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Maxillo-Facial And Ocular Emergencies Flashcards

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1
Q

Causes of Facial Trauma:

A
  • MVC
  • Assaults/ Personal Altercations
  • Domestic Violence
  • Handguns
  • Falls
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2
Q

General Information for Maxillo-Facial and Ocular emergencies:

A
  • Always care for life threatening emergencies first.
  • C-spine and head injuries must be ruled out with significant facial trauma.
  • Injury to vision considered after life/limb threatening injuries.
  • Fractures of the facial plane may injure growth centers with can result in growth problems and functional derangement.
  • Consider facial nerves involved. (“3,4,6 make my eyes do tricks”)
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3
Q

Facial Nerve (VII) controls these:

A
  • Facial expression
  • Taste
  • Branches
  • Zygomatic (close eyes)
  • Temporal (wrinkle forehead)
  • Buccal (elevate upper lip)
  • Cervical
  • Mandibular (purse lips)
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4
Q

Oculomotor Nerve (III) controls this:

A
  • Pupil Response
  • Ocular Movement
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5
Q

Trochlear Nerve (IV) controls this:

A
  • Ocular Movement
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6
Q

Abducens Nerve (VI) controls this:

A
  • Ocular Movement
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7
Q

Trigeminal Nerve (V) controls this:

A
  • Facial sensation
  • Jaw movement
  • Bite
  • Opening against resistance.
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8
Q

What are some Assessment tips with regard to Maxillo-facial and Ocular Emergencies?

A
  • Raccoon Eyes
  • Nasal/ear drainage may be CSF
  • Deep lacerations of cheek (check for underlying damaged structures.
  • Tear-drop shaped pupil
  • Numbness of upper lip
  • Numbness of lower lip
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9
Q

What can raccoon eyes signify?

A
  • Basilar Skull fracture
  • LeFort Fracture
  • Naso-Ethmoid injury
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10
Q

General Treatment Considerations for Maxillo-facial and Ocular Emergencies:

A
  • Elevate head of bed but clear C-spine first)
  • suction
  • no intranasal tubes
  • Cold packs
  • Antibiotics
  • Tetanus Prophylaxis
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11
Q

Laceration considerations with regard to Maxillo-facial and ocular emergencies:

A
  • repair within 24 hours
  • Human and animal bites can be very dirty and may or may not be sutured (use mnemonic RATS = Rabies, Antibiotics, Tetanus, Soap)
  • Permanent tattooing can occur from road rash and gunpowder.
  • Must be careful with Vermilon border.
  • No epinephrine on ears, nose, fingers, or toes.
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12
Q

Important things too note with nasal fractures:

A
  • Septal hematoma must be noted early for drainage, to prevent airway obstruction.
  • Involvement of nasal mucosa and lacrimal system can result in subcutaneous emphysema.
  • Always check for CSF rhinorrhea.
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13
Q

What are some general manifestations of Maxillary fractures?

A
  • Severe facial pain.
  • visual disturbances
  • swelling/ecchymosis
  • Peri-orbital/orbital swelling
  • subconjunctival hemorrhage
  • facial asymmetry
  • elongation of face
  • Epistaxis
  • Malocclusion
  • Anesthesia/ Paresthesia of upper lip
  • CSF leakage
  • Airway obstruction
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14
Q

What are the 3 categories of Maxillary fractures?

A
  • LeFort I
  • LeFort II
  • LeFort III
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15
Q

What is a LeFort I fracture?

A

Where the body of the maxilla is separated from the base of the skull.

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16
Q

What is a LeFort II fracture?

A

Fracture involves the central maxilla, nasal area, and the ethmoid bones.

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17
Q

What is a LeFort III fracture?

A
  • Complete craniotomy-facial separation.
  • Involves Maxilla, zygoma, Mandible, nasal bones, ethmoids, vomer, orbits, all lesser bones of cranium.
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18
Q

What is the treatment for Maxillary fractures?

