02 management of facial injury in a multi trauma

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