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Head and Facial Injuries

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Head and Facial Injuries

Anatomy of Head and Face (cont.)

Anatomy of Head and Face (cont.)

Nose

Composed of bone and hyaline cartilage

Nasal septum

Anatomy of Head and Face (cont.)

Ear

Major areas

Outer ear (auricle and external auditory canal)

Middle ear (tympanic membrane)

Inner ear (labyrinth)

Anatomy of the head & neck - Muscles

Muscle Location Function

Sternocleidomastoid

(SCM)

Anterior aspect of the

neck

Flex neck; rotate the

head

Trapezius Posterior aspect of the

neck

Extends neck; adducts

scapula

PREVENTION

Protective Equipment is crucial

Must be in good, working condition

Must be used properly

Must fit the athlete properly

Examples: helmet, face guard, and mouth guard

Cerebral Conditions

Impact or injuries causes bleeding within the brain called HEMATOMAS

Artery damaged: quick decline in mental status and functioning of the brain (10 – 20 minutes)

Vein damaged: slower onset (24 to 72 hours), slower bleeding and swelling

Both are life-threatening!!!!!!

Mechanisms

Direct impact causes two conditions

1. deformation

2. acceleration

Direct blow can cause fracture at the site of impact

Direct blow can cause fracture at site away from area of impact

Concussion Animation

Impact causes Acceleration

Shock waves pass through skull to brain

Causes acceleration

Leads to :

tensile forces :

compressive forces :

shear forces :

Concussions

Definition = the temporary impairment of brain function caused by impact to the head, or rotational force

Usually caused by a direct hit to the head, plus the injury to the opposite side of the brain where the brain bounces off of the skull.

The more concussions you sustain, the more severe they become, and the easier it is to get one!

Amnesia

Post Traumatic Amnesia (PTA)

Definition = the inability to recall events that have occurred since the time of injury.

Retrograde Amnesia (RA)

Definition = the inability to remember events that occurred before the injury

ESPN Concussions

OTL: College Football Concussions

Second Impact Syndrome

An athlete sustains a 2nd head injury before the symptoms associated with a previous head injury have cleared.

This causes an increase in intracranial pressure.

Leads to respiratory arrest or death.

Signs and Symptoms Dizziness Headache Excessive Drowsiness Unable to focus or concentrate »Irritable and Confused » Convulsions * Nystagmus *Visual problems - Bleeding from nose or ears -Tinnitus (ringing in ears) ~Paralysis ~Weakness in limbs or face ∞Memory problems ∞Balance problems Nausea Vomiting

(( ))

Assessment of Concussions Palpate the neck: look for any deformities

or painful areas

Orientation x 4 : who are they, where are they, what happened, and when????

Move down body w/ symptoms

Head

Neck

Muscles

Stomach

Function

Pupils

PEARL

Pupils

Equal

And

Reactive to

Light

Nystagmus – Eye Tracking

Assessment of Concussions

Pulse

Blood Pressure

Respirations

Reflexes

Dermatomes

Myotomes

Rhomberg Test

1. Olfactory Smell

2. Optic Sight

3. Occulomotor Eye Movement

4. Trochlear Eye Movement

5. Trigeminal Facial Motion/ Sensation

6. Abducens Eye Movement

7. Facial Facial Expression/ Sensation

8. Vestibulochochlear Hearing and Balance

9. Glossopharengeal Tongue and Throat

10.Vagus Digestion/ Excretion

11.Accessory Head, Neck, Shoulder muscles

12.Hypoglossal Speech, Swallowing

Immediate Memory

• 3 Words

Concentration

• Months in reverse order

• Delayed Word Recall

Exertion Maneuver

• Jumping jacks, Sit ups, Push ups, Squats

Neurological Screening

• Loss of Consciousness – Y / N if yes how long?

• Pre- & Post- Amnesia

• Strength

Coordination

• Finger to Nose

• Straight line test: can they walk the line?

Assessment of Concussions

CONCUSSION

GRADE SIGNS & SYMPTOMS MANAGEMENT

GRADE 1

Transient confusion

<30 min

NO loss of

consciousness

All symptoms gone in

< 24 hours

Remove from activity

Examine immediately

Re-examine at 5-10 minute intervals

If asymptomatic, stress test

May return to play if symptoms

resolve in < 15 mins.

GRADE 2

Transient confusion

> 30 min < 24 hours

loss of consciousness

less than 1 minute

Symptoms last > 24

hours and less than 7

days.

Remove from activity

Examine immediately

Re-examine at 5-10 minute intervals

Disallow return that day

May refer to ER for further testing

(i.e., CT scan)

Re-evaluate the following day

May return to play after 1 week of

being asymptomatic at rest & stress

CONCUSSION

GRADE SIGNS & SYMPTOMS MANAGEMENT

GRADE 3

Any loss of

consciousness >1

minute

Transient confusion

> 24 hours

Symptoms > 7 days

Remove from activity

Examine immediately

Refer to ER for further testing (i.e.,

CT scan)

Generally, out of activity for 1 month

once asymptomatic

RETURN TO ACTIVITY IS NOT ALLOWED UNTIL ALL

SYMPTOMS HAVE RESOLVED AT REST AND UNDER

STRESS.

