Face and Neck Injuries

Question 1

Function of hyoid bone

Answer 1

Supports and stabilizes larynx and serves as a point of attachment for many neck and tongue muslces.

Question 2

Which nerve carries parasympathetic nerve fibers that cause constriction of pupils?

Answer 2

Oculomotor nerve

Question 3

Which nerve provides the sense of vision?

Answer 3

Optic nerve

Question 4

How does the eyeball keep its global shape?

Answer 4

Pressure of fluid contained within anterior and posterior chamber.

Question 5

Aqueous humor

Answer 5

Clear watery fluid filling anterior chamber of eyeball.

Loss of aqueous humor will gradually replenish.

Question 6

Vitreous humor

Answer 6

Jellylike substance in posterior chamber.
Maintains shape of globe.
Loss of vitreous humor will cause blindness as it cannot be replenished.

Question 7

What is the external ear compose of?

Answer 7

Pinna and external auditory canal

Question 8

What does the middle ear contain?

Answer 8

Three bones - malleus, icus, and stapes. Move in response to sound waves hitting the TM.

Question 9

What is the inner ear composed of?

Answer 9

Bony chambers filled with fluid

Question 10

Injury to major vessels in the neck can cause :

Answer 10

Cerebral hypoxia
Infarct
Air embolism
Permanent neurologic impairment

Question 11

s/s of facial fx

Answer 11

Ecchymosis
Swelling
TTP
Crepitus
Misalignment of the teeth, facial deformities or asymmetry
Instability of facial bones
Impaired ocular movement
Visual disturbances

Question 12

Nasal fx are characterized by :

Answer 12

swelling, tenderness, and crepitus when palpated

Anterior or posterior epistaxis

Question 13

Deformity of the nose usually appears as ____ displacement.

Answer 13

lateral

Question 14

When should you suspect a mandibular fx?

Answer 14

Hx of blunt force trauma to lower third of face
Dental malocculsion
Numbness of the chine
Inability to open mouth

Question 15

Maxillary fx are most commonly associated with which MOI?

Answer 15

Massive blunt force trauma such as MVCs, falls, and assaults

Question 16

Signs of maxillary fx

Answer 16

Facial swelling
Instability of midfacial bones
Malocculsion
Elongated face

Question 17

Le Fort I fx

Answer 17

Horizontal fx of maxilla that separates the hard palate and lower maxilla from skull.

Question 18

Le Fort II fx

Answer 18

Separates nasal bone and lower maxilla from skull and cranial bones.

Question 19

Le Fort III fx

Answer 19

All midfacial bones, separating the entire midface from cranium.

Question 20

Orbital fx sxs

Answer 20

Diplopia
Loss of sensation above the eyebrow or cheek
Paralysis of upward gaze
Massive nasal discharge

Question 21

Signs of zygomatic fx

Answer 21

Side of face appears flattened
Loss of sensation over cheek, nose, and upper lip
Paralysis of upward gaze

Question 22

When do zygomatic fx commonly result?

Answer 22

Blunt trauma in MVCs and assaults

Question 23

Common MOI for face and neck injuries include :

Answer 23

MVCs, sports, falls, penetrating trauma, and blunt trauma

Question 24

Provide rapid transport for :

Answer 24

Signs of shock
Poor general impression
AMS
Abnormal vital signs
Dyspnea
Severe pain
Isolated injuries to the eye

Question 25

What should be the focus of your physical exam w/ a responsive patient who has an isolated injury w/ limited MOI?

Answer 25

Isolated injury Pt's cc Body region affected

Question 26

Management of chemical burns to eye

Answer 26

Flush w/ water or sterile saline irrigation | Irrigate for 20 minutes if alkali or strong acid

Question 27

Management of thermal burns to eye

Answer 27

Cover both eyes w/ sterile dressing moistened w/ sterile saline

Question 28

Management of burns from UV rays, sun lamp, reflect light, snow blindness

Answer 28

Cover each eye w/ sterile, moist pad and an eye shield

Question 29

Three important guidelines when treating penetrating injuries of the eye :

Answer 29

Never exert pressure on or manipulate the injured eye in any way. Eyeball exposed : apply a moist, sterile dressing to prevent drying Cover the injured eye w/ a protective metal eye shield, cup, or sterile dressing.

Question 30

Hyphema

Answer 30

Bleeding into the anterior chamber of the ye

Question 31

Hyphema may signal what type of injury?

