Chapter 28: Face and Neck Emergencies

Overview

• Focus: Managing trauma-related issues with face and neck injuries.
• Key Learning Outcomes:
  • Recognize life threats associated with face and neck emergencies.
  • Understand anatomy, physiology of head, neck, and eye.
  • Manage injuries such as trauma to mouth, penetrating neck trauma, and facial fractures.
  • Address dental and blast injuries to the eye.
  • Manage common eye injuries (foreign objects, wounds, burns, etc.).

Anatomy and Physiology

• Head:
  • Cranium (skull) contains the brain.
  • Major bones: nasal bone, two zygomas, two maxillae, mandible.
  • Bony orbit protects the eye.
  • Ears: composed of cartilage, with external part known as pinna.
• Neck:
  • Supported by cervical spine (C1-C7).
  • Contains carotid arteries, jugular veins, and several nerves.
  • Major structures: larynx (Adam's apple), cricoid cartilage, thyroid gland.
• Eye:
  • Globe shape, situated in bony orbit.
  • Composed of vitreous humor, aqueous humor, conjunctiva, sclera, cornea, iris, pupil, lens, retina.

Injuries to Face and Neck

• Life-threatening injuries:
  • Penetrating trauma to neck (severe bleeding, air embolism).
  • Obstruction can be caused by blood clots, teeth, swelling.
• Dental and Facial Injuries:
  • Mandible injuries (misaligned teeth, numbness).
  • Maxillary fractures (facial swelling, instability).
  • Avulsed teeth (potential airway obstruction).

Patient Assessment

• Scene Safety: Prioritize safety, consider environmental hazards.
• Primary Assessment:
  • Address life-threatening concerns, manage X ABCs immediately.
  • General impression, control blood loss, check responsiveness.
  • Airway and breathing: ensure clear airway, consider oral airway if unresponsive.
  • Circulation: assess pulse, address significant bleeding.
  • Transport decision: Rapid transport for severe cases.
• History and Secondary Assessment:
  • Obtain medical history, assess signs and symptoms.
  • Physical examination: look for DECAP BTLS.
  • Vital signs: monitor for changes, be aware of internal bleeding.

Emergency Medical Care

• Soft Tissue Injuries:
  • Treat similar to other parts of the body.
  • Control bleeding, manage exposed structures.
• Specific Injuries:
  • Eye Injuries:
    • Foreign objects: Irrigate with saline.
    • Chemical Burns: Flush eye immediately.
    • Lacerations: Apply moist sterile dressing.
    • Blunt trauma: Protect with metal shield.
  • Nose and Ear Injuries:
    • Nosebleeds: Pinch nostrils together, lean forward.
    • Ear lacerations: Apply roller dressing, manage avulsions.
  • Neck Injuries:
    • Control bleeding, apply direct pressure.
    • Consider spinal immobilization, assess for shock.
    • Laryngeal injuries: Maintain airway, avoid rigid collar.

Review Questions

• Adam's apple: Not inferior to cricoid cartilage.
• Eyeball: Known as the "globe."
• Pupil Reaction: Constricts when looking at close objects.
• Chemical Burns: Flush eye away from uninjured eye.
• Head Injury Indicators: Least indicative is pupillary constriction to bright light.
• Eustachian Tube: Equalizes pressure in the middle ear.
• Airway Compromise: Primary concern with facial trauma.
• Subcutaneous Emphysema: Suggestive of tracheal/laryngeal injury.
• Arterial Bleed Management: Direct pressure with gloved hand, apply dressing.
• Crushing Injury to Larynx: Often from hanging.

Conclusion

• End of Lecture: Stay informed on face and neck emergencies to effectively manage in real-life scenarios.
• Subscribe: Follow the lecture series for continued learning on emergency care and transportation.