related to altered neurotransmitter func
- may predispose pt to second impact syndrome

Question 16

second impact syndrome

Answer 16

• precipitated by an earlier event of concussion that is unresolved.
• A second blow to the head results in diffuse cerebral swelling and brainstem herniation.
• happens 3-5min after the second blow
• pt collapses and progressively dies

Question 17

facial red flags

Answer 17

• obvious deformity or crepitus
• irregular eye mvt or failure to accommodate to light
• appearance of long face
• malocclusion of the teeth
• inc pain on palpation

Question 18

normal opening of the jaw

Answer 18

40mm

Question 19

mandible fx

Answer 19

common site: mandibular angle and condyles
management
- imp to keep open airway
- barten bandage
- tongue bite test

Question 20

René le Fort maxilla fx classification

Answer 20

Le Fort Fx I: fx separating of the palate
II: extends into nasal region
III: involve complete craniofacial dissociation

Question 21

epistaxi

Question 22

types of epistaxi (origin)

Answer 22

anterior bleeding: originates form superficial bld vessels on the ant septum
kiesselbach plexus

POSTERIOR bleeding: post nasal cavity via branches of the sphenopalatine arteries leading to significant hemorhage

Question 23

why apply ice to back of neck with nosebleed

Answer 23

activate mammalian diving reflex
causing peripheral vasoconstriction

Question 24

epistaxis red flags

Answer 24

• CSF
• +5min
• loss of smell
• foreign objects that cannot be removed easily
• nasal deformity or fx

Question 25

periodontal disease

Answer 25

gingivitis vs periodontitis mild inflammation to gums vs inflammation of the deeper gums tissues that normally hold the teeth in place

Question 26

oral and dental red flags

Answer 26

-laceration involving the lip, outer border of the lip or tongue - any indv complaining of a persistent toothache or sensitivity heat or cold - loose teeth either laterally displaced, intruded or extruded - inability to close jaw - chipped, crack tooth - malocclusion of the teeth

Question 27

abscessed tooth

Answer 27

painful infection at the root of the tooth or btw the gum and a tooth

Question 28

displaced tooth/luxated tooth

Answer 28

displaced anterior = AT tried to replace it Pushed down= leave it be and refer to dentist luxated: conserve in milk or saline implatation in 2h inc chance of saving tooth

Question 29

otitis externa vs media

Answer 29

externa = localized inflammation of the auditory canal media= impacted cerume (swimmers ear)

Question 30

cauliflower ear

Answer 30

auricular hematoma - red and puffy outer ear - swollen - can be aspirated by physician to avoid cauliflower ear

Question 31

impacted cerumen

Answer 31

ear wax - build up - hearing loss

Question 32

otis externA

Answer 32

bacterial infection involves linning of the external auditory canal - swimmers ear - failure to dry ear canal after water activity -

Question 33

otis media

Answer 33

infection of the middle ear - secondary to upper respiratory infections - dec hearing - ear poping

Question 34

tympanic membrane rupture

Answer 34

cause - infection - direct trauma - change in pressure - loud, sudden noise - foreign objects s/s - very painful - hearing loss

Question 35

periorbital ecchymosis

Answer 35

black eye can lead to - subconjuctival hemorrhage - faulty vision

Question 36

sty

Answer 36

infection of the sebaceous gland at the edge of the eye lid cause - staphylococcus bacteria blepharitis is an inflammation of the eyelash follicle along the edge of the eyelid

Question 37

conjunctivitis

Answer 37

pinkeye inflammation, often resulting from chlorine irritation or bacterial infection of the conjunctiva

Question 38

corneal laceration

Answer 38

abrasion= wet covering and refer to eye doctor laceration= pressure should be avoided, both eyes covered, ems -

Question 39

subconjuctival hemorrhage

Answer 39

direct trauma red eyes (petry) - common w/ high BP - small capillaries ruptur - harmless cond - 1-3wk resolution - referal if: blured vision, pain, limited mvt, blood ant chamber

Question 40

hyphema

Answer 40

hemorrhage into ant chamber - blunt trauma - bleeding in ant chamber - cover both eyes - emergency - hospitalisation

Question 41

scotoma

Answer 41

blind spot perceived by pt

Question 42

orbital blowout fx

Answer 42

- globe descends into the defect in the floor - droopy eye - blunt trauma - displopia (double vision) - NUMBNESS - lack eye mvt - refered