Answer 31

Spinal injury

Question 32

Management for hyphema

Answer 32

Cover the eye Suspect spinal injury Elevate head of the backboard 40 degrees to decrease IOP and discourage activities that may increase IOP

Question 33

Retinal detachment

Answer 33

Separation of the inner layers of the retina from underlying choroid

Question 34

sxs of retinal detachment

Answer 34

Flashing lights, specks, or floaters in visual field

Question 35

Eye findings that would alert you to a possible head injury :

Answer 35

``` One pupil larger than the other Deconjugate gaze Eyes fail to follow movement of your finger Bleeding under the conjunctiva Protrusion or bulging of one eye ```

Question 36

When is the only time you should remove a contact lens in the field?

Answer 36

Chemical burn of the eye

Question 37

Suspect an artificial eye when it :

Answer 37

Does no respond to light Does not move in concert w/ opposite eye Appears different from opposite eye

Question 38

Signs of anterior epistaxis

Answer 38

Originate from area of septum Bleed slowly Resolve quickly

Question 39

Signs of posterior epistaxis

Answer 39

Blood draining into throat causing n/v

Question 40

Management of non-traumatic epistaxis

Answer 40

Place in sitting position, leaning forward, and pinch nares together or press on upper gums

Question 41

s/s of perforated TM

Answer 41

Loss of hearing | Blood drainage

Question 42

In addition to danger of external hemorrhage from facial fractures, ____ may become lodged in ____ and cause an ____.

Answer 42

Blood clots; upper airway; obstruction

Question 43

What are the primary risk associated w/ oral and dental injuries?

Answer 43

Airway compromise from oropharyngeal bleeding Occlusion by displaced dental appliance Aspiration of avulsed or fx teeth

Question 44

Procedure for severe oropharyngeal bleeding in patients w/ inadequate ventilation?

Answer 44

Suction airway for 15 seconds Provide ventilatory assistance for 2 minutes Repeat

Question 45

Reimplantation of avulsed tooth is recommended within :

Answer 45

20 minutes to 1 hour

Question 46

Avulsed tooth should be placed in what solution?

Answer 46

Tooth storage solution Cold milk Sterile saline

Question 47

What structures in the neck are vulnerable to blunt trauma?

Answer 47

``` Upper airway Esophagus Carotid arteries and jugular veins Thyroid cartilage Cricoid cartilage Upper part of trachea ```

Question 48

What can a fracture of the cartilages in the upper airway and larynx lead to?

Answer 48

Loss of voice Difficulty swallowing Severe and sometime fatal airway obstruction Subcutaneous emphysema

Question 49

Management of subcutaneous emphysema secondary to blunt force trauma to neck

Answer 49

Maintain airway as best as you can and provide immediate transport.

Question 50

A large amount of air in the ___ atrium and ___ ventricle can lead to cardiac arrest.

Answer 50

right; right

Question 51

Why should you apply an occlusive dressing on a bleeding wound from the neck?

Answer 51

Prevent air embolism from entering vein or artery

Question 52

Impaled objects in the neck present life-threatening condition including :

Answer 52

Injury to major blood vessels w/ massive hemorrhage Damage to the larynx, trachea, or esophagus Injury to c-spine

Question 53

When is acceptable to remove an impaled object from the neck?

Answer 53

Only if it's obstructing the airway or impeding your ability to effectively manage the airway.

Question 54

s/s of larynx injury

Answer 54

``` Respiratory distress Hoarseness Pain Dysphagia Hemoptysis Cyanosis Pale Sputum in wound Subcutaneous emphysema Bruising on the neck Structural irregularity Hematoma or bleeding ```

Question 55

Mediastinitis

Answer 55

Inflammation of the mediastinum often resulting from gastric contents leaking into the thoracic cavity after esophageal perforation.

Question 56

Management of laryngeal injuries

Answer 56

Provide oxygenation and ventilation, preferably two-person BVM Apply soft c-collar Ready for suction ALS rendezvous IV access 20 mL/kg isotonic crystalloid to maintain adequate perfusion

Question 57

Sprain

Answer 57

Stretching or tearing of ligaments

Question 58

Strains

Answer 58

Stretching or tearing of muscle or tendon

Question 59

What is the most common form of cervical strain?

Answer 59

Whiplash

Question 60

Management of muscular injury to c-spine

Answer 60

Focus on preventing further injury by restricting ROM w/ c-collar and immobilization to backboard