Lecture on Chapter 29: Face and Neck Injuries

Introduction

• Focus on face and neck injuries
• Important for preventing and managing life-threatening conditions
• No extensive drawings or visuals due to technical issues

Key Points

Anatomy Overview

• Face and neck highly exposed to traumatic forces
• Common injuries: soft tissue injuries, fractures
• Life-threatening injuries include penetrating trauma to the neck, potential air embolism, and hematoma causing stroke
• Cervical spine injuries, airway management, and bleeding control are primary concerns

Structures of the Neck

• Anterior neck structures: thyroid cartilage, cricoid cartilage, trachea, muscles, and nerves
• Cricoid cartilage: firm ridge below the thyroid cartilage
• Cricothyroid membrane: joins thyroid and cricoid cartilage, important for cricothyrotomy

Eye Anatomy

• Eyes: globe-shaped, 1 inch in diameter, located in the orbit
• Anterior and posterior chambers: anterior filled with aqueous humor, posterior with vitreous humor
• White of the eye: sclera
• Conjunctiva: covers inner surface of eyelids and exposed surface of the eye
• Lacrimal glands: produce tears
• Pupils: regulate light entry, condition known as anisocoria for unequal pupils

Ear Anatomy

• Divided into three parts: external, middle, and inner ear
• Middle ear: contains malleus, incus, and stapes (ossicles)
• Inner ear: bony chambers filled with fluid

Injury Management

Airway and Soft Tissue Considerations

• Facial and neck injuries can obstruct the airway
• Direct injuries cause significant bleeding and respiratory compromise
• Teeth, dentures can become dislodged
• Swelling can contribute to airway obstruction
• Hematomas may indicate more severe injuries
• Maintain high index of suspicion for airway compromise

Facial Fractures

• Nasal fractures: most common, characterized by swelling, tenderness, crepitus
• Mandibular fractures: from blunt force, common in assaults
• Maxillary fractures: Laforte fractures (types I, II, III)
• Orbital fractures: may cause double vision (diplopia)
• Zygomatic fractures: flattened appearance, loss of sensation

Dental Injuries

• Fractured or avulsed teeth common
• Check for loose teeth or dentures to prevent airway obstruction
• Well-fitting dentures can be left in place

Assessment and Management

• Scene size-up: bring extra gloves, ensure suction works
• Assess for breathing adequacy, control bleeding, check pupils
• Use jaw thrust maneuver for airway management
• Avoid nasopharyngeal airways in suspected nasal fractures

Eye Injuries

• Assess for pupillary reactions, foreign objects
• Chemical burns: irrigate for at least 20 minutes
• Thermal burns: cover eyes with moist sterile dressing
• Light burns: caused by UV rays, welding arcs
• Lacerations: avoid pressure, apply moist sterile dressing and eye shield
• Blunt trauma: manage hyphema with elevated head position
• Retinal detachment: flashing lights, specks, floaters

Nosebleeds (Epistaxis)

• Anterior: usually self-limiting
• Posterior: more severe, may require medical attention
• Position patient leaning forward, pinch nose

Ear Injuries

• CSF drainage: apply loose dressing
• Foreign bodies: removal should be done by a physician
• Tympanic membrane perforation: avoid manipulation

Neck Injuries

• Life-threatening, significant bleeding
• Subcutaneous emphysema: crackling sensation, indicates air in soft tissues
• Laryngeal injuries: manage with careful ventilation, suctioning
• Avoid rigid collars

Muscular Injuries

• Maintain high index of suspicion for cervical involvement
• Strain: stretching or tearing of muscles or tendon (e.g., whiplash)
• Assess for distal pulse, motor, and sensory function

Injury Prevention

• Helmets, face shields, mouth guards, safety eyewear
• Advances in motor vehicle safety: occupant restraints, airbags

Summary

• Emphasis on proper assessment, management, and documentation
• Importance of staying updated on training and best practices

Next Steps

• Plan ride-alongs, think about service preferences
• FISDAP onboarding process for documentation and scheduling

Class Code

• 5656