Transcript Facial Injuries

Chapter 9
Injuries to the Head, Neck and
Face
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The skull
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8 cranial bones & 14
facial bones
parietals (2),
temporals (2), frontal,
occipital, sphenoid &
ethmoid
cranial bones,
articulations of the
suture type
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Soft Tissue
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Anatomy Review

Central Nervous System (CNS)
brain and spinal cord comprise the CNS
 CNS protected by meninges, cranium and
vertebrae
 CNS consists of gray and white matter and
weighs 3.0 to 3.5 lbs.
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The Neck
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Cervical spine
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7 vertebrae providing
support for the head
and protection for the
spinal cord
C-1 (Atlas)
articulates with the
occipital bone
C-2 (Axis) articulates
with C-1 via atlantoaxial joints
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Head Injuries in Sports

Minor trauma can result in serious
injury.
brain tissue is unable to repair itself -- any
damage is permanent
 possible mechanisms of injury are nearly
infinite
 coaches can learn to recognize head
injuries and render aid
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Head Injuries in Sports
From 1982-91, 1.5 million high school
tackle football participants annually
generated the greatest number of direct,
catastrophic injuries in fall sports.
 1/5 high school players have sustained a
concussion annually
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Head Injuries in Sports
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Cranial injury
involves the bones of the skull
 may be associated soft tissue injury
 depressed skull fracture
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 involves
bone fragments being pushed into the
cranial region
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Head Injuries in Sports
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Cerebral concussion
“clinical syndrome characterized by
immediate and transient impairment of
neurologic function secondary to
mechanical forces”
 unconsciousness, disorientation, amnesia,
dizziness, disequilibrium
 related to temporary disruption of blood
supply
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Head Injuries in Sports
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Colorado Medical Society classification
 grade
1 - most common -- no amnesia
 grade 2 - either posttraumatic or retrograde
amnesia
 grade 3 - unique due to loss of consciousness
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Second Impact Syndrome (SIS) –
 recently
recognized as a potentially serious
problem
 a concussion followed by another such injury prior
to the resolution of symptoms related to the first
injury
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Head Injuries in Sports
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involves rapid,
catastrophic
swelling of the
brain -- putting
pressure on the
brain stem, often
resulting in death
Shaded areas of the brain stem represent areas of compression.
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Head Injuries in Sports
(continued)
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Any athlete
sustaining a head
injury, no matter
how minor, should
be assessed prior
to returning to
competition.
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Intracranial injury
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potentially life
threatening
majority result from
blunt trauma
disruption of blood
vessels results in intracranial bleeding and
hematoma
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Head Injuries in Sports
(continued)
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major forms of intracranial bleeding include:
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epidural hematoma
subdural hematoma
intracerebral hematoma
cerebral contusion
epidural hematoma develops quickly due to
arterial bleeding while subdural hematoma
develops slowly due to venous bleeding.
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Initial Treatment
Guidelines

Primary survey
always assume a
neck injury
 check vitals first
 note body and
limb position,
helmet, face
mask, and mouth
guard
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Stabilizing the athlete’s head and neck
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Initial Treatment
Guidelines
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if unconscious, attempt to arouse
note approx. time on injury
immobilize head and neck immediately, not
removing athlete’s helmet.
detect breathing by listening near the airway and
looking for movements of the abdomen and/or
thorax
check carotid pulse with two fingers
monitor pulse for 30 seconds; if none, alert EMS
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Initial Treatment
Guidelines
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Secondary survey
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conscious athlete less complicated than unconscious
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conscious or unconscious?
extremity strength
mental function
eye signs
pain specific to the neck
spasm of the neck musculature
determining level of consciousness is not always easy
if conscious, ask a few simple questions
loss of short term memory can indicate more serious
injury
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Initial Treatment
Guidelines
Don’t arouse someone with ammonia
capsules.
 if conscious, use quick neurological tests,
such as grip strength and skin sensation
 examine the eyes, noting pupil size,
responsiveness to light and side-to-side
movement
 palpate the neck for deformity
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Initial Treatment
Guidelines
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Emergency
procedures for
football
equipment
creates special
problems
 helmet, face
mask, chin strap
and mouth guard

