Chapter 27 Injuries to the Face and Neck The Head Injuries to the Face Components of the Face

Transcription

1 Chapter 27 Injuries to the Face, Neck, and Eyes Injuries to the Face and Neck Face and neck are to injury Reativey unprotected positions on body Some injuries are ife-threatening. Penetrating trauma to the neck may cause severe beeding. Open injury may resut in an air. With appropriate care, a patient with a seemingy devastating injury can have a surprisingy good outcome. The Head Cranium Contains the brain Most posterior portion is caed the occiput. Latera portions on each side are caed tempes or tempora regions. Forehead is caed the region. Anterior to the ear, in the tempora region, you can fee the puse of the superficia tempora artery. Injuries to the Face Injuries about the face can ead to upper obstructions. Beeding from the face can be profuse. Loosened teeth may odge in the throat. If the great vesses are injured, significant may occur. Components of the Face Eyes Ears Nose Mouth Cheeks Jows 1

2 Cheeks Jows 6 Major Bones of the Face Nasa bone Two Two maxiae Mandibe The Orbit of the Eye The orbit of the eye is composed of: Lower edge of the bone of the sku Zygoma Maxia Nasa bone Protects the eye from injury The Face The exposed portion of the ear is composed entirey of covered by skin. About 1 inch posterior to the externa opening of the ear is the mastoid process. The mandibe forms the jaw and chin. Structures of the Neck Neck contains many important structures Supported by the cervica The upper part of the esophagus and the trachea ie in the midine of the neck. The carotid arteries are found on either side of the trachea. The Larynx (1 of 2) Adam s appe is ocated in the center of the neck. Other portion of the arynx is the cartiage. 2

3 The Larynx (2 of 2) The cricothyroid membrane ies between the cartiage and the cricoid cartiage. Soft depression in the midine of the neck Other Structures of the Neck The trachea Beow the arynx in the anterior midine of the neck Connects the and arynx with the main passages of the ungs Sternoceidomastoid musces Originate from the mastoid process Aow movement of the head Anatomy of the Eye (1 of 5) The design of the eye is a gobe that is about 1 in diameter. Located within a bony socket in the sku caed the The orbit protects over 80% of the eyeba. Iris: Musce that reguates the amount of that enters the eye. Anatomy of the Eye (2 of 5) Vitreous Humor: Jey-ike fuid behind the ens. In front of the ens is a fuid caed the humor, which can eak out in penetrating injuries. Cornea: Transparent tissue ayer in front of the pupi and iris. Pupi: Circuar opening in the center of the iris. Scera: portion of the eye. Anatomy of the Eye (3 of 5) Conjunctiva: Lines eyeids, covers exposed surface of the eye (membrane tissue). Eyeid: Skin covering eye, hods ashes. Tear Gands: Produces tears to and protect eyes. 3

4 protect eyes. Anatomy of the Eye (4 of 5) Anatomy of the Eye (5 of 5) The conjunctiva is a membrane that covers the eye. The gands produce fuid to keep the eye moist. Appearance of Eye In a norma, uninjured eye, the entire circe of the iris shoud be visibe. Pupis shoud be, equa in size, react equay when exposed to ight. Both eyes shoud move in same direction when foowing a finger. Aways note patient s signs and symptoms incuding severity and duration. The Eye as a Vita Sign Pupis can be: Diated Constricted Equa Unequa Reactive Norma Pupis Norma eyes are Pupis Equa And Round Reactive To Light Injuries of the Face and Neck Airway obstruction is aways a major concern with face and neck injuries 4

5 Airway obstruction is aways a major concern with face and neck injuries Face is very which causes major beeding Bood cots easiy form Teeth can be broken or disodged Sweing can obstruct airway Cervica spine injury is a major concern Soft-Tissue Injuries Soft-tissue injuries to the face and scap are common. Wounds to the face and scap beed profusey. A bunt injury may ead to a. Sometimes a fap of skin is peeed back from the underying musce. Facia Injury Facia Injury Hematoma Bunt injury that does break the skin may cause a break in a bood vesse wa. Denta Injuries Mandibe injuries are common. Most of these injuries are the resut of coisions and assauts Maxiary fractures are usuay found after bunt force high-energy impacts. Fractured and avused teeth are common foowing facia trauma Care of Soft-Tissue Injuries (1 of 4) Assess the and care for ife-threatening injuries. Foow proper BSI precautions. Bood draining into the throat can ead to. Monitor airway constanty. Take appropriate precautions if you suspect a neck injury. Care of Soft-Tissue Injuries (2 of 4) Contro beeding by appying pressure. Do not appy excessive pressure if an underying sku fracture is suspected. 5

6 suspected. Care of Soft-Tissue Injuries (3 of 4) Injuries around the mouth may obstruct the airway. Be prepared to Care of Soft-Tissue Injuries (4 of 4) Physicians can sometimes graft a piece of avused skin back into position. If you find portions of avused skin: Wrap in a sterie dressing. Pace in a pastic bag and keep coo. If the avused skin is sti attached in a oose fap: Pace the fap in position as cose to as possibe. Eye Injuries Can produce severe compications Examine for shape and reaction. Foreign Objects in the Eye (1 of 2) For sma foreign objects ying on the surface of the eye, with saine. Fush from the nose outward. A foreign body wi eave a sma on the conjunctiva. Foreign Objects in the Eye (2 of 2) To examine the underside of the eyeid, pu the id upward and forward. Never attempt to an object on the cornea. Genty remove the foreign object from the eyeid with a moistened, sterie appicator. Foreign Object in Eye Impaed Objects in the Eye (1 of 4) If there is an object impaed in the eye, do not remove it. Immobiize the object in. 6

