Chapter 20 Head and Facial Conditions

Question 1

What does a small weak pulse indicate?

Answer 1

pulse pressure is diminished, and the pulse feels weak and small; causes include a decreased stroke volume and increased peripheral resistance

Question 2

What does a short, rapid, weak pulse indicate?

Answer 2

indicates heart failure or shock

Question 3

What does a slow bounding pulse indicate?

Answer 3

Indicates increasing intracranial pressure

Question 4

What does an accelerated pulse indicate?

Answer 4

May indicate pressure on the base of the brain

Question 5

What does bradypnea (slow breathing) indicate?

Answer 5

breathing less than 12 breaths per minute indicates increased intracranial pressure

Question 6

What does cheyne-stokes breathing indicate?

Answer 6

Periods of deep breathing alternating with periods of apnea indicates brain damage

Question 7

What is ataxic (Biot’s) breathing and what does it indicate?

Answer 7

characterized by unpredictable irregularity; breaths may be shallow or deep and stop for short periods, indicating respiratory depression and brain damage typically at the medullary level

Question 8

What does apneustic breathing indicate?

Answer 8

characterized by prolonged inspirations unrelieved by attempts to exhale, which indicates trauma to the pons

Question 9

What does an increase in systolic BP or a decrease in diastolic BP indicate?

Answer 9

Increase in systolic BP or a decrease in diastolic BP indicates rising intracranial pressure
Low BP rarely occurs - may indicated a possible c/s injury or serious blood loss from an injury elsewhere in the body

Question 10

What is the normal difference between systolic and diastolic BP?

Answer 10

40mmHg

Question 11

What does a pulse pressure greater than 50mmHg indicate?

Answer 11

a pulse pressure greater than 50 mmHg indicates increased intracranial bleeding

Question 12

What are scalp injuries?

Answer 12

Blunt trauma or penetrating trauma often leads to scalp abrasions, lacerations, contusions or hematomas between layers of tissue
S/S – patient will report being hit on the head, bleeding can be profuse and may mask serious underlying conditions
Important to clear head and spinal injuries

Question 13

What is a skull fracture?

Answer 13

Linear (in a line), comminuted (multiple pieces), depressed (fragments driven internally towards the brain), basilar (involving the base of the skull)
Difficult to detect the presence of a deep scalp hematoma
Break in skin adjacent to the fracture site and tear in underlying dura matter  high risk of septic meningitis
S/S – Racoon eyes, Battle signs

Question 14

What is an epidural hematoma?

Answer 14

Very rare during sport participation
Caused by a direct blow to the side of the head and almost always is associated with a skull fracture
Middle meningeal artery or its branches are severed – subsequent arterial bleeding leads to a high-pressure epidural hematoma
S/S – initial LOC followed by lucid intervals which the patient may feel normal and asymptomatic, within 10 – 20 minutes gradual decline in mental status, headache, vomiting, , ipsilateral dilated pupil, decerebrate posture

Question 15

What is a subdural hematoma?

Answer 15

Hemorrhage occurs when the bridging veins between the brain and the dura matter are torn
MOI – acceleration forces of the head rather than the impact of the force
Acute – 48 – 72 hours after injury or chronic – occurs later in time frame with more variable clinical manifestations
Simple – blood collects in the subdural space but no underlying cerebral injury occurs
Complex - contusions to the brain’s surface and associated cerebral swelling that increases intracerebral pressure
S/S – LOC and remains unconscious, pupil dilation, irregular respiration, falling pulse rate, rise in BP, increased body temperature

Question 16

What is a cerebral contusion?

Answer 16

A focal injury but a mass-occupying lesion is not present
Micro-hemorrhage, cerebral infarction, necrosis and edema of the brain occur
Visible on CT scan as an area of high-density blood interspersed with brain tissue
MOI – acceleration-deceleration mechanism from the inward deformation of the skull at the impact site
Red flags – normal neurological exam but has persistent symptoms such as headaches, dizziness or nausea

Question 17

What are cerebral concussions?