Trainer’s Angel
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Initial Treatment
Guidelines
management of the
helmeted player is
a major issue
 if airway must be
established,
removal of the face
mask is necessary
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cut the clips with
a device like the
“Trainer’s Angel”
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Initial Treatment
Guidelines
Plastic clips secure the face mask.
If a Trainer’s Angel is
not available, removal
of screws that hold the
clips is an option.
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Initial Treatment
Guidelines
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Once the clips are
removed the face
mask can be rolled
up, out of the way
of the airway
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Initial Treatment
Guidelines
In the event of a neck injury, the
helmet provides an excellent means
of cervical immobilization.
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Initial Treatment
Guidelines
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General Guidelines
Don’t move the athlete until the secondary
survey is complete.
 if the athlete is recovered, escort to the
bench for observation
 any suspicious signs/symptom -immobilize
and summon EMS
 in most cases, there is NO reason to move
the athlete prior to arrival of EMS
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Initial Treatment
Guidelines
level of consciousness - single most important
factor
 in the majority of incidents, the athlete never
loses consciousness
 athlete with a head injury usually appears
dazed and unstable
 may also have tinnitus and memory loss
 if there any doubts about severity, refer to a
physician immediately
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Initial Treatment
Guidelines
Romberg’s Test
Finger-to-Nose Test
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Initial Treatment
Guidelines
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CMS guidelines -pull any athlete
with a grade I
concussion for a
minimum of 20
minutes for
observation
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Anyone
sustaining a
Grade II or III
concussion
should be
referred to a
physician
immediately.
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Cervical Injuries
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Neck injuries
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majority occur in football, rugby, ice hockey, soccer,
diving and gymnastics, however cervical injuries can
occur in almost any sport
catastrophic injuries are rare -- 2/100,000 of all neck
injuries, since 1977 less than 10 players/year suffer
permanent cord injuries
mechanisms include: hyperflexion, hyperextension,
rotation, lateral flexion, and axial loading
axial loading places the neck in a slightly flexed
position
1976 NCAA enacted the rule barring “spearing”
however recent research indicates that the rule may
not be effective.
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Axial Loading
Flexion with Axial Loading
Extension
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Background Information
(continued)
Spearing incidence
has not changed
much from 1975.
 cervical injuries
include sprains,
strains,
intervertebral disks
and brachial plexus
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strains generally
more painful than
serious
 severe injuries
involve fractures
that are displaced
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Cervical Injuries
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spinal cord may sustain secondary injury due to
disruption of blood supply
neck strains rarely involve nerve damage
brachial plexus injuries can produce significant,
but transient, symptoms
critical that coaching personnel take great care
when conducting a primary and secondary survey
of an athlete suspected of having a neck injury
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Initial Treatment of Neck
Injury Guidelines
Determine if the
athlete is
conscious, if
unconscious, the
first priority is
basic life support.
 Emergency plan
should designate
a “team leader.”
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Initial Treatment of Injury
Guidelines
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If conscious,
question the
athlete regarding
numbness,
weakness,
dysesthesia.
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Appearance of
such symptoms -immediately
stabilize head and
neck and summon
EMS.
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Spine Boarding an Athlete
1
2
3
4
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Injuries to the
Maxillofacial Region
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Jaw, teeth, eyes, ears, nose, throat, facial
bones and skin
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NEISS recorded 170,000 sports related injuries
within the U.S. to these body areas.
Protective equipment has been developed and
improved for many of these areas:
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mouth guards
protective eye wear
face shields
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Maxillofacial Region
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Dental injuries
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jaw has 32 teeth
teeth are vulnerable to
external blows
common in many
sports
teeth are secured by
cementum and
periosteum
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Maxillofacial Region
majority of dental injuries result from direct
blows that loosen or knock teeth out
 When rendering first aid, take precautions to
avoid bloodborne pathogens.
 Examining dental injuries
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 open/close
mouth without pain?
 general symmetry of the teeth?
 irregularities in adjacent teeth?
 bleeding, especially along gum line?
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Injuries to the Maxillofacial
Region
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Loosened or knocked out
 gently
push back into place
 if knocked out, clean with saline and put back into
place
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High risk sports -- use mouth guard
 required
in high school since 1966, NCAA in 1974