7 If there is an object impaed in the eye, do not remove it. Immobiize the object in. Prepare a doughnut ring by wrapping a 2 piece of gauze around your fingers and thumb. Impaed Objects in the Eye (2 of 4) Remove the gauze from your hand and wrap remainder of gauze around. Carefuy pace the ring over the eye and impaed object, without bumping the object. Impaed Objects in the Eye (3 of 4) An aternative method is to use a to stabiize the object If object is onger than cup, carefuy cut a hoe in the bottom of the cup Use 4 X 4 s inside cup Pace cup over object Immobiize with roer Impaed Objects in the Eye (3 of 3) Stabiize the object with roer gauze. Cover the injured and eye. Do not appy pressure to eye Impaed Object in the Eye Chemica Burns of the Eye Chemicas, heat, and ight rays can the eye. For chemicas, fush the eye with saine soution or cean water. You may have to force the eye open to get enough irrigation to the eye. With an akai or strong acid burn, irrigate the eye for about minutes. Bandage the eye with dry dressing. Chemica Burn Irrigating the Eye 7

8 Irrigating the Eye Therma Burns of the Eye For therma burns, cover both eyes with a, sterie dressing. Transport the patient to a burn center. Light Burns Infrared rays, ecipse ight, direct sunight, and aser burns can damage the eye. Cover each eye with a sterie pad and eye shied. Transport the patient in a position. Lacerations Lacerations to the eyes require very carefu repair. Never exert on or manipuate the eye. If part of the eyeba is exposed, appy a moist, sterie dressing. Cover the injured eye with a protective meta eye shied. Laceration of the Eye Bunt Trauma Bunt trauma can cause a number of serious injuries: A fracture of the (bowout fracture) Retina detachment Bowout Fracture May occur from bunt trauma caused by a fracture of the orbit Bone fragments may entrap that contro eye movement, causing doube vision. Bowout Fracture Retina Detachment Often seen in sports injuries Produces fashing ights, specks, or in fied of vision Needs prompt medica attention Hyphema Beeding in the anterior of the eye May seriousy impair vision 8

9 May seriousy impair vision Eye Injuries Foowing a Head Injury One pupi arger than the other Eyes not moving together or pointing in different directions Faiure of the eyes to equay Beeding under the conjunctiva Protrusion or of one eye Hyphema Pupi Size and Head Injury Variation in pupi size may indicate a head injury. Contact Lenses and Artificia Eyes Contact enses shoud be kept in the eye uness there is a burn. Do not attempt to remove a ens from an injured eye. Notify the hospita if the patient has contact enses. If there is no function in an eye, ask if the patient has an eye. Contact Lens Remova (1 of 2) If absoutey necessary, remove a hard contact ens with a sma suction cup, moistening the end with saine. Contact Lens Remova (2 of 2) To remove a soft contact ens: Pace two drops of norma in eye. Genty pinch it between your goved thumb and index finger. Lift it off surface of eye. Injuries of the Nose trauma is common Bunt trauma to the nose can resut in fractures and soft-tissue injuries. Cerebrospina fuid coming from the nose is indicative of a sku fracture. Beeding from soft-tissue injuries of the nose can be controed with a dressing. Injuries of the Ear Ear injuries do not usuay beed much. 9

10 Injuries of the Ear Ear injuries do not usuay beed much. Pace a dressing between the ear and when bandaging the ear. For an avused ear, wrap the part in a moist sterie dressing. If a foreign body is odged in the ear, do not try to manipuate it. Cear fuid coming from the ear may indicate a sku fracture Outer, Midde, and Inner Ear Ear Injuries Facia Fractures A direct bow to the mouth or nose can resut in a facia fracture. Severe beeding in the mouth, oose teeth, or bone fragments indicate a break. Fractures around the face and mouth can produce deformities. Severe sweing may obstruct the airway. Disodged Teeth Disodged teeth shoud be transported with the patient in a container with some of the patient s or with some mik to preserve them. Bunt Injuries of the Neck A crushing injury of the neck may invove the or trachea. A fracture to these structures can ead to subcutaneous emphysema (air pockets under skin) Be aware of compete airway obstruction and the need for rapid transport to the hospita. Subcutaneous Emphysema Penetrating Injuries of the Neck (1 of 2) Can cause severe beeding. The airway, esophagus, and spina cord can be damaged from penetrating injuries. Appy direct pressure to contro beeding. Pace an dressing on a neck wound. 10

11 66 67 Pace an dressing on a neck wound. Penetrating Injuries of the Neck (2 of 2) Secure the dressing in pace with roer gauze, adding more dressing if needed. Wrap gauze around and under patient s shouder. Key Points Injuries to the face, neck, and eyes can be grotesque and boody Do NOT get vision Aways perform a compete assessment and treat injuries in the order of ife threats CONTROL THE AIRWAY FIRST! 11