Ch.28 face and neck injuries
How should you manage a foreign object in the eye? Penetrating and Non-penetrating
Non-penetrating objects on the sclera: irrigate with saline to remove
Objects penetrating the eye: do not remove, requires a physician. stabilize. ask patient to close both eyes.
Explain these skull fractures: linear, depressed, and basal
BONUS 10 POINTS: why does a scalp laceration bleed so heavily
Linear: no deformity
Depressed: bone displaced into brain tissue, higher brain injury risk
Basal skull fracture: at base of skull; may have CSF leakage, raccoon eyes, battle signs
Scalp is highly vascular → bleeds heavily even with minor lacerations
What are common signs and symptoms of chest trauma that may indicate serious internal injuries?
Pain or tenderness to the chest
Crepitus
Bruising or penetrating injury
Paradoxical motion
Respiratory distress
Hemoptysis (coughing up blood)
Jugular venous distention (JVD)
Hypoxia
Abnormal lung sounds
Signs of shock
What are the differences between tendons, ligaments, and a joint?
Tendons: connect bone to muscle
Ligaments: connect bone to bone
Joint: where two bones meet (actual contact area)
A 3-year-old child and an 80-year-old man are walking outside on a hot, humid day. Name two reasons each of these patients is at higher risk for environmental emergencies
3-year-old: immature thermoregulation, small body mass → lose/gain heat faster
80-year-old: slower metabolism, possible chronic illness or medications → poor thermoregulation
What is an orbital fracture and what are the signs a patient may have one?
An orbital fracture is when you break one or more bones that make up your eye socket
signs include: visual disturbances, double vision, deformity around the orbit, inability to move eye upward
Concussion: temporary brain function disruption, altered LOC, nausea, repetitive questioning
Cerebral contusion: brain bruising; may include edema, decreasing LOC, pupillary changes
Epidural hematoma: arterial bleeding under skull above dura; often temporal fracture; signs: worsening LOC, headache, bradycardia, seizures
What is the difference between a simple pneumothorax, tension pneumothorax, and a open pneumothorax (sucking chest wound)?
Simple pneumothorax: air in pleural space, usually from blunt trauma; minor effect on cardiac function; diminished lung sounds
Tension pneumothorax: progressive collapse of lung; compresses lung and great vessels; absent lung sounds, severe respiratory distress; late sign: tracheal deviation away from affected side
Sucking chest wound (open pneumothorax): air enters pleural space through chest wound during inhalation; treat with occlusive dressing/chest seal
Which 2 orthopaedic injuries are considered potentially life threatening?
Hint: both can lead to hypovolemic shock
Pelvic fractures: risk of hypovolemic shock, embolism, pneumonia, sepsis; high mortality in geriatric patients
Femur fractures: can cause significant blood loss → hypovolemic shock; risk of pulmonary embolism
During a sports event, a 16-year-old female collapses. She is hot to the touch, confused, and not sweating. She has a rapid pulse and shallow breathing. What heat emergency is likely, and how would you manage it?
Type: Heatstroke (systemic heat emergency)
Care: Move to cooler environment, rapid cooling (wet towels, cold packs to neck/groin/armpits), expose as much skin as possible, monitor ABCs, prepare for seizures, rapid transport.
How do you manage a dental avulsion and an impaled object in the cheek?
Dental avulsion: control bleeding, rinse tooth with saline, transport tooth in saline-soaked gauze
Impaled cheek object: stabilize unless it interferes with airway (then remove)
What is Herniation syndrome and Cushing's response?
Herniation: brain compresses due to excessive ICP; can force brain down toward foramen magnum
Cushing’s response: body raises blood pressure to perfuse brain, leading to hypertension, bradycardia, altered respiration → sign of increased ICP
What is cardiac tamponade and what is Beck's triad?
Cardiac tamponade: blood/fluid accumulates in pericardial sac, compressing the heart → decreased cardiac output
Beck’s triad:
Jugular venous distention (JVD)
Muffled heart sounds
Narrowing pulse pressure
BONUS 10 POINTS: When is a traction splint indicated?
Proper splinting: immobilize above and below the injury; check PMS (pulse, motor, sensation) before and after; gentle realignment if pulse absent
Traction splint: for closed midshaft femur fractures (with no other injuries to that side)
Explain hypothermia, frostnip, frostbite, and trench foot
BONUS 20: What core temp considers someone hypothermic?
