L3 Maxillo Facial Injuries PDF May 2022

Support the management of trauma in the emergency & urgent care setting Component 8 Maxillo-Facial Emergencies 1 ©Department of...

Support the management of trauma in the emergency & urgent care setting Component 8 Maxillo-Facial Emergencies 1 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Objectives Explain mechanisms associated with maxilla facial injuries Describe signs and symptoms and complications of maxilla facial injuries Explain treatment of maxilla facial injuries 2 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Introduction Maxillofacial injury, involving the maxilla &/or face are common. Causes include: Road traffic accidents Assaults Falls Sport-related injuries Alcohol is a common factor, especially in relation to injuries from assault. 3 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Facial Structures & Injuries Orbit: A blow to the eye can cause the orbit to ‘blow out’ & fracture. 4 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Facial Structures & Injuries Signs & symptoms of a blowout facture include: The eyeball retracts into the socket (Enophthalmos) Double vision (diplopia) &/or loss of upward vision Pupils at different horizontal level to each other Loss of sensation above eyebrow & over cheek 5 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Facial Structures & Injuries Maxilla: Most commonly fractured by RTCs, other blunt injury causes include assault & sports injuries. Maxilla fractures are associated with injuries to other middle facial structures. 6 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Facial Structures & Injuries Teeth: Frequently knocked out (avulsed) due to facial trauma. Can be inhaled in the unconscious patient. Avulsed teeth can displace into the soft tissues, including the lips. Fractures to the crown of a tooth is extremely painful. 7 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Facial Structures & Injuries Soft tissue: Facial tissue has an abundant blood supply & can result in dramatic looking wounds. Uncommon to lead to hypovolaemia (except in children) & other causes should be assumed responsible. Large facial lacerations often gape due to muscle pull & those in the middle third of the face can swell rapidly, masking underlying fractures. If swelling involves the eyelids, this can prevent examination of the globe of the eye, hiding damage to the patient’s vision. 8 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Facial Structures & Injuries Soft tissue: Injuries vary in severity… And can be caused by many things such as laceration, blunt force trauma etc. 9 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Complications Immediate Airway compromise (consider C-spine too) Aspiration Haemorrhage Infection Longer-term Scars and permanent facial deformity Nerve damage leading to loss of facial sensation movement, smell, taste or vision. 10 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Management Follow standard ABC approach: Airway (with C-Spine as appropriate) It may be necessary to open the mouth, do a finger sweep, to clear any debris, and feel for lacerations or deformities. Breathing If the patient is breathing spontaneously, administer O2 to ensure the brain (which may be injured as well) is perfused. Circulation Control any bleeding. If a laceration extends all the way through a cheek, it will be necessary to apply pressure to both sides of the wound. Consider early advanced assistance for any airway or breathing issues. Do not immobilise a mandible fracture - allow patient to self support! 11 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Management of Unconscious Maxillo-Facial Injured Patients Remember your PPE- Facial and eye protection especially Although C-spine needs to be considered, the lack of a patent airway can kill the patient first - clear debris from the patient’s mouth! Consider postural drainage &/or suction OP’s are not always helpful in facial injuries NP’s are better tolerated- but use with caution Application of BVM can be challenging Advanced airway and pain management are usually required – consider early advanced assistance. ©Clinical Education & Standards v.2 12  Maxillo Facial Injuries - Component 8 Management: General Generally, patients with facial injuries are best managed sitting up & leaning forward, to allow for drainage of blood & debris from the mouth & reduce venous return. However, C-spine injury needs to be considered! 13 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Any Questions? 14 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Eye Injuries Can be categorised into four types: Chemical burns Corneal abrasions Blunt trauma Foreign bodies 15 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Eye Injuries – Chemical Burns Vary in severity Can lead to severe corneal injury & blindness Do not contaminate yourself - wear appropriate PPE Irrigate patient’s eye with copious amounts of water for 20 minutes, do not contaminate the unaffected eye 16 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Management of Chemical Eye Injury Remember your PPE- Facial and eye protection especially Flush with copious amounts of clean water Do not contaminate other eye Do not apply direct pressure to the eye Cover both eyes with sterile dressings Get sample of chemical, if you can safely do so ©Department of Clinical Education & Standards 17  Maxillo Facial Injuries - Component 8 Eye Injuries – Corneal Abrasion Superficial injury to the surface of the cornea Can be caused by a foreign body, e.g. leaves, branches, fingernails Not normally a serious injury, but often very painful Requires ophthalmic assessment 18 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Eye Injuries – Blunt Trauma Typically caused by mechanisms such as a blow from a fist or a small ball Assess for visual acuity- This can be approximated by asking the patient to read text. Even if patient’s vision appears unaffected they still require a thorough examination 19 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Eye Injuries – Foreign Bodies Vary in severity Foreign bodies such as grit or a loose eyelash can safely be rinsed out of the eye If object is in the upper eyelid, instruct patient to grasp the eyelashes of their upper eyelid & gently pull it over the lower lid Any embedded foreign objects in the cornea or that are intra-ocular should not be removed & the patient should be conveyed to hospital 20 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Management of an Embedded Object Cover both eyes with sterile dressings Use built - up dressings around the embedded object to prevent movement Do not try to remove foreign body Do not apply direct pressure to the eye itself 21 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Eye Injuries – Examination Check for damage to: The Orbits and the Eyelids – bruising, swelling, lacerations or tenderness. The Conjunctivae – Redness, pus and foreign bodies 22 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Assessment Pupillary Reaction: Size, shape, equality & reaction Clarity of Vision: Visual activity, test each eye separately Eye Movement: That the eye moves in all directions. Document all results 23 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Management – General Check for contact lenses, if worn, ask the patient to remove them if possible Cover both eyes to prevent patient moving injured eye with good one Do not forget to tell the patient what is happening and why May be associated maxillo - facial, head or c-spine injury Consider removal to specialist eye unit Constant reassurance for patient 24 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Complications Lacerations & contusions Avulsed eyelid Laceration of eyeball Avulsion of eye Burns 25 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Nasal Injuries Nasal injuries usually result in a nosebleed or epistaxis. Common occurrence with multiple causes: Direct trauma to the nose Nose-picking Blowing the nose too hard Bleeding disorders Inside of nose being too dry Some medications will also increase the risk of nosebleeds Child abuse should be considered in nasal fractures 26 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Management Instruct patient to sit down & lean forward. Ask the patient to squeeze the soft part of their nose for ten minutes. Advise patient to breathe through their mouth & to gently spit blood out rather than swallowing it. After ten minutes, ask patient to release pressure to see if the bleeding has stopped. If bleeding continues, reapply pressure for a further ten minutes & reassess. If bleeding continues >30mins, or on anticoagulant medication, transport patient to appropriate receiving unit. 27 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Ear Emergencies Causes: Foreign objects in ears- These objects can be hard to remove. The ear canal is a tube of solid bone that is lined with thin, sensitive skin. Any object pressing against the skin can be very painful. Sudden changes in air pressure Loud noises 28 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Signs & Symptoms Bleeding or clear fluid (CSF) coming from the ear Bruising or redness Dizziness Loss of hearing Nausea and vomiting Noises in the ear Sensations of an object in the ear or earache Swelling Visible object in the ear 29 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Treatment Ruptured Eardrum: Place sterile cotton gently in the outer ear canal to keep the inside of the ear clean Remove to hospital Do not put any liquid into the ear Consider pain relief 30 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Treatment Cuts on the Outer Ear: Apply direct pressure until the bleeding stops. Cover the injury with a sterile dressing shaped to the contour of the ear, and tape it loosely in place. Apply cold compresses over the dressing to reduce pain and swelling. If part of the ear has been cut off, keep the part and cover it then place it on ice. 31 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Treatment Drainage from inside the Ear: Cover the outside of the ear with a sterile dressing shaped to the contour of the ear, and tape it loosely in place. Have the person lie down on the side with the affected ear down, so that it can drain. Consider C-spine injuries. Remove to hospital. 32 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Treatment DO NOT DO NOT block any drainage coming from the ear. DO NOT try to clean or wash the inside of the ear canal. DO NOT put any liquid into the ear. DO NOT attempt to remove the object by probing with a cotton swab, a pin, or any other tool. To do so will risk pushing the object farther into the ear and damaging the middle ear 33 ©Department of Clinical Education & Standards  Maxillo Facial Injuries - Component 8 Any Questions? 34 ©Department of Clinical Education & Standards