TRANSITION SERIESTRANSITION SERIES

Topics for the Advanced EMTTopics for the Advanced EMT

CHAPTERCHAPTER

Emergencies Involving the Emergencies Involving the Eyes, Ears, Nose, and ThroatEyes, Ears, Nose, and Throat

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ObjectivesObjectives

• Review the epidemiology of facial injuries.

• Discuss pathophysiologic changes that occur with facial emergencies.

• Review pertinent questions and physical findings of facial injuries.

• Discuss proper use of Morgan Lens kit.• Indentify proper prehospital treatment.

IntroductionIntroduction

• Facial injuries can cause significant injuries and emotional stress.

• Airway patency is always a concern with trauma to the face.

• Associated injuries to the neck and spine may also occur.

EpidemiologyEpidemiology

• Greater than 1 million facial injuries per year.

• 50% of high-impact fractures also have other major injuries.

• Associated cervical injury occurs up to 6% of the time.

Types of facial fractures

Common neck and throat injuries

PathophysiologyPathophysiology

• Dispersion of kinetic energy during deceleration produces the forces that result in injury.

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Eye injuries– Irrigation may be necessary.– Chemical burns require flushing >20

minutes.– Alkali burns require flushing till arrival at

hospital.

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Epistaxis– Anterior bleeding– Posterior bleeding– Control by pinching nostrils together for

10 minutes

Controlling a nosebleed: Have the patient sit and lean forward.

Controlling a nosebleed: Pinch the fleshy part of the nostrils together.

Assessment FindingsAssessment Findings

• General assessment considerations– Consider maintaining cervical spinal

immobilization during assessment.– Assess and treat any threats to ABCs

first.– Determine answers to specific questions

regarding consciousness, vision problems, hearing problems, malocclusion of teeth, drainage from ears, or open neck trauma.

Assessment Findings (cont’d)Assessment Findings (cont’d)

• General findings– History consistent with trauma– Structural damage to facial structures– Open hemorrhage and/or oral

hemorrhage– Punctures, penetrations, lacerations to

head, face, or neck– Pain to cervical vertebrae, possible

neuromuscular deficits from cord injury

Emergency Medical CareEmergency Medical Care

• Take spinal precautions.• Ensure airway, suction as needed.• Provide oxygen based on need.

– Apply oxygen to keep SpO2 >95%.

– NRB or PPV based on breathing adequacy.

Emergency Medical Care (cont’d)Emergency Medical Care (cont’d)

• Control external hemorrhage as appropriate.

• Initiate transport

Case StudyCase Study

• You are called for a motor vehicle versus pedestrian incident on a busy city street. Upon arrival a crowd has gathered around a motionless victim lying supine in the road. At the patient's side, you see facial trauma with hemorrhaging, the right arm is abnormally angled, and breathing seems labored.

Case Study (cont’d)Case Study (cont’d)

• Scene Size-Up– Scene is safe, controlled by PD.– Standard precautions taken.– Patient is 17 year old female, 120 lbs.– Entry and egress from site is

unobstructed.– MOI is traumatic incident.– No additional resources needed.

Case Study (cont’d)Case Study (cont’d)

• Primary Assessment Findings– Patient unresponsive.– Blood and broken teeth in airway.– Breathing labored and tachypneic.– Peripheral perfusion intact.– Patient not responding to painful stimuli.

Case Study (cont’d)Case Study (cont’d)

• Is this patient a high or low priority?• What kind of differentials for the

unresponsiveness exist?• What care should be initiated

immediately?

Case Study (cont’d)Case Study (cont’d)

• Medical History– Unknown

• Medications– Unknown

• Allergies– Unknown

Case Study (cont’d)Case Study (cont’d)

• Pertinent Secondary Assessment Findings– Pupils equal but sluggish to respond.– Airway established by EMS, now patent.– Perfusion intact peripherally, pulse

rapid.– Breathing spontaneously adequate.– No major bleeds to the body.

Case Study (cont’d)Case Study (cont’d)

• Pertinent Secondary Assessment Findings (continued)– Right arm angulation to be managed by

back board.

– SpO2 95% on room air, 99% on oxygen.

– No further findings contributory to this report.

Case Study (cont’d)Case Study (cont’d)

• Care provided:– Patient fully immobilized.– Airway maintained with suctioning and

manual technique.– Oxygen via NRB mask with adequate

breathing.

Case Study (cont’d)Case Study (cont’d)

• Care provided:– Arm angulation immobilized by back

board.– Transport initiated to ED with Paramedic

intercept planned en route.

SummarySummary

• Facial injuries can result in life-threatening conditions.

• Associated injuries to the brain and spinal cord may occur as well.

• Assessment and management should focus on maintenance of the airway, breathing, and circulation functions.