Anatomy and Physiology of the Head 9/10/2015

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1 Kevin Badgley, E I/C Paramedic At the end of this seminar the participant will be able to: Describe potential facial injuries Describe potential complications of facial injuries Describe potential neck injuries from blunt and penetrating trauma Discuss treatment modalities Face tructure Facial Bones Zygoma Prominent bone of the cheek axilla Upper jaw andible Jaw bone Nasal bones Facial tructure Covered with skin Flexible and thin Highly vascular inimal layer of subcutaneous tissue Circulation External carotid artery upplies facial area Branches Facial, temporal, and maxillary arteries Anatomy and Physiology of the Head CN I II III IV V VI VII VIII IX Optic Oculomotor Trochlear Trigeminal Abducens Facial Acoustic Name Olfactory Glossopharyngeal F mell ight Pupil Const, rectus and obliques uperior obliques Opthalmic (FH), axillary (cheek), andible (chin) Chewing muscles Lateral rectus muscle Tongue Face muscles Hearing balance Face muscles Innervation Posterior pharynx, taste to anterior tongue X Vagus Taste to posterior tongue Posterior palate and pharynx XI Accessory Trapezius and sternocleido muscles XII Hypoglossal Tongue 1

2 Nasal Cavity Upper Border Bones Junction of ethmoid, nasal, and maxillary bones Bony eptum Right and left chamber Turbinates Lower Border Bony hard palate oft palate oves upward during swallowing Nasal Cartilage Forms nares Oral Cavity Formed tructures axillary bone Palate Upper teeth meeting the mandible and lower teeth Floor Tongue Connects to hyoid bone andible Articulates with the TJ joint inuses Hollow spaces in cranium and facial bones Function Lighten head Protect eyes and nasal cavity Produce resonant tones of voice trengthen area against trauma Pharynx Posterior and inferior to the oral cavity Aids in swallowing Bolus of food propelled back and down by tongue Epiglottis moves downward Larynx moves up Combined effect seals airway Peristaltic wave moves food down esophagus Ear Function Hearing Positional sense tructures Pinna Outer visible portion Formed of cartilage and has poor blood supply External Auditory Canal Glands that secrete cerumen (wax) iddle and Inner Ear tructures for hearing and positional sense 2

3 tructures for Hearing tructures for Proprioception emicircular canals ense position and motion Present when eyes are closed Vertigo Continuous movement sensation Eye tructures clera Cornea Conjunctiva Anterior chamber Aqueous humor Iris Pupil Lens Posterior chamber Vitreous humor Retina Lacrimal Fluid Bathes, protects, and nourishes cornea Vasculature of the Neck Carotid Arteries Arise from Brachiocephalic artery Aorta plit Internal and external carotid arteries Carotid bodies and sinuses Bodies: onitor CO 2 and O 2 levels inuses: onitor blood pressure Jugular Veins External uperficial, lateral to the trachea Internal heath with the carotid artery and vagus nerve Airway tructures Larynx Epiglottis Thyroid and cricoid cartilage Trachea Posterior border is anterior border of esophagus Other tructures of the Neck Cervical pine usculoskeletal Function External skeletal support of the head and neck Attachment point for spinal column ligaments Attachment point for tendons to move head and shoulders Nervous Function pinal cord contained within Peripheral nerve Exit between vertebrae 3

4 Difficult to assess in the prehospital setting Commonly threaten life ay expose victims to lifelong disability Injuries to the head, neck, and face are divided by mechanisms of injury Blunt Injury Head injuries most frequently result from auto and motorcycle crashes The face is frequently subjected to blunt trauma The neck is anatomically well protected from most blunt trauma Penetrating Injury Usually result from either gunshots or stabbings Other types of penetrating injuries Defined as a traumatic insult to the cranial region Result in injury to soft tissues, bony structures, and the brain Common Injuries Contusions Lacerations Avulsions ignificant hemorrhage may occur Reconsider OI for severe underlying problems Photo Researchers, Inc. Physiological Issues Indicate pressure on CN-II, CN-III, CN-IV, and CN-VI Reduced peripheral blood flow Pupil ize and Reactivity Reduced pupillary responsiveness Depressant drugs or cerebral hypoxia Fixed and dilated Extreme hypoxia 4