A
  • aggressive airway management
  • suctioning to prevent aspiration.
  • Fowler’s position
  • Antibiotics
  • Tetanus
  • Surgery for internal fixation.
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19
Q

What are the types of Zygomatic fractures?

A
  • Zygomatic arch
  • Tripod
    • Zygomatic arch
    • Posterior 1/2 of infra-orbital rim
    • Frontozygomatic suture
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20
Q

What are some manifestations of a zygomatic fracture?

A
  • Flattened cheek.
  • Step off deformity
  • Asymmetry
  • Peri-orbital swelling
  • Ecchymosis
  • Subconjunctival hemorrhage
  • Pain with movement of jaw.
  • TIDES ( Trismus, Infraorbital anesthesia, Diplopia, Epistaxis, Symmetry absence.)
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21
Q

What is Trismus?

A

Tonic contraction of muscles of mastication.

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22
Q

What is an Orbital Blow-Out fracture?

A

Fracture of orbital floor from blunt trauma.

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23
Q

What can become entrapped in an orbital blow-out fracture?

A
  • Inferior rectus muscle
  • Inferior oblique muscle
  • Infraorbital nerve
  • Orbital fat
  • Connective tissue
  • globe
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24
Q

What are some manifestations of an Orbital blow-out fracture?

A
  • Inability to gaze upward.
  • Diplopia
  • Bulging eye (may also see exopthalamus).
  • Epistaxis
  • Infraorbital paresthesia
  • Periorbital edema/ecchymosis
  • Subconjunctival hemorrhage.
  • Subcutaneous Emphysema when blowing nose.
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25
What should you advise the patient to be care with when they have an orbital blow-out fracture?
- Nose blowing - coughing - sneezing - vomiting - straining
26
What are some manifestations of Mandibular fracture?
- point tenderness - crepitus - step off deformity - malocclusion - decreased range of motion - asymmetry - Paresthsia of lower lip/chin - Trismus
27
What is the treatment for a Mandibular fracture?
- Airway management - Cold packs - Surgery for intermaxillary fixation/wiring. - antibiotics - Dental growth can complicate fracture.
28
What are the classifications of Mandibular fractures (by location)?
- Condyle (growth center which occurs downward and forward. - Angle - Body - Dentoalveolar - Symphysis (less common)
29
What is a Hyphema?
Bleeding into anterior chamber from blood vessels in the iris.
30
What comorbities increase the rate of complications associated with a Hyphema?
- Bleeding disorders - Anticoagulant therapy - Kidney disease - Liver disease - Sickle cell disease
31
What are some complications that can occur due to a Hyphema?
- Secondary glaucoma - Corneal blood staining - Loss of vision - Loss of eye (If there is any rebleeding within 2-5 days they need to come back)
32
What is the treatment for a Hyphema?
- strict bed rest vs. mild activity. - elevate head of bed 30 degrees. - Beta blockers - Mydriatics for comfort (to dilate pupil) - Steroids - Antifibrinolytics - Analgesics - Anti-emetics - Patch both eyes - Diuretics
33
What causes a globe rupture of the eye?
- Blunt or penetrating trauma. - Most common area of rupture is under recuts muscles because it is very thin.
34
What are manifestions of Globe rupture?
- Decreased IOP <10. - Decreased vision - Assymetry - Globe protrusion - Irregular Pupil boarders - Altered Light Perception - Pupil Herniation - Nausea - Tear-drop shaped pupil (tip of the drop is point of perforation). - Extrusion of aqueous/vitreous humor.
35
What are the Interventions for a Globe Rupture?
- No manipulation - Leave impaled object in place. - Patch both eyes - Semi-fowler’s - No eye drops - Pain management - Tetanus - Anti-emetics - Surgery - Antibiotics - Rigid eye shield - Send to ophthalmology.
36
