Chapter 26 - Head, Face, Eyes, Ears, Nose, Throat Flashcards Preview

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Flashcards in Chapter 26 - Head, Face, Eyes, Ears, Nose, Throat Deck (156):
1

what joints make up the skull?

sutures - immovable joints

2

cranial vault

houses brain

3

bones of skull

frontal, ethmoid, sphenoid, 2 parietal, 2 temporal, occipital bones

4

cerebrum

2 hemispheres; voluntary muscle activity

interprets sensory impulse,

controls higher mental functions (memory, reasoning, intelligence, learning, judgement, emotions)

5

Cerebellum

controls synergistic movements of skeletal muscle

coordination of voluntary movements

6

pons

controls sleep, posture, respiration, swallowing, bladder

7

medulla oblongata

lowest part of brain stem, regulates HR, BP, coughing, sneezing, vomiting

8

Meninges: outer to inner

dura mater - subdural space - arachnoid mater - subarachnoid space - pia mater

9

where is the CSF located?

b/w arachnoid mater and pia mater

( surrounds and suspends the brain)

10

History: head injury

retrograde amnesia - loss of memory of events before injury

anterograde amnesia - loss of memory of events after injury

11

Observation: head injury

disorieneted, blank stare, slurred speech, delayed verbal/motor responses, coordination, unfocused, distracted, memory deficit, normal cognitive functioning

12

palpation: head injury

tenderness, deformity on neck or skull

13

Special tests: head injury

neurologic, eye function, balance tests

14

neuro exam: head injury

cerebral testing (cognitive)

cranial nerve testing

cerebellar testing (coordination of motor function)

sensory testing

reflex testing

motor testing

15

Eye function exams

PEARL, eyes tracking, blurred vision

16

PEARL

pupils equal and reactive to light

dilated or irregular,

inability to accommodate light variance

17

Eye tracking

smooth movement,
rotary movement - nystagmus (possible lesion in posterior fossa of brain)

18

Balance tests

Romberg, BESS, coordination, cognitive tests, neuropsychological assessments

19

Romberg test

stand in double leg, single leg, tandem stances with shut eyes and hands at the sides

(+) tendency to sway or fall

20

BESS

balance error scoring system

double, single (non dominant foot), tandem stances (non dominant food to back) on hard and airex pad.

hands on hips, eyes close, for 20 sec, opposite limb is in 30 degrees of hip flexion and 40-50 degrees of knee flexion

max error score of 10

21

BESS errors

hands lifted off iliac crest, opening eyes, step, stumble, fall, moving angle of hip or knee, lifting forefoot, or heel, can't stay in position of more than 5 sec

22

coordination tests

finger to nose, heel toe walking, standing heel to knee test

(injury to cerebellum)

23

Cognitive tests

count backwards from 100 by 7s, backwards spelling, naming months in reverse, tests of recent memory

24

Neuropsychological assessments

SAC, SCAT, ANAM

25

SAC

standarized assessment of Concussion

measures of orientation, immediate memory recall, concentration, delayed recall, neurological screening (LOC, amnesia, strength, sensation, coordination)

26

ANAM

Automated Neuropsychological Assessment Metrics

ex. ImPACT

sensitive to measuring cognitive function most susceptible to deficit after concussion

27

Skull Fx Etiology

often from blunt traum

28

skull fx S/Sx

severe headache, nausea, defect or indentation, blood in middle ear/ear canal/nose; ecchymosis around eyes (raccoon eyes); ecchymosis behind the ear (Battle's sign), cerebrospinal fluid in ear canal and nose

29

skull fx management

complications from intracranial bleeding

bone fragments in brain

infection

immediate hospitalization and referral to surgeon

30

cerebral concussions

mild head injury

31

concussion etiology

immediate and transient post-traumatic impairment of neural functions

direct blow

32

countrecoup

injury to opposite side of initial contact

33

concussion S/Sx

blurred vision, dizziness, drowsiness, excess sleep, easily distracted, fatigue, in a fog, slowed down, headache, irritable, LOC, disorientated, memory issue, poor balance, ringing in ears, sensitive to light or noise, sleep disturbance, nausea/vomiting

34

post concussion syndrome etiology

occurs following a concussion, may be a few hours or a day after the initial impact

35

post concussion symtpoms/signs

persisten headache, impaired memory, lack of concentration, anxiety and irritable, giddy, fatigue, depression, visual disturbances, (can be weeks - months long)

