chapter 22. scalp scalp skin connective tissue apeneurosis loose connective tissue periosteum
TRANSCRIPT
HEAD AND FACECHAPTER 22
ANATOMY
SCALPScalp
SkinConnective TissueApeneurosisLoose Connective
TissuePeriosteum
CRANIUMEncases the brainBones of the head
Parietal (2)Temporal (2)Occipital (1)Sphenoid (1)Frontal (1)Ethmoid (1)
CRANIUMBones of the face
Nasal (2)Zygomatic (2)Maxilla (2)Mandible - jaw
MENINGESBetween the skull and brainCovers the brain and spinal cordThree layers
1. Dura mater – thick, dense, inelastic layer1. Epidural space – between skull and dura mater
2. Arachnoid – looks like spider web, delicate3. Pia mater – thin, transparent, follows brain contour
Cerebrospinal FluidFind it in Subarachnoid space
Between arachnoid and the pia materFunction is to cushion the brain
BRAINCerebrum
Coordinates voluntary muscle activity
SensesHigher mental
functions Memory, reasoning,
learning, judgement, emotions
CerebellumMuscle movementsBalance
BRAINPons
SleepPostureBreathingSwallowingBladder
Medulla OblongataHeart rateBlood pressureCoughing and sneezingVomiting
HEAD INJURIES
Head InjuriesFYI: Damage done is not always proportional
to the blow to the headSame blow to two different people will can
cause two dramatically different injuries
Signs of a Worsening Head InjuryDecreased level of consciousnessMore confused or irritablePersistent or increasing headacheDecreased pulseIncreased blood pressurePupil irregularityWeakness in extremitiesNausea, vomitingAnything you can say is not characteristic
of person
Skull FractureMOI: VERY hard blow (ie, shot put, hammer,
baseball bat)Can be obvious (depressed) or subtle (crack)
fractureSigns and symptoms
Rhinorrea: Discharge from nose – can be blood or cerebrospinal fluid
Otorrea: Discharge from ears – can be blood or cerebrospinal fluid
Epidural HematomaEpidural: Between the skull and the dura
mater Hematoma: collection of bloodCause: hit to the headSymptoms come about rapidlyThey have a “Lucid Interval”:
May show signs of getting better and then becomes unconscious
Will need surgery to relieve pressure in brain
Subdural HematomaSubdural: below the dura mater, b/n the dura
mater and the arachnoidCause: hit to the headSlower onset
Acute: most common cause of death with head injury in athletics (ie, boxing)
Chronic: can take days or weeks for symptoms to manifest Small amount of blood, and a membrane develops around
it and it increases in size over time
Also surgically relieved
ConcussionA traumatically induced alteration in mental
status not necessarily with a loss of consciousness
Can happen from a directly or indirectlyDirectly: hit to the headIndirectly: hit to the body or whiplash
Any athlete who shows signs or symptoms of a concussion must be removed from play!
ConcussionSigns and Symptoms
HeadacheDizzinessNauseaLoss of consciousnessAmnesia (memory loss)Inability to concentrateVision problemsRinging in earsEmotional instabilityFatigue
CONCUSSIONCare
REST – No activity – physical or mentalRefer to doctor
YOU SHOULD NEVER, NEVER PARTICIPATE IN ANY PHYSICAL ACTIVITY WHILE YOU HAVE SYMPTOMS OF A CONCUSSION!
SECOND IMPACT SYNDROMERapid swelling of the brain that occurs when
someone sustains a second head injury before the previous head injury has resolved.
This can be a very minor injury (2nd one) that causes major problems.
This typically is fatal.Athlete must be rushed to hospital
IMMEDIATELY.
FACIAL INJURIES
Mandibular (Jaw) FracturesCause: Direct blow, will usually fracture at
the angleS/S
Will be unable to fully open and close mouthMalocclusion: unable to bring teeth togetherPossible bleeding at base of teethMay have numbness in low lipMay have multiple fractures
Care: Immobilize, jaw wired shut for 4-6 weeks
Nasal FractureCause: Direct blowMay or may not be displacedCare
Control bleeding – do not put anything up noseIceRefer to MD
Epitaxis (Nose bleed)Cause: can be many things
Hit to the noseDry air
Control by sitting upright, head forward, gauze at nostrils and apply pressure at bridge of nose
Do not remove gauze if bloody, just apply fresh gauze around it
Cauliflower EarSkin in upper ear separates from cartilage
and it fills with bloodWrestling – ear sticks to mat
Will harden if left untreated – permanent deformity
MD can drain it if caught early on
SWIMMER’S EAR (Otitis Externa)Infection of the ear canalS/S
Ear pain DizzinessEar itchesDischarge from ear
CareRefer to MD, rule out ear drum ruptureAntibiotics
Corneal AbrasionCause: Poked in the eyeWill feel like something is in the eyeEye may tear upCan be painful, may not want to open eyeIf no relief from eyewash, see MD
Periorbital Hematoma Black Eye – no big deal, right?
Eye symptoms to worry aboutBlurred and/or double visionSpotty visionPainBlood in the eye
Blow Out FractureFracture of the orbit of the eyeCause: Direct hit to the eyeUsually it is the floor of the eye that fracturesLimits movement – cannot look upMay have double vision (diplopia)Immediate referral to MD
Tooth displacement and avulsionCause: direct hit to mouthIf found keep the tooth
If it is still in place somewhat, leave it thereOtherwise, in sterile saline or milk
Immediate referral to dentist – two hour window for re-implantation