What are the types of Ocular Burns?
- Chemical - Thermal - Radiation
37
What is important to know about Chemical Ocular Burns?
- These are the most urgent. - Acids cause damage immediately by immediate desaturation of tissue proteins, then act as a barrier against further damage. - Alkalis are the worst because they continue to damage by combining with cellular lipids producing coagulation necrosis. - Top priority is irrigation until pH neutral (7-8). This may take 30 minutes of irrigation with 2L of NS/LR.
38
What is important to know about Thermal Ocular burns?
- Rarely involves globe. - May cause lid contracture.
39
What is important to know about Radiation Ocular burns?
Ultraviolet - These burns are very painful and can cause keratitis (corneal inflammation) and conjunctivitis. Infrared - Permanent loss of vision from absorption of rays via the iris and an increased temperature in the lens. - Complications include cataracts, focal retinitis, and x-ray burns.
40
What are some types of Lid infections?
- Hordeleum - Chalazion - Blepharitis
41
What is a Hordeleum?
- stye - Infection of eyelash oil gland. - Use a warm compress - May need I&D.
42
What is a Chalazion?
- Internal Hordeoleum. - Inflammation of meibomian gland (sebaceous gland). - causes dryness, burning, and irritation.
43
What is Blepharitis?
- inflammation of the eyelid. - Causes ulceration. - Usually caused by Staph Aureus. - Red scales on lashes.
44
What is Keratitits?
Inflammation of the cornea.
45
What can cause Keratitis?
- Ulcer - Bacteria - Fungus
46
What are the manifestations of Keratitis?
- Light sensitivity - Redness - Painful - Profuse tearing - Hypopyon (condition involving inflammatory cells in the anterior chamber of the eye)
47
What is the treatment for Keratitis?
- Cultures - Antibiotics - Fungal drops - Cyclopegics drugs (used to dilate the pupil) - No Patching
48
What is Uveitis/ Iritis?
Inflammation of the uveal tract.
49
What are some manifestations of Uveitis/ Iritis?
- Unilateral - Blurred vision - Photophobia - Constricted pupil - Tearing - Headache - Pain - Pain in affected eye when light is shone in opposite eye.
50
What is the treatment for Uveitis/ Iritis?
- Analgesia - Antibiotic Opthalamic - Topical Steroids - Mydriatic Drugs
51
What is Orbital Cellulitis?
- Can be life threatening. - Associated with infected sinus/throat - Also known as Cavernous Sinus Thrombosis.
52
What are the usual etiologies of Orbital Cellulitis?
- Pneumococcal - Staphylococcal - Streptococcal
53
What are the manifestations of Orbital Cellulitis?
- Chills - Headache - Fever - Lethargy - Nausea/ Vomiting - Decreased Vision - Facial/Globe Edema - Vascular congestion of eyelids - Exopthalamus - Decreased pupil reflexes - Papilledema - Paralysis of extra-ocular muscles
54
What is the treatment for orbital cellulitis?
- Antibiotic (Opthalamic) - Parenteral Antibiotics - Bed rest - Hospitalization - Warm compresses
55
What is Central Retinal Artery Occlusion?
- A true ocular emergency (only have 60-90 minutes to get to surgery). - Painless loss of vision.
56
What are the etiologies of Central Retinal Artery Occlusion?
- Embolus - Thrombus - Giant Cell Arteritis - Angiospasms
57
What is the treatment for Central Retinal Artery Occlusion?
- Must re-establish circulation. - Ocular Massage - IOP lowering drugs - Vasodilation techniques
58
What is Retinal Detachment?
A retinal tear with seepage of vitreous humor between retina and choroid which causes loss of blood supply.
59
What are the manifestations of Retinal Detachment?
- see flashing lights. - see floaters - “veil” over eyes
60
What is the treatment for Retinal Detachment?
- Bedrest - bilateral eye patches - laser repair
61
What is Glaucoma?
- Two types : Open Angle and Closed Angle. - Aqueous Humor which is produced by the ciliary body is blocked and cannot exit through the Schlemm’s canal.
62
What are the manifestations of Glaucoma?