Answer 17

“a complex pathophysiological process affecting the brain induced by traumatic biomechanical forces”
Caused by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force that can be transmitted to the head
Neuropathologic changes may occur, acute clinical symptoms reflect functional disturbance rather than structural injury
May or may not involve LOC
16 different classification schemes
Most resolve within 7-10 day, no two concussions are identical

Question 18

What is the RTP protocol for a concussion?

Answer 18

Active recovery – symptom limited physical and cognitive rest
Light aerobic exercise – walking, swimming, stationary cycling < 70% of maximum predicted heart rate, no resistance training
Sport-specific exercise with no head impact activities
Noncontact training drills – more complex drills, start resistance training progressively
Full-contact practice – following medical clearance, participate informal training activities
Return to play – normal game play

Question 19

What is a posttraumatic headache?

Answer 19

Can be confused with a simple concussion or a post-concussive headache
Vascular headache – result of vasospasm and does not usually occur with impact but develops shortly after
S/S – localized area of blindness, brilliantly coloured shimmering lights
Post-traumatic migraine headaches – repetitive heading of the ball

Question 20

What is post-concussion syndrome?

Answer 20

May develop after any concussion and tends to occur more frequently in women than men
Cognitive physical or emotional impairments may last several weeks or months after injury – extended duration of symptoms is thought to be related to altered neurotransmitter function
Some symptoms may predispose individual to second-impact syndrome

Question 21

What is second-impact syndrome?

Answer 21

Type of diffuse brain injury, is precipitate by an earlier event where a patient sustains a concussion which is unresolved
While in postconcussive state, patient receives a second blow to the head
Diffuse cerebral swelling and brainstem herniation occur – 3 to 5 minutes from time patient receives hit
S/S – patient collapses with rapid dilating pupils, loss of eye movement, respiratory failure

Question 22

What is temporomandibular joint conditions?

Answer 22

Sliding hinge joint stabilized by ligaments and is separated into upper and lower compartments by a fibrocartilage meniscus
S/S - injury occurs when a blow to the mandible transmits the force to the condyles
Intracapsular bleeding, inflammation of capsular ligament, meniscal displacement, subluxation/dislocation of the condyles or fracture

Question 23

What are zygomatic fractures?

Answer 23

Can affect vision, function of the jaw, width of the face
S/S – flat or depressed appearance of cheek, preorbital ecchymosis around eye occluding vision, double vision, numbness

Question 24

What is a Le Fort Fracture I?

Answer 24

fracture to the maxilla may involve separation of the palate

Question 25

What is a Le Fort Fracture II?

Answer 25

extends into nasal region

Question 26

What is a Le Fort Fracture III?

Answer 26

Complete craniofacial dissociation

Question 27

What is the management for all type of Le Fort Fracture?

Answer 27

maintain airway, forward sitting to allow for adequate drainage of saliva and blood

Question 28

What is epistaxis?

Answer 28

Nosebleed – anterior bleeds more common Originates from superficial blood vessels on the anterior septum known as the Kiesselbach plexus Posterior bleeding – arises from posterior nasal cavity via branches of the sphenopalatine arteries MOI – picking of nose, secondary to blunt facial impact or MVC, mucosal hyperemia secondary to allergic or viral rhinitis, foreign body, chronic intranasal drug use S/S – mild pressure at nasal bone for 5-15 minutes, mouth breathing and leaning forward

Question 29

What is a deviated septum?

Answer 29

May be congenital and asymptomatic Nasal trauma can occur

Question 30

What is a nasal fractures?

Answer 30

Most prominent facial feature, most commonly fractured bone S/S – epistaxis almost always present, nose appears to be flattened and lose its symmetry

Question 31

What is gingivitis?

Answer 31

Gingivitis (mild inflammation of the gums) to periodontitis (inflammation of the deeper gum tissues that normally hold the teeth in place) Gingivitis caused by bacteria that irritates the gums, leading to swelling and bleeding  untreated = periodontitis  loss of teeth Reduce risk – daily brushing, regular flossing, frequent professional cleaning

Question 32

What are dental caries?