Hypothermia: systemic, affects entire body, can appear like cardiac arrest
Frostnip: local, skin pale/cold, loss of sensation, tissue not frozen
Trench foot: local, prolonged exposure of feet to cold/wet conditions, risk of tissue death
Frostbite: local, tissue frozen, hard/mottled, blisters possible, risk of permanent damage
core temp < 35°C/95°F
What are the priority interventions for neck injuries to prevent life-threatening complications?
Secure the airway
Control life-threatening bleeding
Apply occlusive dressing to large open neck injuries to reduce risk of air embolism
How do you immobilize a patient with suspected spinal injury include special considerations for helmets?
Manual immobilization first, then cervical collar
Long spine board: supine or standing patients, rapid extrication
helmets: may need removal if airway is blocked or improper fit. Immobilization can secure head
Give an example of a solid and hollow organ. What is the risks in injuring each?
Solid organs: bleed heavily → risk of hemorrhagic shock; ex: liver, spleen, kidneys, pancreas
Hollow organs: spill contents → risk of infection and toxicity; ex: stomach, intestines, bladder
How do you differentiate between a strain, sprain, and dislocation?
Strain: injury to muscle or tendon; pain and tenderness, minimal swelling
Sprain: injury to ligament; pain, delayed swelling/discoloration, often in shoulder/knee/ankle
Dislocation: bone out of joint; pain, deformity, loss of function, possible weak/absent distal pulse
What is High altitude pulmonary edema (HAPE) vs. High altitude cerebral edema (HACE)? What interventions should be taken?
High altitude pulmonary edema (HAPE): fluid in lungs, SOB, cough pink sputum, cyanosis; provide oxygen, rapid descent/transport
High altitude cerebral edema (HACE): severe headache, ataxia, fatigue, vomiting, altered LOC; oxygen, rapid descent
Match the anatomy part to their function:
Cornea, Iris, Pupil, Sclera, Lens
A. Colored part of the eye that controls the size of the pupil
B. Focuses light onto the retina for clear vision
C. Opening in the center of the iris that allows light to enter
D. White, tough outer layer of the eye that provides structure and protection
E. Transparent covering over the iris; helps focus light and protects the eye
A. Iris
B. lens
C. pupil
D. sclera
E. cornea
A patient was in a high-speed car accident. They are complaining of neck pain, cannot move their legs, and have no sensation below the waist. What type of spinal injury might this be, and what signs alert you to possible severe spinal trauma?
Possible spinal injury: Transected or severe spinal cord injury
Warning signs of severe spinal trauma:
Pain or tenderness along the spine, Motor deficits (weak or absent movement), Sensory deficits (loss of touch or feeling), Paralysis (paraplegia or quadriplegia), High risk of respiratory paralysis if injury at C5 or above
What is a flail chest, and why is a pulmonary contusion a concern in these patients?
Flail chest: 2+ consecutive ribs fractured in 2+ places (or sternum separated from rib cage); paradoxical motion of chest wall
Pulmonary contusion: alveoli filled with blood; causes hypoxia; commonly associated with flail chest → ventilate with BVM
Name at least 4 types of fractures and one key characteristic for each
Displaced fracture: produces deformity, bone ends separated
Nondisplaced fracture: simple crack, bone remains aligned
Comminuted fracture: bone broken into more than two fragments
Greenstick fracture: incomplete fracture, common in children
Epiphyseal fracture: occurs in growth plate of child’s bone
Open fracture: bone protrudes through skin
Closed fracture: skin intact
A hiker gets caught in a blizzard on a mountain. He is wearing wet clothes, standing on icy rocks, and strong winds are blowing across the slope. His lips are pale, fingers numb, and he begins shivering.
Identify at least three ways this hiker is losing heat from his body, based on the five mechanisms of heat loss.
Conduction: Direct contact with cold surface (standing on icy rocks)
Convection: Heat lost to moving cold air (strong wind blowing across him)
Evaporation: Heat lost from wet clothes
Radiation: Heat radiating away from exposed body surfaces in cold environment
Respiration: Heat lost through exhaled warm air in cold environment