- Severe eye pain - Hard globe - severe headache - decreased peripheral vision - fixed, dilated pupil - foggy cornea - halos around lights - nausea/vomiting
63
What is the treatment for Glaucoma?
- Decrease IOP - Pilocarpine 2% q 15 minutes until constriction- causes pupillary constriction (miotic). - Timolol 0.5% to decrease IOP. - Antiemetics - Narcotics - Ophthalmology consult - diuretics
64
What are the etiologies of a Ruptured Tympanic Membrane?
- slap over the ears - driving injury - aircraft/ altitude injury - blast injury - self-instrumentation
65
What are the manifestations of a Ruptured Tympanic Membrane?
- Pain - Bleeding - Hearing impairment
66
What is the treatment for Ruptured Tympanic Membrane?
- May heal spontaneously - Antibiotics - May need surgical repair
67
What is Otitis Media?
Middle ear infection
68
What are the manifestations of Otitis Media?
- Pain - fullness in ear - decreased hearing - N/V - Fever - Pulling at ear
69
What is the treatment for Otitis Media?
- Decongestants - Antibiotics - Analgesics - Myringotomy
70
What is Otitis Externa?
An inflammatory reaction that causes swelling and maceration in the external ear canal. Can get cellulitis from this.
71
What are the etiologies of Otitis Externa?
- Swimmer’s ear - Cleaning canal with object - Chemical irritant - Earphones/ earmuffs/ earplugs - Perforated Tympanic Membrane
72
What is Labyrinthitis?
Inner ear infection that can mimic cardio-vascular concerns.
73
What are the manifestations of Labyrinthitis?
- severe dizziness - nystagmus - N/V - Hearing loss - Difficulty standing/ walking
74
What is the treatment for Labyrinthitis?
- bed rest - IV hydration - antiemetics - Diazepam (IV) - Meclizine
75
What is Meniere’s Disease?
A disorder of vestibular system of the inner ear that usually affects individuals aged 40’2 to 60’s.
76
What are the symptoms of Meniere’s Disease?
- Rotational Vertigo - Diaphoresis - Sensitivity to sound - Ataxia - Tinnitus - Headache - Feeling of spinning - Hearing loss - Blurred vision - N/V - Pressure in ear - Nystagmus - Can have vagal symptoms (abdominal pain, diaphoresis, Bradycardia, pallor)
77
What is the treatment for Meniere’s Disease?
- Vasodilating agents - Meclizine - Diuretics - Steroids - Anticholinergics - Benzodiazepines - Bed rest - Position changes slowly - Avoid alcohol/ caffeine - ENT referral
78
What is Ludwig’s Angina?
- board-like swelling (submandibular, sublingual, submental). - can be caused by the spread of existing untreated dental infection or cellulitis. - Need to be concerned with airway compromise.
79
What is the treatment for Ludwig’s Angina?
- ABC’s - Pain relief - Antibiotics - Elevate head of bed - Oxygen - Continuous Pulse-Oximetry - Monitor vital signs and mental status - IV fluids
80
What is a Peri-Tonsillar Abscess?
Collection of pus that penetrates the tonsillar capsule and may invade the muscle in surrounding tissue.
81
What are the manifestations of a Peri-Tonsillar Abscess?
- Difficulty speaking - Trismus - Dysphagia - Drooling - Deviation of uvula
82
What is the treatment for Peri-Tonsillar Abscess?
- Airway management - Antibiotics - Possible I&D
83
What are the 2 types of Epistaxis?
Anterior and Posterior
84
What are the etiologies of epistaxis?
- Infection - Trauma - Foreign bodies - Anticoagulant therapy - Hypertension - Coagulation disorders - Tumor
85
What labs need to be performed on an Epistaxis patient?
- CBC - Protime (if patient is on Coumadin)
86
What is the treatment for Epistaxis?
- Cocaine - Balloon/foley (for posterior bleeds) - Packing - Silver Nitrate (for anterior bleeds) - Nasal tampon
87
What are some complications to be concerned with regarding Epistaxis?
- Syncope - Hypoxia - Dislodged nasal packing - hypovolemia - Sinusitis - Toxic Shock - Cardiac Dysrhythmias - Respiratory/ Cardiac Arrest

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