36

second impact syndrome etiology

rapid swelling and herniation of the brain after a second head injury that occurs before the first is resolved.

brains blood auto regulatory system causes swelling of brain - increases pressure

37

second imapct S/Sx

no LOC, may look stunned, happens rapidly, dilated pupils, loss of eye movement, LOC -->coma, respiratory failure,

50% mortality rate

38

second impact management

must be noticed within 5 min, send to EMS,

prevention is key to avoiding second impact syndrome

39

Cerebral Contusion etiology

focal injury to brain that involves small hemorrhages or intracerebral bleeding in cortex, brainstem, or cerebellum

impact injury, head strikes immoveable object

40

cerebral contusion S/Sx

LOC, later becomes very alert and talkative, neuro exam will be normal, (headache, dizzy, nausea will persist)

41

cerebral contusion management

hospitalization, CT or MRI tests

42

Malignant Brain Edema etiology

occurs in young athletic population

diffuse brain swelling resulting from hyperemia or vascular engorgement

little to no injury to the brain

raises intracranial pressure, can be life-threatening

43

hyperemia

an excess of blood in the vessels supplying an organ or other part of the body.

44

Malignant Brain Edema S/Sx

rapid neuro detioration to coma and sometimes death

45

management of malignant brain edema

immediate recognition

rapid tx in emergency facility

46

Epidural hematoma etiology

blow to the head or skull fracture can cause tear of meningeal arteries

rapid blood accumulation --> hematoma

(happens in minutes o hours)

47

Epidural hematoma S/Sx

LOC, gradually worsening symptoms,

head pain, dizziness, nausea, dilation of one pupil (same side as injury), sleepiness

later symptoms: deteriorating consciousness, neck rigidity, depression of pulse/respiration, convulsions

48

management epidural hematoma

CT scan to diagnose, pressure must be surgically released

49

Subdural hematoma etiology

more frequent than epidural,

most common cause of death in athletes

acute: progress rapidly, like an epidural hematoma, arterial bleeding, assoc with brain contusion and skull injury

chronic: venous bleeding, low pressure, takes longer to become "serious"

50

S/Sx of subdural hematoma

complicated: LOC, dilation of one pupil (same side as injury)

Uncomplicated and complicated mutual symptoms: headache, dizzy, nausea, sleepiness

51

management for subdural hematoma

immediate transfer, CT scan, MRI needed

52

Migraine headaches etiology

neurological disorder which can last 4-72 hours

common in women
may be genetic

triggers: foods, meds, sensory stimuli, lifestyle changes

53

migraine symptoms

throbbing, pulsating pain on one side of head, nausea, vomiting, sensitive to light/sound/smell, aura, visual changes, tingling sensation, numbness, dizziness

54

management for migraine

prevention - prophylactic meds

55

where are frontal sinuses housed

supraorbital ridges

56

temporomandibular joint

articulation b/w mandibular condyle and mandibular fossa of temporal bone

hinge joint, also glides forward and backward, side-to-side when chewing.

57

mandible fracture etiology

mostly in collision sports;
usually lower jaw frontal angle

58

mandible fx S/Sx

deformity, loss of normal occlusion of teeth, pain when biting, bleeding around teeth, lower lip numbness

59

mandible fx management

temporary immobilization,

reduction and fixation by physician

4-6 week recovery, resume full activity in 2-3 months

60

mandibular dislocation etiology

prone to dislocation,
side blow to open mouth, forces condyle forward out of temporal fossa

61

mandibular dislocation s/sx

locked open position, malocclusion of teeth

62

managemtn - mandibular dislocation

ice, immobilize, reduce
soft food diet, NSAIDs, analgesics,

63

TMJ Dysfunction etiology

usually involves disk-condyle derangement
disk is positioned anteriorly when the jaw closes, when jaw opens condyle translates forward

audible click is heard -

causes deterioration of posterior stabilizing structures and eventually anterior dislocation of disc

64

TMJD s/sx

headache, earache, vertigo, inflammation, neck pain - trigger points,

inflammation of synovial capsule, disk derangemetn, malocclusion, hyper/hypo-mobility, msucle dysfunction, limited ROM

