Emergencies Involving the Eyes, Ears, Nose, and Throat

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

• 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.

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Introduction

• 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.

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Epidemiology

• 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.

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Types of facial fractures
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Common neck and throat injuries
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Pathophysiology

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

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Pathophysiology (contd)

• Eye injuries
• Irrigation may be necessary.
• Chemical burns require flushing gt20 minutes.
• Alkali burns require flushing till arrival at
  hospital.

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Pathophysiology (contd)

• Epistaxis
• Anterior bleeding
• Posterior bleeding
• Control by pinching nostrils together for 10
  minutes

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Controlling a nosebleed Have the patient sit and
lean forward.
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Controlling a nosebleed Pinch the fleshy part of
the nostrils together.
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Assessment 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.

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Assessment Findings (contd)

• 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

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Emergency Medical Care

• Take spinal precautions.
• Ensure airway, suction as needed.
• Provide oxygen based on need.
• Apply oxygen to keep SpO2 gt95.
• NRB or PPV based on breathing adequacy.

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Emergency Medical Care (contd)

• Control external hemorrhage as appropriate.
• Initiate transport

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Case 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.

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Case Study (contd)

• 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.

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Case Study (contd)

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

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Case Study (contd)

• Is this patient a high or low priority?
• What kind of differentials for the
  unresponsiveness exist?
• What care should be initiated immediately?

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Case Study (contd)

• Medical History
• Unknown
• Medications
• Unknown
• Allergies
• Unknown

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Case Study (contd)

• 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.

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Case Study (contd)

• 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.

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Case Study (contd)

• Care provided
• Patient fully immobilized.
• Airway maintained with suctioning and manual
  technique.
• Oxygen via NRB mask with adequate breathing.

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Case Study (contd)

• Care provided
• Arm angulation immobilized by back board.
• Transport initiated to ED with Paramedic
  intercept planned en route.

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Summary

• 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.