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CEN > Maxillofacial and Ocular Emergencies > Flashcards

Maxillofacial and Ocular Emergencies Flashcards

1. Explain concepts related to the assessment of emergency department patients experiencing maxillofacial and ocular emergencies. 2. Describe various patient presentations related to maxillofacial and ocular emergencies. 3. List interventions necessary for patients presenting with maxillofacial and ocular emergencies. (168 cards)

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1
Q

ophthalmic branch VI

A

sensation to:

scalp, forehead
upper eyelid
conjunctive, cornea
nose

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2
Q

maxillary branch V2

A

infraorbital nerve (maxillary fracture)

sensation to upper lip, lower eyelid, cheek

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3
Q

mandibular branch V3

A

inferior alveolar nerve (mandibular fracture)

sensation to lower lip, chin, jaw

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4
Q

define Bell’s Palsy

A

unilateral facial paralysis due to CN VII damage

often d/t herpes simplex

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5
Q

sx Bell’s Palsy

A 
facial droop
can't blink/close affected eye
postauricular pain
change to tear production
ipsilateral loss of taste
HA
hyperacusis: increased sensitivity to sound frequencies and volume ranges
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6
Q

assessing Bell’s Palsy

A

diagnosis of exclusion

r/o stroke, meningitis, facial nerve tumor

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7
Q

intervene for Bell’s Palsy

A 
antivirals, steroids
analgesics
sunglasses
artificial tears
lubricants at night
moist heat
facial massage to prevent contractures/paralysis
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8
Q

define trigeminal neuralgia

A

sudden onset unilateral severe, brief, stabbing, recurrent pain along one or more branches of CN V

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9
Q

branches of CN V

A

ophthalmic (V1)
maxillary (V2)
mandibular (V3)

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10
Q

overview of trigeminal neuralgia

A

aka tic doloureux
usually w/ facial tic
worse w/ brushing teeth, chewing
fall/spring exacerbations

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11
Q

causes of trigeminal neuralgia

A 
compression of CN V d/t:
MS
tumor
trauma
AV malformation
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12
Q

sx trigeminal neuralgia

A

shock-like stabbing pain for seconds or minutes
unilateral
affects: lips, cheeks, jaw, eyes, forehead, scalp, nose

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13
Q

intervene for trigeminal neuralgia

A

carbamazepine to diagnose or be therapeutic

educate about triggers

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14
Q

pharm management of trigeminal neuralgia

A 
carbamazepine/baclofen
phenytoin
clonazepam
lamotrigine
valproic acid
gabapentin
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15
Q

define temporal arteritis

A

inflammation of temporal artery

aka giant cell arteritis or cranial arteritis

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16
Q

cause of temporal arteritis

A

immune system issues

linked to severe infections and high dose abx

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17
Q

sx temporal arteritis

A

severe stabbing pain in temporal area

redness, swelling to temple w/ tenderness

signs of systemic infection

reduction in vision

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18
Q

intervene for temporal arteritis

A

steroids x 2 years
analgesics
biopsy

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19
Q

complications of temporal arteritis

A

if untreated:

blindness or death d/t MI or aortic dissections

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20
Q

define temperomandibular joint (TMJ) dislocation

A

anterior/superior displacement of jaw

unilateral or bilateral

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21
Q

causes of TMJ dislocation

A

trauma
yawning
grinding teeth

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22
Q

sx TMJ dislocation

A 
malocclusion
head/ear/neck ache
pain with jaw movement
pop, click, snap sensation
limited ROM
pain on TMJ palpation
palpable depression
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23
Q