65

management of TMJD

correct mobility issue, strengthening exercises, joint moves,

dental appliance is recommended

66

Zygomatic Complex (Cheekbone) Fx Etiology

direct blow to cheekbone,

can be classified as a LeFort Fx

67

Lefort Fx

fx of one or more facial bones

68

facial bones

zygomatic, maxillary, orbital, nasal

69

Zygomatic Fx - S/Sx

obvious deformity, bony discrepancy, nosebleed, double vision, numbness of cheek

70

management zygomatic fx

cold application, immediate referral, healing takes 6-8 weeks

71

epistaxis

nosebleed

72

diplopia

double vision

73

Maxillary fx etiology

severe blow to upper jaw

74

maxillary fx s/sx

pain with chewing, malocclusion, nosebleed, double vision, numbness in lip and cheek

75

maxillary fx management

airway maintained, transportation in upright forward leaning position,

fx reduction, fixation, immobilization

76

crown

portion protruding from gum - covered by enamel

77

root

portion that extends into alveolar bone of the mouth

covered by cementum

78

dentin

beneath enamel and cementum, bulk of tooth

79

pulp

lies w/in dentin,
contains nerves, lymphatics, blood vessels that supply entire tooth

80

Preventing dental injuries

mouth guards, dental hygiene

81

progression of cavity

abscess --> gingivitis (gums inflamed) ---> periodontitis (degeneration of dental periosteum, surrounding bone, and cementum)

82

Tooth Fx etiology

impact, direct trauma

83

uncomplicated crown fx

small portion broken, no bleeding, pulp chamber not exposed,

84

complicated crown fx

larger portion broken, bleeding from fx, pulp chamber exposed, great deal of pain

85

root fx

occurs below gum line
tooth may appear normal, bleeding from gum,
crown of tooth may be pushed back or loose

86

Tooth Subluxation, luxation, avulsion S/Sx

slightly loosened tooth, completely dislodged,
luxated - extremely loose,

87

Tooth Subluxation, luxation, avulsion management

sublux - immediate tx not required

luxation - move tooth to normal position if possible, see dentist ASAP

avulsion - rinse tooth, put in save a tooth, re-implant if possible - transport to dentist

88

nose functions

clean, warm, and humidify inhaled air

89

nasal fx / chondral separations etiology

lateral force causes greatest deformity

90

nasal fx/chondral separation s/sx

separation of frontal processes of maxilla, separation lateral cartilage, or combo of 2

profuse bleeding, swelling, hemorrhaging, crepitus

91

deviated septum

cause: compression or lateral trauma

s/sx: bleeding, septal hematoma, nasal pain

tx: compression applied, must be drained and packed

92

3 parts of the ear

external ear

middle ear

internal ear

93

middle ear

tympanic membrane

94

internal ear

labyrinth, formed partly by temporal bone of skull

95

eustachian tube

aids the organs of hearing and equalizing pressure between the middle and internal ear

joins ear and nose

96

external auditory canal

meatus

97

auricle

pinna

98

auricle hematoma aka

cauliflower ear

99

auricular hematoma etiology

compression or shearing to the auricle
causing subcutaneous bleeding

100

auricular hematoma s/sx

hematoma,
untreated - keloid formation

101

keloid

elevated, rounded, white, nodular, and firm (like a cauliflower)

102

auricular hematoma management

petroleum jelly and headgear

cold pack,

aspiration by physician

pack ear with cotton

103

tympanic membrane rupture etiology

fall/slap to unprotected ear

sudden underwater pressure variation



104

otoscope

inspection device for ear

105

tympanic membrane rupture management

heal in 1-2 weeks; infection is possible

106

swimmer's ear known as

otitis externa

107

otitis externa etiology

infection of external auditory ear canal

caused by: Pseudomonas Aeruginosa (Bacillus)

108

otitis externa s/sx

pain, dizziness, itching, discharge, partial hearing loss,

109

otitis externa management

prevent by drying ears, using ear drops, and an alcohol solution

tx with acidification through drops into the ear or antibiotics

110

Otitis media aka

middle ear infection

111

otitis media etiology

accumulation of fluid in middle ear caused by local and systemic inflammation and infection

112

otitis media s/sx

intense pain, fluid drainage, loss of hearing, systemic infection which could cause fever, headache, irritability, loss of appetite, and nausea

113

otitis media management

analgesics, antibiotics

114

Impacted Cerumen etiology

excessive amounts of earwax

115

impacted cerumen s/sx

muffled hearing, little to no pain
no infection

116

impacted cerumen management

remove earwax with irrigation, do no use a q-tip,

may need a physician to remove with a curette

117

sclera

tough, white outer layer covering the eye

118

cornea

transparent portion of the sclera, covers pupil

119

how do we see

light passes through the cornea, then the anterior chamber, past the iris and the lens, and through the vitreous body - which focuses the image on the retina, where it is detected by the optic nerve

