02 management of facial injury in a multi trauma
TRANSCRIPT
MANAGEMENT OF FACIAL INJURY IN A
MULTI TRAUMA PATIENT
FACIAL TRAUMA
• MAY BE ISOLATED
• MAY BE IN ASSOCIATION WITH MULTIPE TAUMA
FACIAL TRAUMA
• LIFE THREATENING COMPLICATIONS CAN OCCUR
• EVIDENT INJURY CAN BE TRIVIAL
FACIAL TRAUMA
• INJURIES CAN BE – FRACTURES– SOFT TISSUE INJURIES– OPHTHALMIC INJURY– PANFACIAL INJURY
FACIAL TRAUMA
• ASSOCIATED INJURIES CAN BE– ANTERIOR NECK INJURIES– SPINAL INJURIES– HEAD INJURY– INJURIES RESULTING IN PROFUSE
BLOOD LOSS– PERIPHERAL INJURIES – FACTURES
FACIAL TRAUMA MANAGEMENT
• PRIMARY SURVEY
• RESUSCITATION
FACIAL TRAUMA MANAGEMENT
• PRIMARY SURVEY AIMS TO– IDENTIFY ANY LIFE THREATENING
CONDITIONS
• RESUSCITATION– TO STABILISE THE PATIENT
FACIAL TRAUMA MANAGEMENT
• NORMALLY IN A CASE OF FACIAL TRAUMA THE PATIENT IS TO BE KEPT SEMIPRONE
• IN A CASE OF MULTI-TRAUMA THE C-SPINE HAS TO BE IMMOBALIZED AND THE AIRWAY ALSO CONTROLLED
AIRWAY CONTROL
• HIGH INDEX OF SUSPICION FOR OBSTRUCTING AIRWAY
• FREQUENT RE-ASSESSMENT• AIRWAY STARTS FROM MOUTH AND
UPTO THE LARYNX
AIRWAY CONTROL
• OBSTRUCTION MAY OCCUR DUE TO– DROWSINESS
• ALCOHOL• HEAD INJURY
– FOREIGN BODY• GUMS SWEETS DENTURES
TEETH– BLOOD / VOMITUS
AIRWAY CONTROL
• IDENTIFY ORAL OR NASAL BLEEDING
• IF THE NECK IS IMMOBALISED • PRESENCE OF AN EXPERIENCED
ANAESTHETIST
AIRWAY CONTROL
• CAN THE PATIENT SIT UP?– IN AN AGGRESSIVE PATIENT– EITHER RULE OUT SPINAL INJURY OR– KEEP THE NECK IN A RIGID CERVICLE
COLLAR– CAREFUL MONITORING
AIRWAY CONTROL
• FRACTURES AND SOFT TISSUES SWELLING– BILATERAL FRACTURE MANDIBLE– MIDFACE FRACTURE– PANFACIAL INJURIES– SOFT TISSUE INJURY TO THE NECK
• MAY TAKE HOURS TO DEVELOP
AIRWAY CONTROL
• ANTERIOR NECK INJURY LOOK FOR– HOARSE VOICE– HAEMOPTYSIS– SURGICAL EMPHYSEMA– FRACTURE CREPITUS
AIRWAY CONTROL
• CAREFULLY PALPATE THE – GREAT VESSELS– HYOID BONE– LARYNX– LOOK FOR EXTERNAL SWELLING
THE CERVICLE SPINE
• ALWAYS ASSUME CERVICLE SPINAL INJURY TO BE PERSENT
• UNSTABLE LIGAMENTOUS INJURY CAN BE PRESENT DESPITE NORMAL BONY STRUCTURE
AIRWAY MAINTAINENCE TECHNIQUES
• SUCTION• JAW THRUST• CHIN LIFT• OROPHARYNGEAL AIRWAY• LMA• ENDOTRACHEAL INTUBATOIN
AIRWAY MAINTAINENCE TECHNIQUES
• SURGICAL AIRWAY– NEEDLE CRICOTHYROIDOTOMY– SURGICAL CRICOTHYROIDOTOMY
– TRACHEOSTOMY• NOT SUITABLE FOR EMERGENCY SETTINGS
BREATHING
• ESTABLISHED AS SOON AS POSSIBLE
• ALL FOREIGN BODIES HAVE TO BE REMOVED
CIRCULATION
• ANY COLD AND TACHYCARDIAC PATIENT SHOULD BE CONSIDERED TO BE IN HYPOVOLEMIC SHOCK
• FACIAL INJURIES UNLIKELY THE SOLE CAUSE
CIRCULATION
• SEVERE FACIAL HAEMORRHAGE REPORTED TO BE IN 1 IN 10 FATAL INJURIES
• SEVERE MID FACE AND PANFACIAL INJURIES
CIRCULATION
• CONTROL OF HAEMORRHAGE
• I/V ACCESS
• SURGICAL INTERVENTION
CIRCULATION
• HAEMOSTASIS• PACKING• STABILISING FACIAL FRACTURES
– IMF– PLATING– SPLINTS
• LIGATION OF MAJOR VESSELS
THANK YOU