Post Concussive Syndrome

Persistent symptoms following concussion

Persistent headache

Impaired memory

Lack of concentration

Anxiety

Irritability

Fatigue

Depression

Visual disturbances

Athlete should not return to play until all symptoms have resolved

Prevention of Head and Facial Injuries

Protective equipment

Helmets

Face guards

Mouth guards

Eye wear

Ear wear

Throat protectors

Scalp Injuries

Highly vascularized; bleeds freely

Laceration Control bleeding

Prevent contamination

Assess for skull fracture (fx)

Management: If no fx, cleanse, cover, and refer

Abrasions and contusions Cleanse; ice and pressure

24 hours: no improvement – refer

Cranial Injury Mechanisms

Injury dependent on:

Material properties of skull

Thickness of skull

Magnitude and direction of force

Size of impact area

Bone deforms and bends inward

Inner border – tensile strain

Outer border – compressed

Skull Fracture

Types

Linear

Comminuted

Depressed

Basilar

Skull Fracture (cont.)

Potential for varying signs and symptoms (S&S)

Visible deformity–do not be misled by a “goose egg”; a fracture may be under the site

Deep laceration or severe bruise to scalp

Palpable depression or crepitus

Unequal pupils

Raccoon eyes or Battle’s sign

Skull Fracture (cont.)

Bleeding or CSF from nose and/or ear

Battle Sign

Raccoon Eye’s

“Halo” Sign

Loss of smell

Loss of sight or major vision disturbances

Unconsciousness 2 minutes after direct trauma to the head

Management: activation of EMS

Facial Conditions

Facial soft tissue conditions

Contusions, abrasions, and lacerations are managed the same as elsewhere on the body

Complicated injuries—immediate physician referral

Facial Conditions (cont.)

Fractures

Zygomatic

S&S: cheek appears flat or depressed, double vision, numbness in affected cheek

Management: ice, immediate referral

Mandibular

Common: mandibular angle and condyles

S&S: malocclusion, changes in speech, oral bleeding, + tongue blade

Management: ice, immediate referral

Facial Conditions (cont.)

Maxillary

LeFort fx (upper jaw)

S&S: appearance of longer face, nasal bleeding, malocclusion, nasal deformity, ecchymosis

Management: ice, immediate referral

Facial “red flags”

Nasal Conditions

Epistaxis (nose bleed) Anterior – bleeding from anterior septum

Posterior – bleeding from lateral wall

Management: ice, mild pressure, slight forward head tilt; nasal plug; 5 minutes – physician referral

Deviated septum S&S

Consistent difference in airflow between the 2 sides of the nose when one nostril is blocked

Confirm using otoscope

Management: physician referral

Nasal Conditions (cont.)

Fractures

Most common: lateral displacement

Range of severity varies

S&S

Asymmetry – especially with lateral force

Epistaxis

Crepitus

Management: control bleeding; refer

Nasal “red flags”

Oral and Dental Conditions

Mouth lacerations

Minor lacerations are the same as in other lacerations

Lip and tongue lacerations: require special suturing

Loose teeth

Displaced outward or lateral: attempt to place back in normal position

Intruded: immediate referral to dentist

Oral and Dental Conditions (cont.)

Fractured tooth

Enamel: no symptoms

Dentin: pain and increased sensitivity to heat and cold

Pulp or root: severe pain and sensitivity

Management: refer to dentist

Oral and Dental Conditions (cont.)

Dislocated tooth

Time is of the essence; refer

Hold tooth by crown

Do not rub the tooth or remove any dirt; milk or saline

Oral and dental “red flags”

Ear Conditions

Cauliflower ear (auricular hematoma)

Repeated trauma pulls cartilage away from perichondrium – hematoma forms

Untreated – forms a fibrosis

Management: ice; possible aspiration by physician

Key is prevention!

Impacted cerumen (wax)

Possible hearing loss or muffled hearing

Management: irrigate canal with warm water

Ear Conditions (cont.)

Otitis externa (swimmer’s ear)

Bacterial infection to lining of external auditory canal

S&S: pain, itching

Management: ear drops, custom ear plugs

Otitis media

Middle ear infection due to bacteria or virus

S&S: earache, hearing difficulty, possible serous otitis

Management: physician referral

Ear Conditions (cont.)

Tympanic membrane rupture

Caused by:

Infection

Direct trauma

Changes in pressure

Loud, sudden noises

Foreign objects in the ear

Ear Conditions (cont.)

S&S Very painful

Tinnitus

Pus-filled or bloody drainage from the ear

Sudden decrease in ear pain followed by drainage

Hearing loss

Management: physician referral

Ear “red flags”

Eye Conditions

Preorbital ecchymosis (black eye)

Assessment

Management: ice, referral to ophthalmologist

Foreign bodies

S&S: intense pain, tearing

Management

Not embedded: removal, inspection

Embedded: do not touch, activate EMS

Eye Conditions (cont.)

Orbital “blowout” fracture Impact from a blunt object, usually larger than the

eye orbit

S&S: Diplopia

Numbness below eye

Lack of eye movement

Recessed downward displacement of globe

Management: ice; immediate referral to physician

Eye “red flags”

Cervical Spine

Fracture

S&S

Pain

Numbness

Tingling

Management

Spinal immobilization

Refer to a physician

Brachial Plexus

31 pairs of spinal nerves

Brachial C5-T1

“Stinger”

Numbness

Loss of function

Management

Remove from play

Allow RTP once symptoms resolve