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



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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