The Head and Face - University of West Alabama
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Transcript The Head and Face - University of West Alabama
The Head and Face
Chapter 27
Preventing Injuries to the Head,
Face, Eyes, Ears, Nose, and Throat
Wearing proper protective equipment
Instruct proper techniques of wearing the
head and face equipment
Instruct proper techniques of usage of head
and face equipment
Anatomy of the Head
Skull (comprised of 22 bones)
– http://www.gwc.maricopa.edu/class/bio201/skull/sku
lltt.htm
Scalp
– http://www.lrc.bcm.tmc.edu/courses/anatomy/bighe
adneck/headneck22.html
Brain
http://www.pbs.org/wnet/brain/3d/index.html
meninges
– cerebrospinal fluid
Assessing Head Injuries
History
Observation
Palpation (skull, cervical region)
Special Test
– Eye function (PEARL, tracking, vision blurred)
– PEARL (pupils equal and reactive to light)
• Dilated or irregular:
• Accommodation to light
– Eyes track smoothly (nystagmus:involuntary back and
forth or up and down motion indicates cerebral
involvement)
– Vision blurry
Special Tests (continued)
– Balance Test (Rhomberg’s; variations?)
• Rhomberg’s:eyes closed, stand with hands at side; variations
include single leg balance and tandem (heel toe) stance
• BESS (balance error scoring system): variations in stance and
regaining lost balance
– Coordination Test (“DUI”, heel toe walk)
• Inability to perform indicates cerebrum injury
– Cognitive Test (counting backwards, months of the
year, etc
– Neuropsychologiccal Assessments:
• SAC(Standard Assessment of Concussion)
• Others?
Assessing the Unconscious
Athlete
First priority to deal with life threatening
injuries
Breathing in particular
Always suspect cervical injury
Spine Board
If no life threatening injury suspected:
– Note length of time unconscious and do not
remove if not necessary
Recognition and Management of
Specific Head Injuries
Skull Fracture
– Etiology: blunt trauma
– Symptoms and Signs:headache, nausea, defect, blood
from ear, nose, raccoon eyes(eechymosis around eyes)
or battle’s sign(ecchymosis behind ears); straw colored
fluid in ear canal or mouth
– Management
Cerebral Concussion
– Defn: immediate or transient posttraumatic impairment
of neural function
– Etiology: direct blow (coup or contrecoup)
– Symptoms and Signs (headache, tinnitus, nausea, etc)
– Management: return to play?
Concussions
2 primary symptoms: disturbances in LOC and
posttraumatic amnesia
– Retrograde: nothing right before injury
– Anterograde :no memory of events after injury
Galscow Commas Scale
Classifications
– Based primarily on length of LOC
– LOC appears in less than 10% of mild head injuries
– More recent classifications account for ability to
concentrate, attention span difficulties, balance and
coordination problems
Determining when to return
Dilemma
If LOC, remove from competition
Some tests say that even with mild injury (bell
rung) that cognitive function does not return for 35 days
Should not return until all symptoms have
subsided (conservative)
Returning too early increases risk of second
impact syndrome
Post Concussion Syndrome
– Poorly understood condition following concussion
– Etiology: unknown
– Symptoms and Signs: headache, lack of concentration,
anxiety, vision problems, etc
– Management: treat symptoms; do not allow return
Second Impact Syndrome
– Etiology: rapid swelling and herniation of brain from
2nd injury before all symptoms have resolved; minor
blow may causes this; brain autoregulation is disrupted
• Greater likelihood in athletes 20 or younger
– Symptoms and Signs: initially looks minor but within
15secs to mins, rapidly worsens (dilated pupils, loss of
eye movement, LOC, respiratory failure); 50%
mortality
– Management: Prevent it; tx within 5 mons. Of dramatic
life saving measures
Cerebral Contusion
– Etiology:Intracranial bleeding; impact with
immoveable object
– S/S:vary; LOC then alert and talking but have
headaches, nausea and dizziness
– Management: refer – CT or MRI
Epidural Hematoma
– Etiology:tear of meningeal arteries; direct blow or
fracture
– S/S: created very fast; usually LOC; regained and then
gradual digression; will go as far as convulsions,
decrease in respirations and pulse
– Management: life threatening; refer for surgical relief
Subdural hematoma
– Etiology:venous bleed into subdural space from
acceleration/deceleration forces
– S/S:slow onset of symptoms; LOC not required,
headaches, dizziness, nausea, sleepy; increases
intracranial pressure
– Management:life threatening
Migraine headaches
– Etiology: unknown but appear to be vascular related
– S/S: flashes of light, blindness in half field of vision
– Management: prevent (meds)
Scalp injuries