Answer 32

Caused primarily by plaque  plaque collects and hardens, tartar is formed  bacteria within plaque dissolves tooth enamel  openings in tooth enamel  bacteria infects tooth centre Abscessed tooth  painful infection at the root of a tooth or between the gum and a tooth

Question 33

What do you do with a displaced tooth ?

Answer 33

try to place tooth back into its normal position without forcing it  dentist immediately

Question 34

What do you do for an intruded tooth?

Answer 34

leave it alone

Question 35

What do you do with a dislocated tooth?

Answer 35

rinsed in milk or saline and replaced intraorally in the tooth socket within 30 minutes

Question 36

What is a fractured tooth?

Answer 36

Dentist will attach a permanent composite resin crown Pulp exposed  more dental work Pulp exposure small  pulp-capping procedure whereby calcium hydroxide is placed on the area, can bridge the exposed area and can eliminate need for root canal

Question 37

What is an auricular hematoma or cauliflower ear?

Answer 37

Auricular hematoma or cauliflower ear – repeated blunt trauma pulls the cartilage away from the perichondrium Hematoma forms between the perichondrium and cartilage of the ear and compromises blood supply to the cartilage leading to a painful, throbbing injury S/S – outer ear red, puffy, swollen, untreated  hematoma forms a fibrosis in the overlying skin Ice to reduce swelling  still present  hematoma aspirated by physician  pressure dressing NSAIDs not but antibiotics recommended

Question 38

What is an internal ear condition?

Answer 38

A blow to the ear, pressure changes and infection may injure the external auditory meatus and eardrum S/S – fullness, nausea, tinnitus, dizziness, hearing loss

Question 39

What is an impacted cerumen?

Answer 39

Ear wax is produced by the ceruminous glands which as modified apocrine glands in the external auditory canal Cerumen builds up excessively and becomes compacted S/S – hearing loss/muffled hearing

Question 40

What is an otitis externa?

Answer 40

Bacterial infection that involves the lining of the external auditory canal “swimmer’s ear” Occurs in patients who fail to dry ear canal after being in water, resulting in a change of the pH of the ear canal’s skin S/S – itching common, may or may not be discharge of pus Management – ear plugs, ear drops

Question 41

What is an otitis media?

Answer 41

Localized infection of the middle ear occurs secondary to upper respiratory infections S/S – complaint of fullness in the ear, swelling of mucous membrane may cause partial or complete block of eustachian tube, inhibition of hearing, tympanic membrane red and bulging

Question 42

What is a tympanic membrane rupture?

Answer 42

Damage interrupts the hearing process and may impair hearing, allows bacteria to enter causing infection S/S – very painful, tinnitus, pus or blood in ear

Question 43

What is periorbital ecchymosis?

Answer 43

Impact forces causing swelling and hemorrhage into the surrounding eyelids – black eye

Question 44

What is a sty?

Answer 44

An infection of the sebaceous gland at the edge of the eyelid and is typically caused by Staphylococcus bacteria Blepharitis is an inflammation of the eyelash follicle alone the edge of the eyelid

Question 45

What is a conjunctivitis?

Answer 45

An inflammations often resulting from chlorine irritation or bacterial infection of the conjunctiva S/S – itching, burning or watering of eye, conjunctiva becomes inflamed and red

Question 46

What is a partial-thickness corneal laceration?

Answer 46

Partial-thickness Doesn’t violate globe of eye – abrasion Pain, tearing, photophobia

Question 47

What is a full-thickness corneal lacerations?

Answer 47

Penetrates through cornea causing a ruptured globe Pain, decreased visual acuity, displacement of pupil

Question 48

What is a subconjunctival hemorrhage?

Answer 48

Red eye – several small capillaries rupture making the white sclera of the eye appear red, blotchy and inflamed Resolves in 1-3 weeks

Question 49

What is a hyphema?

Answer 49

Hyphema – Results from blunt trauma caused by small object Red tinge in anterior chamber Management – patch eyes and refer to physician

Question 50

What is a detached retina?

Answer 50

When fluid seeps into the retinal break and separates the neurosensory retina from the retinal epithelium S/S – positive scotoma (blind spot), curtain falling over eyes, flashes of lights Management – patch, physician, surgery