National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 22 Face, Eye, and Neck Injuries

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 22.1 Describe the function of the iris List possible causes of eye injuries Describe and demonstrate how to assess eye injuries Describe and demonstrate the management of a patient with a penetrating injury to the eyeball Identify the important structures of the anterior and posterior neck. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 22.6 List the signs and symptoms of emergencies of the neck and upper airway List the functions of the following: a.facial bones b.lacrimal glands c.neck muscles 22.8 List the signs and symptoms of emergent injuries to the face, eyes, and neck. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 22.9 Describe and demonstrate how to assess face, eye, and neck injuries Describe and demonstrate the proper care of a face, eye, or neck injury.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Anatomy and Physiology Common Face, Eye, and Neck Injuries Assessment Management Chapter Summary

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation A snowboarder is lying in the snow beyond a yellow closure rope. He is lying on his back, holding his neck with both hands and is in considerable distress. Copyright Studio 404

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Facial Structures ◦ Bones, cartilage, and muscle ◦ Nose, mouth, eyes Auditory and Balance System ◦ External ear ◦ Auditory canal and ear drum ◦ Bones, cochlea, auditory nerves ◦ Vestibular system continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Visual System ◦ Eyeball ◦ Optic nerve ◦ Bony orbit ◦ Muscles ◦ Eyelid ◦ Lachrymal glands continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Neck Anatomy ◦ Carotid arteries, jugular veins ◦ Esophagus, trachea ◦ Larynx, thyroid cartilage ◦ Muscles ◦ Cervical vertebrae (posterior)

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Face, Eye, and Neck Injuries Trauma related ◦ Soft tissue ◦ Penetrating or impaled objects Environmental Airway concerns C-Spine issues

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Face and Neck Injuries Trauma ◦ Soft tissue injuries ◦ Penetrating injuries ◦ Blunt injuries ◦ Fractures ◦ Crushing injuries Environmental injuries Airway obstruction C-Spine involvement

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Eye and Ear Injuries Contusions, lacerations Rupture Abrasive and penetrating injuries ◦ Foreign or impaled objects Light related (UV or excessively bright) Chemical burns

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Eye and Ear Injuries

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Nose, Mouth, and Jaw Injuries Fractures Damage to teeth Soft tissue injuries, bleeding ◦ Epistaxis Airway concerns ◦ Blood ◦ Swelling

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Neck Injuries Life threatening Closed ◦ Swelling can compromise airway ◦ Crushing of larynx or trachea Open ◦ Damage multiple structures ◦ Profuse bleeding ◦ Air enters blood system C-spine may be involved

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Facial Fractures

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update You suspect the snowboarder could have serious neck trauma. The patient is clearly anxious and is having difficulty breathing. His respiration rate is 24 per minute; he can speak in only a hoarse whisper. and is drooling from his mouth. His pulse is 100 bpm. When you examine the patient’s neck, you notice a dark red abrasion and underlying swelling on the right anterior portion of his neck. He has no tenderness or deformities.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Expect anxiety, C-spine involvement, and airway/breathing concerns Bleeding can be significant, may be disproportional to size of wound Continuously monitor for changes in status

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment of the Eye Inquire about vision ◦ Lens, retina, structural involvement Pupils – Equal? Reactive? Movement Blood ◦ Sclera (bloodshot) ◦ Hyphema continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment of the Eye continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment of the Eye External structures ◦ Eyelid ◦ Orbit

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment of the Nose and Mouth Symmetry and stability Blood – external or from within Abnormal color – bluish or pale Broken or missing teeth Jaw alignment

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management of Facial Injuries

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment of the Ear External structures Fluids – color noted Battle’s sign Foreign body in ear canal Hearing

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment of the Ear

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment of the Neck Symmetry Midline shift Swelling Airway compromise C-spine involvement Bleeding

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment of the Neck

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Rapid assessment and frequent re- evaluation ABCDs ◦ Suction ◦ Oxygen Controlling blood and other fluids ◦ Varies based on location

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Specific Management Issues Tooth care Dizziness, balance issues, nausea Foreign body removal ◦ Ear or Eye Penetrating injuries, impaled objects Eyeball injuries continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Specific Management Issues continued An Avulsed Tooth ◦ If a patient has altered mental status or is unable to clear his own secretions, never place an avulsed tooth back in the socket because of the significant risk that the patient will swallow or aspirate it during transportation.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Specific Management Issues continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Specific Management Issues Burns to the eye Contacts Open wounds of the neck

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition You reassure the snowboarder while stabilizing his head and neck. Upon the arrival of other patrollers and equipment, you apply high-flow oxygen and affix a C-collar. Rapid transport is necessary. You give the ALS provider your hand-off report, which includes your concern for a progressively worsening compromise of the patient’s airway. He is eventually intubated en route and survives.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Facial and neck injuries can be associated with severe pain and anxiety and rapidly become life threatening. Assess the stability of the patient’s airway by listening to the patient talk. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Direct pressure applied to an injured globe of the eye may worsen the injury. Facial and neck asymmetry is a clue to traumatic injury. Facial fractures require a significant mechanism of injury, so associated closed head or cervical-spine injuries must be considered as well. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Facial and neck injuries are likely to increase your chance of exposure to the patient’s bodily fluids. Face and neck injuries require frequent assessment. Any significant face, neck, or head injury requires cervical (and spinal) immobilization.