– Etiology: blunt or penetrating trauma (laceration,
abrasions, contusions, hematomas)
– S/S: bleeding
– Management: clean areas (why is this difficult)
Recognition and Management of
Specific Head Injuries
Dental Injuries
– Anatomy(pg 801)
• gum, crown, root,
dentin, pulp
– Prevention
Tooth Fracture
– Etiology: impact
– Symptoms and Signs:
varies
– Management: refer
Tooth Subluxation,
Luxation, Avulsion
– Etiology: impact
– Symptoms and Signs:loose
or dislodged
– Management
• Subluxation: refer within
24 hours
• If possible, put back in
normal position
• Avulsed tooth should be
rinsed only and placed in
Save-A –Tooth, milk or
saline
• Sooner it is re-implanted
the better
Facial Anatomy
Bones
– Carry over form skull
– Maxillary, mandible(supports teeth, larynx, trachea,
upper airway, upper digestive tract)
Muscles
TMJ
– Joint capsule
– Meniscus between mandibular condyle and temporal
bone
Facial Injuries
Fractures
– Madibular
• Etiology: collision sports; direct blow; 2nd most common
• S/S: deformity, inability to bite normally, bleeding of gum,
inability to fell lower lip
• Mange: temp. immobilize and refer; fixation approx 4-6 weeks
– Zygomatic complex (cheekbone)
• Etiology: 3d most common; direct blow
• S/S: deformity on cheek region; epistaxis (nosebleed), diplopia
(double vision)
• Mange: refer; healing takes 6-8 weeks
Facial
Injuries
TMJ
– Etiology:disk – condyle derangement (disk moves
anteriorly or stability problems at the joint (too much or
too little)
– S/S: headache, ear ache, neck pain and muscle
guarding; may report pain and clicking when jaw
moves
– Mange:if cause is hypermobilty, strengthen ;
hypomobility corrected with joint mobilizations; treat
pain PRN; severe = dental referral
Facial Laceration
– Etiology:direct impact or indirect compressive force
– S/S:
– Mange: sutured require referral
– Special considerations: eyebrows?
Nasal Injuries
Nasal Fracture
– Etiology: most common fx to face; direct blow from
front or side
– S/S: profuse hemorrhage, deformity, mobility or
crepitus on palpation
– Manage: control bleeding; refer for x-ray and reduction
Deviated Septum
– Etiology: compression and lateral trauma
– S/S; bleeding, septal hematoma, deformity; painful
– Manage: apply compression at site of hematoma (these
are drained surgically), then nose packed and drainage
allowed to continue. If this is mismanaged, the
hematoma can complicate healing and cause difficult to
correct deformities
Nasal Injuries
Epistaxis
– Etiology: direct blow resulting in contusion
– S/S: nose will bleed; usually stops; some will
cauterize to prevent future problems
– Manage: site upright with cold compress; may
place gauze between lip and gum (direct
pressure to arties supplying nasal mucosa); if
doesn’t stop, try styptic solution on hemorrhage
point; may “plug” nose with guaze
Ear Injuries
Auricular Hematoma (cauliflower Ear)
– Etiology: Compression or shearing injury that causes
subcutaneous bleeding into auricular cartilage
– S/S: deformity due to accumulation of fluid / hematoma
/ coagulation results in keloid (elevated, nodular) This
can only be removed through surgery.
– Manage:to prevent, ear headgear, apply lubricant to ear
of those predisposed; immediate application of cold
pack will reduce hemorrhage
Ear Injuries
Otitis Externa (swimmers ear)
– Infection in ear canal caused by bacteria;
– athlete will complain of pain, itching, and partial
hearing loss
– Prevention: clean and dry ears, do not stick objects in
ear, avoid drastic environmental exposures
Otitis Media (inner ear infection)
– Accumulation of fluid in middle ear caused by local
and systemic infection
– results in intense pain, hearing loss, fever, headache,
nausea
– Treat with antibiotics
Eye injuries
Orbital Fractures
– Etiology: Direct Blow to orbit
– S/S: diplopia, restricted movement, hemorrhage
– Mange: refer for x-ray; antibiotics
prophylatically
Foreign Body in eye
– Severe cases: when the object cannot be wiped
away or washed out, close eye, cover with
patch and refer to doctor for further treatment
Retinal Detachment
– Blow to the eye; separate retina from eth pigment; more
common among nearsighted athletes
– S/S: painless, speaks floating before eye, flashes of
light, burred vision
– Management: immediate referral to ophthalmologist
Acute conjunctivitis
– Etiology: bacteria or allergens; irritations
– S/S: swelling of eyelid, discharge, itching, burning
– Mange: highly infectious
Sty (Hordeolum)
– Infection of eyelash follicle or sebaceous gland; usually
caused by organism that is spread by rubbing or dust
particles
– S/S: erythema of eye; localizes to pustule in a few days
– Manage: hot, moist compresses and ointment; if