Chapter 28: Face and Neck Injuries

Introduction

• Face and neck are vulnerable due to unprotected positioning.
• Common injuries: soft tissue damage, fractures, penetrating trauma.
• Potential issues: severe bleeding, air embolism, stroke.
• EMT objectives: prevent further injury, manage airway, control bleeding.

Anatomy and Physiology

The Head

• Cranium: Brain housed, connects to spinal cord.
  • Occiput: Most posterior cranial area.
  • Temporal regions: Lateral sides near temples.
  • Parietal regions: Between temporal and occiput.
  • Frontal region: Forehead.

The Face

• Composed of eyes, ears, nose, mouth, cheeks.
• Main bones: nasal bone, maxillae, zygomas, mandible.
• Orbit: Protects eyes, composed of several facial bones.
• Ears: Composed of cartilage (pinna, lobes, tragus).
• Mandible: Jaw and chin, motion occurs at TMJ.

The Neck

• Supported by cervical spine (C1-C7).
• Contains esophagus, trachea, carotid arteries, jugular veins.
• Thyroid cartilage: Adams apple.
• Cricothyroid membrane: Between thyroid and cricoid cartilage.

Eyes

• Globe shaped, protected by bony orbit.
• Vitreous humor: Back fluid, Aqueous humor: Front fluid.
• Conjunctiva: Delicate membrane over eye.
• Sclera: White of eye, protective fibrous tissue.
• Cornea: Transparent front part for light entry.
• Iris: Pigmented muscle, regulates light entry.
• Pupil: Central opening in iris.
• Lens: Focuses images on retina.
• Retina: Light-sensitive, nerve endings for vision.
• Choroid: Nourishes retina.

Injuries of the Face and Neck

Airway Obstruction

• Bleeding can cause clots, obstruct airway.
• Direct injuries to nose, mouth, larynx, trachea can cause bleeding.
• Swelling and head positioning may contribute to obstruction.

Soft Tissue Injuries

• Common due to vascular nature.
• Hematoma: Blood collection under skin.

Dental Injuries

• Mandible fractures common from high impact.
• Signs: Teeth misalignment, chin numbness.
• Maxillary fractures from blunt force.

Patient Assessment

Scene Size-Up

• Check for hazards, potential violence.
• Use standard precautions.
• Mechanism of injury: motor vehicle, sports, falls.

Primary Assessment

• Treat life-threatening hemorrhage first.
• Evaluate airway, breathing, circulation.
• Control blood loss promptly.

History Taking

• Gather medical history and chief complaint.
• Obtain SAMPLE history from patient or bystanders.

Secondary Assessment

• Uncover missed injuries, focus on face and throat.
• Evaluate facial alignment, nasal deviation, drooping.
• Detailed examination of eyes, neurologic system, respiratory system.

Reassessment

• Repeat primary assessment, vital signs.
• Recheck interventions.

Emergency Medical Care

Soft Tissue Injuries

• Control bleeding, manage airway.
• Use sterile dressings, avoid pressure on skull fractures.

Eye Injuries

• Proper treatment can prevent vision loss.
  • Foreign Objects: Irrigate with saline.
  • Burns: Immediate irrigation, cover with moist dressing.
  • Lacerations: Avoid pressure, cover exposed parts.

Nose Injuries

• Anterior nosebleeds self-limiting, posterior more severe.

Ear Injuries

• Control bleeding, manage avulsions.
• Avoid manipulating foreign bodies.

Facial Fractures

• Not acute emergencies unless bleeding.

Neck Injuries

• Blunt trauma can affect airway, cause subcutaneous emphysema.
• Penetrating injuries can cause exsanguination, air embolism.
  • Laryngeal Injuries: Manage airway, consider spinal precautions.