assessing TMJ dislocation

A

open/closed mouth xray
post-reduction view
MRI is image of choice

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24
Q

intervene for TMJ dislocation

A

IV for sedation
suction
manual reduction
analgesia

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25
dc education for TMJ dislocation
soft diet for 3-4 days awareness of habits education on triggers
26
define zygomatic fractures
loss of malar eminence 2nd most common facial fracture associated with orbital wall fractures and ocular trauma
27
sx zygomatic fractures
``` TIDES: trismus infraorbital hypesthesia diplopia epistaxis symmetrical abnormality (assymmetry) ```
28
trismus
reduced ability to open jaw r/t muscle spasm
29
infraorbital hypesthesia
abnormal loss of sensation to pain, heat, cold, touch
30
intervene for zygomatic fractures
``` cold pack elevate HOB ophtho consult avoid: -valsalva maneuver -sleep on affected side -straining/blowing nose ```
31
function or orbit
holds eye in correct position
32
two types of orbital wall fractures
blow in | blow out
33
blow in orbital fracture
bone fracture into orbit towards eye ``` eye bugling (exophthalmos) d/t baseball hitting side of face ```
34
blow out orbital fracture
bone fracture outward from eye eye suck into socket (enophthalmos) direct force to eye socket
35
sx orbital fractures
``` ocular entrapment diplopia edema ecchymosis subconjunctival hemorrhage infraorbital hypesthesia ```
36
intervene for orbital fractures
cold pack | ophthalmology consult
37
dc teaching for orbital fractures
avoid: valsalva maneuvers straining blowing nose
38
ocular entrapement
eye unable to rotate within orbit
39
overview of maxillary fractures
requires tremendous force intracranial/spinal trauma do not always follow Le Fort classifications
40
complications of maxillary fractures
``` airway compromise loss of bony stability difficulty swallowing edema blood traumatic debris ```
41
assessing maxillary fractures
facial, head CT facial XR chest XR if missing teeth
42
intervene maxillary fractures
``` airway suctioning elevate HOB ice ophthalmology, neuro, ESS consults for Le Fort II, III fractures ```
43
Le Fort I
transverse detachment of entire maxilla above teeth at level of nasal floor malocclusion, lip lac, fractured teeth, maxillary swelling aka free-floating maxilla
44
Le Fort II
pyramidal-shaped fracture with: transverse detachment of maxilla at base fracture of bridge of nose at top fractures through lacrimal and ethmoid bones into median portion of both orbits massive edema, nasal bone fracture, epistaxis, face lengthening, paresthesia to cheeks, malocclusion
45
Le Fort III
craniofacial disjunction that creates a free-floating segment of mid-face (complete separation of cranial attachments from facial bones) involves maxilla, zygona, orbits, bones of cranial base massive swelling, severe intrafacial hemorrhage, diplopia, malocclusion
46
tip to remember Le Fort fractures
A man with a Mustache goes to the Pyramids and takes of his Mask
47
mandibular fractures
blunt trauma concern when malocclusion: most common fracture sites at canine or third molar sites, angel of mandible and condyles
48
sx mandibular fractures
``` malocclusion trismus edema ecchymosis signs of trauma point tenderness numbness to lower lip ```
49
dc teaching for mandibular fractures
jaw rest soft diet avoid talking/using jaw avoid strenuous exertion
50
define peritonsillar abscess
collection of purulent material around tonsils that may lead to deep tissue infection often follows pharyngitis, tonsillitis
51
sx peritonsillar abscess
``` uvula deviation drooling/difficulty swallowing fever halitosis muffled voice pain in throat that radiates to ear swollen soft palate cervical lymphadenitis erythematic tonsils with exudate trismus ```
52
intervene peritonsillar abscess
``` airway throat cultures fluids, abx, steroids, pain needle aspiration, I&D ENT ```
53
Ludwig's angina
bacterial cellulitis of floor of mouth fast moving - lethal
54
causes of Ludwig's angina
