Post on 14-Dec-2015
TRANSITION SERIESTRANSITION SERIES
Topics for the Advanced EMTTopics for the Advanced EMT
CHAPTERCHAPTER
Emergencies Involving the Emergencies Involving the Eyes, Ears, Nose, and ThroatEyes, Ears, Nose, and Throat
3434
ObjectivesObjectives
• Review the epidemiology of facial injuries.
• Discuss pathophysiologic changes that occur with facial emergencies.
• Review pertinent questions and physical findings of facial injuries.
• Discuss proper use of Morgan Lens kit.• Indentify proper prehospital treatment.
IntroductionIntroduction
• Facial injuries can cause significant injuries and emotional stress.
• Airway patency is always a concern with trauma to the face.
• Associated injuries to the neck and spine may also occur.
EpidemiologyEpidemiology
• Greater than 1 million facial injuries per year.
• 50% of high-impact fractures also have other major injuries.
• Associated cervical injury occurs up to 6% of the time.
Types of facial fractures
Common neck and throat injuries
PathophysiologyPathophysiology
• Dispersion of kinetic energy during deceleration produces the forces that result in injury.
Pathophysiology (cont’d)Pathophysiology (cont’d)
• Eye injuries– Irrigation may be necessary.– Chemical burns require flushing >20
minutes.– Alkali burns require flushing till arrival at
hospital.
Pathophysiology (cont’d)Pathophysiology (cont’d)
• Epistaxis– Anterior bleeding– Posterior bleeding– Control by pinching nostrils together for
10 minutes
Controlling a nosebleed: Have the patient sit and lean forward.
Controlling a nosebleed: Pinch the fleshy part of the nostrils together.
Assessment FindingsAssessment Findings
• General assessment considerations– Consider maintaining cervical spinal
immobilization during assessment.– Assess and treat any threats to ABCs
first.– Determine answers to specific questions
regarding consciousness, vision problems, hearing problems, malocclusion of teeth, drainage from ears, or open neck trauma.
Assessment Findings (cont’d)Assessment Findings (cont’d)
• General findings– History consistent with trauma– Structural damage to facial structures– Open hemorrhage and/or oral
hemorrhage– Punctures, penetrations, lacerations to
head, face, or neck– Pain to cervical vertebrae, possible
neuromuscular deficits from cord injury
Emergency Medical CareEmergency Medical Care
• Take spinal precautions.• Ensure airway, suction as needed.• Provide oxygen based on need.
– Apply oxygen to keep SpO2 >95%.
– NRB or PPV based on breathing adequacy.
Emergency Medical Care (cont’d)Emergency Medical Care (cont’d)
• Control external hemorrhage as appropriate.
• Initiate transport
Case StudyCase Study
• You are called for a motor vehicle versus pedestrian incident on a busy city street. Upon arrival a crowd has gathered around a motionless victim lying supine in the road. At the patient's side, you see facial trauma with hemorrhaging, the right arm is abnormally angled, and breathing seems labored.
Case Study (cont’d)Case Study (cont’d)
• Scene Size-Up– Scene is safe, controlled by PD.– Standard precautions taken.– Patient is 17 year old female, 120 lbs.– Entry and egress from site is
unobstructed.– MOI is traumatic incident.– No additional resources needed.
Case Study (cont’d)Case Study (cont’d)
• Primary Assessment Findings– Patient unresponsive.– Blood and broken teeth in airway.– Breathing labored and tachypneic.– Peripheral perfusion intact.– Patient not responding to painful stimuli.
Case Study (cont’d)Case Study (cont’d)
• Is this patient a high or low priority?• What kind of differentials for the
unresponsiveness exist?• What care should be initiated
immediately?
Case Study (cont’d)Case Study (cont’d)
• Medical History– Unknown
• Medications– Unknown
• Allergies– Unknown
Case Study (cont’d)Case Study (cont’d)
• Pertinent Secondary Assessment Findings– Pupils equal but sluggish to respond.– Airway established by EMS, now patent.– Perfusion intact peripherally, pulse
rapid.– Breathing spontaneously adequate.– No major bleeds to the body.
Case Study (cont’d)Case Study (cont’d)
• Pertinent Secondary Assessment Findings (continued)– Right arm angulation to be managed by
back board.
– SpO2 95% on room air, 99% on oxygen.
– No further findings contributory to this report.
Case Study (cont’d)Case Study (cont’d)
• Care provided:– Patient fully immobilized.– Airway maintained with suctioning and
manual technique.– Oxygen via NRB mask with adequate
breathing.
Case Study (cont’d)Case Study (cont’d)
• Care provided:– Arm angulation immobilized by back
board.– Transport initiated to ED with Paramedic
intercept planned en route.
SummarySummary
• Facial injuries can result in life-threatening conditions.
• Associated injuries to the brain and spinal cord may occur as well.
• Assessment and management should focus on maintenance of the airway, breathing, and circulation functions.