120

when dealing with the eye what injuries would require immediate referral

retinal detachment

perforation of the globe

foreign object embedded in cornea

blood in anterior chamber,

decreased vision

loss of visual field

poor pupillary adaptation

double vision

laceration

121

Testing pupillary reaction

pupil dilation and accommodation by covering eye then exposing it to full light

122

testing for visual acuity

snellen eye chart

123

ophthalmoscope

instrument for observing interior of the eye (especially the retina)

124

Orbital Hematoma aka

black eye

125

orbital hematoma etiology

blow to eye may initially injure the surrounding tissue & produce capillary bleeding into tissue spaces

126

orbital hematoma s/sx

ecchymosis, pain

more serious: subconjunctival hemorrhage or faulty vision

127

oribtal hematoma management

ice, do not blow nose

128

orbital fx etiology

blow to eyeball that forces it posteriorly, compresses the orbital fat until a blowout or rupture occurs to the floor of the orbit

129

orbital fx s/sx

diplopia, restricted eye movement, downward displacement of the eye, pain accompanied by soft tissue swelling and hemorrhage

130

orbital fx management

prophylactic antibiotics

treated surgically

131

corneal abrasions and lacerations etiology

caused by rubbing of a eye where there is a foreign body

132

corneal abrasion s/sx

severe pain and watering eyes, photophobia, spasm of the orbicular muscle of the eyelid

133

corneal abrasion management

eye patch

diagnose with fluorescein strip

antibiotics

134

hyphema etiology

collection of blood within the anterior chamber,

caused by being struck in the eye (by a ball)

135

hyphema s/sx

referral to physcian, hospitialize, bed rest, patch both eyes, sedation,medication

136

globe rupture etiology

blow to eye by a small object (golf ball)

137

globe rupture s/sx

pain, decreased visual acuity, diplopia, irregular pupils, increased intra-ocular pressure, orbital leakage

138

globe rupture management

immediate rest, eye protection, antiemetic medication to avoid increasing intra-ocular pressure

139

retinal detachment etiology

blow to the eye that partially or completely separates the retina from underlying retinal pigment epithelium

common among those with myopia or nearsightedness

140

retinal detachment s/sx

specks floating in the eye, flashes of light, blurred vision

as it progresses, may notice a 'curtain' closing over the field of vision

141

retinal detachment management

immediate referral to ophthalmologist

142

acute conjunctivitis etiology

usually caused by various bacteria or allergens,

143

acute conjunctivitis s/sx

eyelid swelling, purulent discharge, itching, burning

144

acute conjunctivitis management

highly infectious; 10% solution of sodium sulfacetamide

145

hordeolum (sty) etiology

infection of the eyelash follicle or the sebaceous gland at the edge of the eyelid;

caused by staphylococcal

146

hordeolum s/sx

erythema of the eye, localized into a painful pustule within a few days

147

hordeolum management

application of hot, moist compresses and 1% yellow oxide or mercury;

may need surgery

148

throat contusion etiology

getting "clotheslined"

could injure carotid artery, causing a clot to form that occludes blood flow to the brain or it becomes dislodged and migrate to the brain

149

throat contusion s.sx

severe spain, spasmodic coughing, hoarse speaking voice, difficult to swallow and breathe, inability to breathe, expectoration of froth body, cyanosis

150

throat contusion management

immediate concern is integrity of airway; apply cold intermittently to control hemorrhage and swelling, immediate referral

151

thyroid gland disorder

thyroid gland produces thyroxine and triiodothyronine

152

Hyperthyroidism

overproduction of thyroxine which impairs glucose metabolisms, and causes increased metabolism, rapid fatigue during exercise, weight loss, hyperthermia during exercise

153

Grave's disease

may lead to weakness, tremors, difficulty swallowing/speaking

154

Hyperthyroidism

deficient secretion of thyroid hormone,

causes lowered metabolism, poor circulation, dry skin, low blood pressure, slow pulse, depressed muscular activity, intolerance to cold, increasing obesity, development of goiter

155

thyroid gland disorders management

refer to physciant, may need meds or surgery

156

how long can the brain last without oxygen without incurring damage

4-6 minutes