untreated dental abscess | abx resistant abscess
55
sx Ludwig's angina
``` resp distress submandibular, sublingual swelling pain, tenderness dysphagia, drooling muffled voice, trismus fever ```
56
intervene Ludwig's angina
``` airway labs, blood cultures fluids, abx, pain xray, CT if stable admission, surgery ```
57
dental subluxation
loose toolth
58
intervene for dental subluxation
mild: soft diet moderate: dental consult
59
avulsed tooth
tooth out of socket
60
intervene avulsed tooth
preserve tooth: replace in socket put in cheek/gum, under tongue put in glass of milk put in Hank's balanced electrolyte solution replace max 6 hours, ideally 30 min
61
anterior epistaxis
more common that posterior front of nasal cavity hemorrhage bright red drips from nostrils
62
causes of anterior epistaxis
nose picking dry mucosa intranasal meds or inhalant use
63
posterior epistaxis
more profuse hemorrhage dark red drips down throat
64
causes of posterior epistaxis
``` elevate HOB, suction fluids pinch nostrils 10 min cauterization nasal packing ```
65
types of cauterization for posterior epistaxis
silver nitrate sticks diathermy electrocautery
66
nasal packing for posterior epistaxis
nasal sponge epistaxis balloon pledget soaked with 4% cocaine, phenylephrine, lidocaine with epi
67
nasal foreign body
most common in peds monitor for potential aspiration
68
sx nasal foreign body
nasal, sinus pain purulent nasal drainage recurrent epistaxis fever
69
intervene nasal foreign body
``` blow nose balloon catheter post obstruction decongestants alligator forceps educate on dangers of small objects ```
70
define sinusitis
bacterial infection of mucosal lining of paranasal sinuses
71
sx sinusitis
``` pain depends on sinus cavity nasal congestion mucopurulent discharge malaise, fever facial swelling ```
72
intervene sinusitis
Water's view XR for frontal view oral abx analgesia, antipyretics
73
dc teaching sinusitis
hob elevated to relieve pressure
74
otitis externa overview
infection of external auditory canal aka swimmer's ear
75
causes of otitis externa
usually bacterial excessive moisture trauma
76
sx otitis externa
``` pain with movement of tragus, auricle swelling, erythema of ear canal discharge eharing loss periauricular cellulitis ```
77
intervene otitis externa
``` analgesics, abx warm otic drops heat, keep ear dry no objects into canal earplugs ```
78
otitis externa overview
infection of external auditory canal aka swimmer's ear
79
causes of otitis externa
usually bacterial excessive moisture trauma
80
sx otitis externa
``` pain with movement of tragus, auricle swelling, erythema of ear canal discharge eharing loss periauricular cellulitis ```
81
intervene otitis externa
``` analgesics, abx warm otic drops heat, keep ear dry no objects into canal earplugs ```
82
otitis media
infection of inner ear blocked Eustachian tubes fluid buildup behind TM
83
most common age group for otitis media
6 mo - 3 yo after URI
84
sx otitis media
``` sharp middle ear pain sensation of fullness hearing loss fever bulging tympanic membrane history of URI pulling at ear ```
85
intervene otitis media
systemic abx analgesics antipyretics prn
86
mastoiditis
rare complication of otitis media infection may erode mastoid and affect surrounding structures
87
sx mastoiditis
``` recent, recurrent otitis media pain, swelling in mastoid area otalgia hearing loss fever, HA possible tympanic membrane rupture ```
88
intervene mastoiditis
ID consult IV abx analgesics surgery
89
labyrinthitis
inflammation of inner ear or labyrinth usually follows otitis media, URI, allergies rare in children
90
sx labyrinthitis
``` self limiting recent infection vertigo w/ movement hearing loss, tinnitus N/V otalgia fever nystagmus ```
91
intervene labyrinthitis
``` r/o neuro bed rest, hydration antiemetics benzos abx corticosteroids ```
92
cause of ruptured tympanic membrane
trauma barotrauma infection
93
sx ruptured tympanic membrane
sudden, severe sharp pain at time of rupture bloody, purulent drainage hearing loss, tinnitus vertigo
94
intervene ruptured tympanic membrane
