Head & Facial Trauma ppt

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Questions and Answers

What is the primary cause of blunt injury in young adults and children?

Assaults

Falls

Motor Vehicle Accidents (MVA) (correct)

Sports-related injuries

What GCS range classifies a traumatic brain injury as mild?

14 to 15 (correct)

1 to 5

3 to 8

9 to 13

Which neurological examination finding may indicate an intracranial hematoma?

A single fixed and dilated pupil (correct)

Bilateral pinpoint pupils

Bilateral fixed and dilated pupils

Constricted pupils

Which patient history aspect is crucial in understanding head trauma mechanisms?

Height of fall Signup and view all the answers

What characterizes decerebrate posturing during a neurological exam?

Extend arms, points toes outward, and arches back Signup and view all the answers

Which of the following represents a hallmark sign of increased intracranial pressure?

Bilateral fixed and dilated pupils Signup and view all the answers

What is the typical GCS classification for a severe traumatic brain injury?

3 to 8 Signup and view all the answers

Spontaneous movements during a neurological exam suggest what about the corticospinal tracts?

They are intact Signup and view all the answers

What is a key management step for moderate to severe head trauma?

Secure the airway and control blood pressure Signup and view all the answers

Which of the following examination findings would indicate a potential zygomatic fracture?

Trismus and lateral subconjunctival hemorrhage Signup and view all the answers

What differentiates a LeFort II fracture from a LeFort I fracture during physical examination?

Grasping hard palate causes movement of the nose but not the eyes Signup and view all the answers

What is the most appropriate initial management step for nasal fractures with septal hematoma?

Drain the septal hematoma using surgical intervention Signup and view all the answers

Which type of fracture requires facial CT for diagnosis and is characterized by complete facial skeleton separation from the skull?

LeFort III Signup and view all the answers

What is the management protocol for managing mandibular fractures?

Closed treatment involves oral antibiotics and soft foods Signup and view all the answers

Which presentation is considered a diagnostic clue for a tripod fracture?

Infraorbital anesthesia and lateral subconjunctival hemorrhage Signup and view all the answers

Which type of primary injury involves bruising of brain parenchyma?

Contusion Signup and view all the answers

What should be monitored in the emergency room for patients with mild head traumas?

Return to baseline neurologic function Signup and view all the answers

What is a key characteristic feature of an epidural hematoma on imaging?

Convex or lens shape Signup and view all the answers

What significant step is part of the examination process in cases of maxillofacial trauma?

Documenting cervical spine examination findings Signup and view all the answers

What is the commonly reported 'talk and die' phenomenon associated with?

Epidural Hematoma Signup and view all the answers

What is the concern most emphasized for facial trauma assessment?

Airway compromise and hemorrhage control Signup and view all the answers

Which of the following is most likely to lead to increased intracranial pressure (ICP)?

Subdural hematoma Signup and view all the answers

What is the typical treatment for a concussion?

Observation and brain rest Signup and view all the answers

Which demographic is particularly at risk for chronic subdural hematomas?

Elderly individuals. Signup and view all the answers

What imaging technique is primarily utilized to visualize bleeding and skull fracturesrelated to head trauma?

CT scan without contrast Signup and view all the answers

What is the expected recovery course for a concussion?

Full recovery is typical Signup and view all the answers

Which of the following is not a classic symptom of a concussion?

Cerebral edema Signup and view all the answers

Which type of skull fracture is characterized by leaking of cerebrospinal fluid (CSF)?

Basilar fracture Signup and view all the answers

Study Notes

Traumatic Brain Injury (TBI)

TBI is brain function impairment caused by external force.
Classified into mild (GCS 14-15, 80% of cases), moderate (GCS 9-13, 10%), and severe (GCS 3-8).
Higher incidence in males compared to females.
Motor vehicle accidents (MVA) are the leading cause of blunt injuries in young adults and children; falls are predominant in the elderly.

Patient Examination and Historical Considerations

Mechanism of injury (MOI) should be assessed, including fall height, surface condition, vehicle damage, airbags, seatbelt use, and any fatalities at the scene.
Patient's medical history, including comorbidities, medications (especially anticoagulants), and substance use, needs to be reviewed.
Red flags in history: focal neurological deficits, seizures, vomiting, altered consciousness.

Neuro Examination

Assess ABCD (Airway, Breathing, Circulation, Disability).
Maintain cervical spine (C-spine) protection until evaluated.
Glasgow Coma Scale (GCS) evaluation.
Pupillary response: A single fixed and dilated pupil suggests intracranial hematoma; bilateral pinpoint pupils indicate opiate exposure.

Intracranial Injuries

Primary injuries: axonal damage is usually irrecoverable; includes contusions and hematomas.
Secondary injuries: Edema and neurotoxic cascades that develop post-primary injury.
Symptoms include headaches, general neurological signs, and focal deficits.
Increased intracranial pressure (ICP) leads to brain swelling, constrained by the fixed cranial vault.

Specific Injuries

Concussion: Blunt trauma; symptoms include headache, confusion, and possible amnesia. CT scan often normal; typically managed with analgesics and brain rest.
Contusion: Blunt trauma leading to localized brain bruising with symptoms similar to concussion; diagnosed via CT showing hemorrhagic focus.
Epidural Hematoma: Often associated with skull fracture and arterial bleeding; rapid herniation risk. CT shows a lens-shaped collection of blood.
Subdural Hematoma: Venous bleeding; can be acute or chronic, more common in the elderly. CT shows crescent-shaped blood collection on the brain's surface.

Skull Fractures

Types include open, closed, depressed, and basilar fractures.
Indicative signs: CSF leak, raccoon eyes (periorbital bruising), Battle's sign (mastoid bruising), and hemotympanum.

Diagnostic Workup for Head Trauma

CT scans without contrast evaluate for bleeding and skull fractures.
Imaging guidelines: high-risk features include seizures, acute confusion, nuchal rigidity, or prominent neuro deficits.

Management of Head Trauma

Mild Injury: Monitor in ER; discharge only with reliable supervision at home.
Severe Injury: Focus on airway securing, blood pressure control, C-spine precautions, and potential diuretic use (Mannitol or hypertonic saline).

Maxillofacial Trauma

Common causes: assaults, motor vehicle crashes, falls, and sports injuries.
Greatest concerns include airway compromise and hemorrhage.
Radiographs help diagnose; CT scans often utilized for fracture identification.

Fractures of the Face

LeFort Fractures: Classified into three types based on anatomical involvement of maxilla and facial skeleton.
Zygomatic Fractures: Includes tripod and arch fractures, assessed through specific palpation techniques and symptoms.
Nasal Fractures: Common but typically of little concern unless a septal hematoma is noted.

Mandibular Trauma

Most common fractures occur in the body, angle, and condylar regions; symptoms include malocclusion and pain.
Mandibular Dislocation: Occurs due to blunt trauma; dislocation presentation includes chin deviance and locking of the condyle.

Follow-Up and Referral

Outpatient management for less severe injuries; ensure follow-up with oral and maxillofacial surgery or plastic surgery as needed.

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