5 9/10/2015 Facial oft-tissue Injury Highly vascular tissue Contributes to hypovolemia uperficial injuries are rarely life threatening Deep injuries can result in blood being swallowed and endanger the airway oft tissue swelling reduces airflow Consider likelihood of basilar skull fracture or spinal injury Facial Dislocations and Fractures Common Fractures andibular axillary and Nasal Le Fort I, II, and III Criteria Orbit Nasal Injury Rarely life threatening welling and hemorrhage interfere with breathing Epistaxis ost common problem Avoid nasotracheal intubation Passage of ET tube into the cerebral cavity Ear Injury External Ear Pinna frequently injured due to trauma Poor blood supply Poor healing Internal Ear Well protected from trauma ay be injured due to rapid pressure changes 5

6 Eye Injury Foreign bodies Corneal abrasions and lacerations Hyphema Blunt trauma to the anterior chamber of the eye ub-conjunctival hemorrhage Less serious condition ay occur after strong sneeze, severe vomiting, or direct trauma Eye Injury (cont.) Acute Retinal Artery Occlusion Non-traumatic origin Painless loss of vision in one eye Occlusion of retinal artery Retinal Detachment Traumatic origin Complaint of dark curtain/obstruction in the field of view Possibly painful depending on type of trauma oft-tissue Lacerations Blood Vessel Trauma Blunt trauma erious hematoma Laceration erious exsanguination Entraining of air embolism Cover with occlusive dressing Airway Trauma Tracheal rupture or dissection from larynx Airway swelling and compromise Cervical pine Trauma Vertebral fracture Paresthesia, anaesthesia, paresis, or paralysis beneath the level of the injury Neurogenic shock may occur ubcutaneous emphysema Tension pneumothorax Traumatic asphyxia Penetrating trauma Esophagus or trachea Vagus nerve disruption Tachycardia and GI disturbances Thyroid and parathyroid glands High vascular 6

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8 Breathing Ensure that the patient is moving an adequate volume of air Head injury is likely to produce irregular breathing patterns Ventilations for the serious head injury patient (GC 8) are guided by capnography aintain an end-tidal CO 2 reading of between 35 and 40 mmhg For patients with suspected herniation, the endtidal CO 2 reading should range between 30 and 35 mmhg Apply oxygen via nonrebreather mask to the breathing patient Circulation onitor the patient s pulse rate and rhythm Look for any hemorrhage from the head, face, and neck and control any moderate to severe bleeding aintain a blood pressure of at least 90 mmhg A quick and directed head-to-toe examination of a patient anage any life-threatening injuries and conditions as you find them during the rapid trauma assessment If the patient shows any signs of pathology within the cranium, consider rapid transport anagement priorities for the patient sustaining head, face, or neck trauma include: aintaining the patient s airway and breathing Ensuring circulation through hemorrhage control Taking steps to avoid hypoxia and/or hypovolemia Airway Patients may be unable to control the airway Altered level of consciousness Damaged airway structures ellick s manuever uctioning ay increase ICP Emesis is common with head injury 8

9 Cricoid pressure Helps prevent regurgitation and reduce gastric distention Applies gentle pressure posteriorlyon the anterior cricoid cartilage Great concept DOEN T WORK Airway (cont.) Patient positioning Initial left-lateral recumbancy with cervical precautions, if possible Approximately 30 elevation of head of spine board Basic airway adjuncts Oro and nasopharyngeal airways Be prepared for emesis calp Avulsion Cover the open wound with bulky dressing Pad under the fold of the scalp Irrigate with N to remove gross contamination Pinna Injury Place in close anatomic position as possible Dress and cover with sterile dressing Dislodged Teeth Rinse in N Wrap in N-soaked gauze Impaled Objects ecure with bulky dressing tabilize object to prevent movement Indirect pressure around wound 9