analgesia do not irrigate abx 90% heal spontaneously
95
dc teaching rupture tympanic membrane
keep ear dry cotton ball w/ petroleum jelly to decrease moisture wear ear protection
96
complications of ear foreign body
bleeding live insects - anxiety tympanic membrane rupture
97
sx ear foreign body
``` ear pain purulent discharge, foul odor hearing loss dizziness N/V ```
98
intervene ear foreign body
``` kill insects w/ lidocaine, mineral oil suction, alligator forceps don't irrigate if organic don't push into ear canal consider sedating ```
99
how to irrigate an ear
adults: superiorly and posteriorly pediatrics: posteriorly and interiorly
100
dc teaching for Meniere's disease
``` limit salt, sugar avoid caffeine, alcohol, smoking limit activity bed rest slow movements, position changes ```
101
sx Meniere's disease
``` tinnitus, hearing loss rotational vertigo N/V nystagmus vagal stimulation episodic -few min to several hours -can recur for weeks/months ```
102
causes of Meniere's disease
``` no known cause can develop at any time more common 40-60 yo clustered or sporadic no curable resolution known ```
103
intervene Meniere's disease
``` meclizine anithistamines steroids anticholinergics benzos diuretics ```
104
dc teaching for Meniere's disease
``` limit salt, sugar avoid caffeine, alcohol, smoking limit activity bed rest slow movements, position changes ```
105
cycloplegics
eye drops | dilate and paralyze pupil
106
miosis
constricted pupil
107
mydriasis
dilated pupil
108
enophthalmos
sinking of eye inward
109
exophthalmost
bulging of eye outwards
110
ptosis
drooping eyelid
111
how to administer eye drops
instill into conjunctival sac never directly to cornea never more than 1 drop at a time never meds while wearing contacts
112
define corneal abrasion
scratching of cornea by foreign body most common eye injury seen in ED differentiate from corneal ulcer
113
sx corneal abrasion
``` pain sensation of foreign body photophobia tearing blurred vision ```
114
assessing corneal abrasion
visual acuity topical anesthetic before exam fluorescein staining slit lamp exam
115
intervene corneal abrasion
ophtho abx drops topical ophtho nonsteroidal agents systemic analgesics no patching
116
define corneal ulceration
inflamed epithelium of cornea
117
common causes of corneal ulceration
infection (bacterial, fungal, parasitic, viral) often following eye injury, trauma, or other injury
118
complications of corneal ulceration
can cause blindness in 24-48 hours if left untreated true ocular emergency
119
risk factors for corneal ulceration
contacts eye trauma immunosuppression
120
sx corneal ulceration
``` pain, photophobia sensation of foreign body tearing, blurred vision eyelid swelling purulent discharge "white spots" ```
121
intervene keratitis
abx, antivirals, antifungals topic cycloplegics systemic analgesics no patch
122
define keratitis
corneal inflammation can cause permanent damage and blindness
123
causes of keratitis
herpes simplex bacterial, fungal, amoebic infections contact lenses exposure to UV light
124
sx keratitis
``` pain, photophobia mucopurulent drainage purulence in anterior chamber decreased vision reddened sclera ```
125
intervene keratitis
abx, antivirals, antifungals topic cycloplegics systemic analgesics no patch
126
causes of ocular burns
chemical thermal heat radiation
127
acid chemical ocular burns
limited penetration
128
alkali chemical ocular burns
penetrate deeply until neutralized lye-containing substances
129
sx ocular burns
``` severe pain decreased visual acuity excessive tearing photophobia blepharospasm foreign body sensation ```
130
types of chemical ocular burns
acid alkali petroleum-based products
131
blepharospasm
involuntarily tightly closed eyelid
132
intervene for ocular burns
immediate irrigation with NS or LR until 7-7.5 pH irreversible damage at 11.5 pH anesthetic drops tetanus patch ophtho
133
ocular foreign body overview
generally superficial organic can blind in 24-48 hrs organic w/ higher infection rate metallic leaves rust ring
134
