Chapter 22 Face Eye and Neck Injuries BRADY

Chapter 22 Face, Eye, and Neck Injuries BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Objectives 22. 1 Describe the function of the iris. 22. 2 List possible causes of eye injuries. 22. 3 Describe and demonstrate how to assess eye injuries. 22. 4 Describe and demonstrate the management of a patient with a penetrating injury to the eyeball. 22. 5 Identify the important structures of the anterior and posterior neck. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Objectives 22. 6 List the signs and symptoms of emergencies of the neck and upper airway. 22. 7 List the functions of the following: a. facial bones b. lacrimal glands c. neck muscles 22. 8 List the signs and symptoms of emergent injuries to the face, eyes, and neck. BRADY continued National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Objectives 22. 9 Describe and demonstrate how to assess face, eye, and neck injuries. 22. 10 Describe and demonstrate the proper care of a face, eye, or neck injury. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Topics l Anatomy and Physiology l Common Face, Eye, and Neck Injuries l Assessment l Management l Chapter Summary BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Case Presentation A snowboarder is lying in the snow beyond a yellow closure rope. He is lying on his back, holding his neck with both hands and is in considerable distress. BRADY Copyright Studio 404 National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Anatomy and Physiology l Facial Structures ◦ Bones, cartilage, and muscle ◦ Nose, mouth, eyes l Auditory ◦ ◦ BRADY and Balance System External ear Auditory canal and ear drum Bones, cochlea, auditory nerves Vestibular system continued National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Anatomy and Physiology continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Anatomy and Physiology continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Anatomy and Physiology l Visual ◦ ◦ ◦ System Eyeball Optic nerve Bony orbit Muscles Eyelid Lachrymal glands continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Anatomy and Physiology continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Anatomy and Physiology l Neck ◦ ◦ ◦ BRADY Anatomy Carotid arteries, jugular veins Esophagus, trachea Larynx, thyroid cartilage Muscles Cervical vertebrae (posterior) National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Anatomy and Physiology BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Common Face, Eye, and Neck Injuries l Trauma related ◦ Soft tissue ◦ Penetrating or impaled objects l Environmental l Airway concerns l C-Spine issues BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Face and Neck Injuries l Trauma ◦ ◦ ◦ Soft tissue injuries Penetrating injuries Blunt injuries Fractures Crushing injuries l Environmental injuries l Airway obstruction l C-Spine involvement BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Eye and Ear Injuries l Contusions, lacerations l Rupture l Abrasive and penetrating injuries ◦ Foreign or impaled objects l Light related (UV or excessively bright) l Chemical burns BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Eye and Ear Injuries BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Nose, Mouth, and Jaw Injuries l Fractures l Damage to teeth l Soft tissue injuries, bleeding ◦ Epistaxis l Airway concerns ◦ Blood ◦ Swelling BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Neck Injuries l Life threatening l Closed ◦ Swelling can compromise airway ◦ Crushing of larynx or trachea l Open ◦ Damage multiple structures ◦ Profuse bleeding ◦ Air enters blood system l C-spine BRADY may be involved National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Facial Fractures BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Case Update You suspect the snowboarder could have serious neck trauma. The patient is clearly anxious and is having difficulty breathing. His respiration rate is 24 per minute; he can speak in only a hoarse whisper. and is drooling from his mouth. His pulse is 100 bpm. When you examine the patient’s neck, you notice a dark red abrasion and underlying swelling on the right anterior portion of his neck. He has no tenderness or deformities. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment l Expect anxiety, C-spine involvement, and airway/breathing concerns l Bleeding can be significant, may be disproportional to size of wound l Continuously monitor for changes in status BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment of the Eye l Inquire about vision ◦ Lens, retina, structural involvement l Pupils – Equal? Reactive? l Movement l Blood ◦ Sclera (bloodshot) ◦ Hyphema continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment of the Eye continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment of the Eye l External structures ◦ Eyelid ◦ Orbit BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment of the Nose and Mouth l Symmetry and stability l Blood – external or from within l Abnormal color – bluish or pale l Broken or missing teeth l Jaw alignment BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Management of Facial Injuries BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment of the Ear l External structures l Fluids – color noted l Battle’s sign l Foreign body in ear canal l Hearing BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment of the Ear BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment of the Neck l Symmetry l Midline shift l Swelling l Airway compromise l C-spine involvement l Bleeding BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment of the Neck BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Management l Rapid assessment and frequent reevaluation l ABCDs ◦ Suction ◦ Oxygen l Controlling blood and other fluids ◦ Varies based on location BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Specific Management Issues l Tooth care l Dizziness, balance issues, nausea l Foreign body removal ◦ Ear or Eye l Penetrating injuries, impaled objects l Eyeball injuries continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Specific Management Issues l An Avulsed Tooth ◦ If a patient has altered mental status or is unable to clear his own secretions, never place an avulsed tooth back in the socket because of the significant risk that the patient will swallow or aspirate it during transportation. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Specific Management Issues continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Specific Management Issues l Burns to the eye l Contacts l Open wounds of the neck BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Case Disposition You reassure the snowboarder while stabilizing his head and neck. Upon the arrival of other patrollers and equipment, you apply high-flow oxygen and affix a C-collar. Rapid transport is necessary. You give the ALS provider your hand-off report, which includes your concern for a progressively worsening compromise of the patient’s airway. He is eventually intubated en route and survives. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Chapter Summary l Facial and neck injuries can be associated with severe pain and anxiety and rapidly become life threatening. l Assess the stability of the patient’s airway by listening to the patient talk. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Chapter Summary l Direct pressure applied to an injured globe of the eye may worsen the injury. l Facial and neck asymmetry is a clue to traumatic injury. Facial fractures require a significant mechanism of injury, so associated closed head or cervical-spine injuries must be continued considered as well. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Chapter Summary l Facial and neck injuries are likely to increase your chance of exposure to the patient’s bodily fluids. l Face and neck injuries require frequent assessment. Any significant face, neck, or head injury requires cervical (and spinal) immobilization. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