 stock, mouth-formed and custom fitted
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Eye Injuries
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Eye injuries
–
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eye consists of a
round ball-like
structure housed
within the orbit
globe is filled with
vitreous body
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Eye Injuries
–
–
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posterior/inferior eye
is covered by the
retina
eyeball is encased
in the sclera
eye injuries in the
U.S. are on the
increase (basketball
and cycling).
Proper position of the fingers for an
initial examination of the eye
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Eye Injuries
–
two categories -- contusional and
penetrating
contusional injuries vary in severity -simple abrasions to rupture of the eye
 detached retina
 penetrating injuries are less common -shooting sports.
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Eye Injuries
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Initial evaluation guidelines
majority are simple corneal abrasions or small
foreign objects
 hold upper eyelid away from anterior eye
 small foreign bodies usually found by
observation
 visible foreign object can be removed with a
moist cue-tip, if imbedded, cover both eyes
and transport to medical facility
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Eye Injuries
if nothing can be seen in the eye, probably a
corneal abrasion
 contusions may result in hemorrhage around
the eye known as a “black eye”
 more severe cases may involve bleeding into
the anterior eye known as “hyphema” -- refer
to medical facility immediately
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 symptoms:
pain, visual deficit (diplopia) and
obvious bleeding into the eye
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Eye Injuries
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retinal injuries develop slowly -- early
symptoms include:
 floating
particles in field of vision
 distorted vision
 changes in the amount of light seen
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Eye Injuries
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Contact lens problems
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many athletes wear contacts with few problems;
however, data show more problems related to hard
lenses
biggest problem -- lens slipping or debris getting
trapped between the lens and the eye
coach should have first aid kit to treat common
problems including: wetting solution, small mirror,
contact lens case
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Nose Injuries
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Nose injuries
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often injured due to location -bloody nose (epistaxis) may
be the most common facial
injury in sports
Anatomically, the nose
consists of mostly cartilage
and skin along with the R & L
nasal bones.
Evaluation & treatment
guidelines
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any blow to the nose can
cause a fracture
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deformity and swelling at the
bridge of the nose
If a fracture is suspected, treat
the bleeding and refer to a
medical doctor.
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Ear Injuries
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Ear injuries
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anatomically, the ear is similar to the nose
external opening and extensive internal structure
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external ear (auricula)
external acoustic meatus
middle ear
inner ear (labyrinth)
inner ear has a role in equilibrium
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Anatomy of the Ear
Temporal
bone
Semicircular Canals
Incus
Stapes
Malleus
Cochlear
nerve
Pinna
External auditory
meatus (canal)
Vestibular
nerve Auditory
nerve
Tympanic
membrane
Cochlea
Oval
Window
Round
Window
Eustachian
tube
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Ear Injuries
majority of ear problems are related to
the external ear
 sports such as wrestling are related to
numerous ear problems because of
contact with opponents and/or playing
surface, required head gear has
reduced incidence of such injuries
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Ear Injuries
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Cauliflower ear
should be treated
with cold pack and
immediately referred
to a medical doctor.
severe blows to the
outer ear can result
in a ruptured ear
drum
inner ear infections
can result in
problems in high risk
sports
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Injuries to the Maxillofacial
Region
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Fractures of the
face
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certain sites are
more common:
 lower
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jaw
signs/symptoms
include:
 pain/swelling
 deformity
&
malocclusion
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Face Injuries
–
Signs/symptoms include:
•
•
•
–
–
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extreme pain/deformity in the region of the
TMJ
inability to move lower jaw
jaw is “locked”
Do NOT attempt to put back into place.
treatment includes: application of ice pack
and medical referral.
zygomatic bone may be fractured
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Injuries to the Maxillofacial
Region
–
signs/symptoms include:
•
•
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pain and swelling
discoloration that spreads to the region of the
orbit
treatment includes: application of ice pack
and medical referral
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Face Injuries
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Wounds of the facial region
wounds can take many forms and treatment
should follow basic first aid protocol
 carefully clean with mild soap and apply
sterile dressing
 such wounds can present cosmetic problems
 In general, any wound with observable space
between margins may require suturing.
 after suturing, return to play decisions are
made by the doctor
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