sx ocular foreign body
sensation of "something in eye" excessive pain, tearing, photophobia
135
intervene ocular foreign body
ophtho anesthetic agent before exam examine for other foreign body or rust ring treat corneal abrasion
136
how to remove ocular foreign body
invert upper lid irrigate with NS gently remove w/ cotton tip 25/27 gauge needle if adhering to cornea
137
acute angle closure glaucoma
aqueous humor cannot escape anterior chamber intraocular pressure increases compresses optic nerve CN III
138
complications of acute angle closure glaucoma
blindness within hours if not treated
139
sx acute angle closure glaucoma
``` acute eye pain decreased periph vision halos around lights N/V severe HA red eye fixed, slightly dilated pupil cloudy cornea globe may feel firm ```
140
intervene acute angle closure glaucoma
``` drain, decrease pressure miotic eye drops topic beta blockers carbonic anhydrase inhibitors antiemetics opioids ```
141
dc teaching acute angle closure glaucoma
head above waist avoid coughing, straining don't lift > 5 lbs ophtho follow-up
142
define acute conjunctivitis
inflammation of membrane that lines the eyelid and sclera
143
causes of acute conjunctivitis
infection - bacterial, viral, fungal allergic chemical
144
sx acute conjunctivitis
``` crusted eyelid in morning sensation of foreign body conjunctival erythema discharge pruritus - allergic ```
145
types of discharge in acute conjunctivitis
bacterial - purulent | allergic, viral - serous
146
sx iritis/uveitis
painful red eye, redness around outer ring of iris ``` blurred vision photophobia tearing decreased visual acuity irregular pupil ```
147
intervene iritis/uveitis
cycloplegics warm compress ophtho consult
148
define iritis (uveitis)
inflammation of middle portion of eye - iris, ciliary body, choroid
149
causes of iritis/uveitis
``` idiopathic trauma infection systemic conditions -rheumatic disease -syphilis -lupus ```
150
sx iritis/uveitis
painful red eye, redness around outer ring of iris ``` blurred vision photophobia tearing decreased visual acuity irregular pupil ```
151
intervene iritis/uveitis
cycloplegics warm compress ophtho consult
152
retinal artery occlusion
loss of perfusion to retina circulation must be restored within 60-90 min to prevent permanent blindness
153
causes of retinal artery occlusion
emboli (a.fib), thrombosis HTN giant cell arteritis angiospasm
154
sx retinal artery occlusion
sudden, painless loss of vision w/ reported "curtain came down over my eye" elevated intraocular pressure
155
assessing retinal artery occlusion
intraoccular pressure reading (normal 10-21 mmHg) EKG - a.fib coags
156
intervene retinal artery occlusion
``` high triage supine digital massage by MD acetazolamide topical beta blocker sublingual nitro fibrinolytics anterior chamber paracentesis ```
157
retinal detachment
tear in retina allows vitreous humor to leak, diminishing blood supply to retina
158
causes of retinal detachment
trauma (sudden onset) | degenerative (gradual onset)
159
sx retinal detachment
photopsia - flash of light sudden decrease/loss of vision "veil" or "curtain" effect
160
assessing retinal detachment
visual acuity detailed fundus, slit lamp exam ophtho US
161
intervene retinal detachment
ophtho consult surgery absolute bedrest bilateral patching
162
hyphema
blood in anterior chamber of eye
163
causes of hyphema
trauma bleeding disorders fibrinolytic agents
164
sx hyphema
pain | reddish hue to vision
165
intervene hyphema
minimize activities that increase intraocular pressure head up position patch affected eye analgesia, steroids no aspirin or NSAIDs
166
ruptured globe
loss of integrity of the globe usually r/t traumatic ocular injury ``` penetrating blunt (2/2 increase intraocular pressure) ```
167
sx ruptured globe
tear-drop shape to pupil visual disturbances evisceration of aqueous or vitreous humor
168
intervene ruptured globe
``` secure protruding objects bilateral patch elevate HOB never instill topical meds ophtho consult ```

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