Identification and management of facial fractures

Identification and management of facial fractures

You and your crew respond code three to a motorcycle crash. You arrive to find an unresponsive, unhelmeted patient, who was thrown from his motorcycle after hitting a large road defect. His jaw is grossly deformed and obviously unstable, and he as multiple lacerations around his face and eyes. Initial vital signs are within normal limits, pulse strong and regular at 88, respiration’s deep and easy at 20 breathes per minute. His SPO2 Sats were 85%. Your partner stabilizes the C-spine. While suctioning the airway and applying highflow O2, you notice a significant jaw deformity. You open your airway bag and anticipate a difficult intubation.

What would your emergency care plan be for this patient:

 

 

 

 

 

 

 

 

 

 

 

Try to answer these questions, you may need to do some extra research to answer the questions.

1. EMS in urban areas most often encounter facial fractures secondary to:
  1. Assault
  2. Motor vehicle crashes
  3. Sporting injuries
  4. Falls
2. Sutures between bones are:
  1. Especially strong and not prone to injury
  2. Weak points susceptible to fracture
  3. Only present following injury
  4. Not present between facial bones
3. The only mobile joint in the face is the:
  1. Temporomandibular joint
  2. Zygomatic joint
  3. Maxillary joint
  4. Mandibular joint
4. The zygomatic bones are also known as the:
  1. Jawbones
  2. Cheekbones
  3. Nasal bones
  4. Frontal bones
5. Cervical spine injuries associated with facial fractures are:
  1. Common – almost all facial injuries have associated C-spine injuries
  2. Frequent – about half of facial fractures have associated C-spine injuries
  3. Usual – about 25% of facial fractures have associated C-spine injuries
  4. Rare – about 1 – 2% of facial fractures have associated C-spine injuries
6. Brain injuries occur in what percentage of facial fractures?
  1. 10 – 15%
  2. 20 – 50%
  3. 50 – 60%
  4. 60 – 75%
7. Scalp injuries:
  1. Bleed very little and can be ignored
  2. Commonly cause life-threatening bleeding
  3. Bleed profusely even if relatively minor
  4. Should be clamped as soon as practical to avoid hypovolemia
8. To stop nosebleeds, apply pressure:
  1. Just below the nasal bones
  2. To the cheekbones on both sides
  3. Directly to the bleeding by packing the nostrils
  4. Directly between the eyes, over the nasal bones
9. Occlusion of the teeth relates to:
  1. Pain experienced with biting down
  2. How well teeth fit together
  3. Loose teeth still in the oral cavity
  4. Teeth that have become dislodged from their sockets
10. In awake, mentating patients, prehospital providers:
  1. Will be unable to tell if a fracture exists until a CT scan is completed
  2. Shouldn’t evaluate for facial fractures – an ED X-ray will be performed
  3. Will be able to identify most facial fractures by palpation of the bones
  4. Should suspect facial fractures only if fluid is leaking from the ears and nose.
11. The injury most commonly associated with facial fracture is:
  1. Cervical spine injury
  2. Eye injury
  3. Head injury
  4. Soft tissue injury to the neck
12. Orbital floor or blowout fractures:
  1. Are a rare type of fracture
  2. Are most commonly caused by pressure on the zygomatic arch
  3. Often cause the eyeball to sink into the orbit
  4. Look frightening but rarely have serious complications
13. Le Fort fractures describe:
  1. Fractures of the maxilla
  2. Types of mandibular fractures
  3. Fractures of the cribriform plate
  4. Degrees of orbital fractures
14. The most frequently fractured facial bone is the:
  1. Maxilla
  2. Frontal bone
  3. Mandible
  4. Nasal bone
15. In an alert patient, subluxed teeth should be:
  1. Immediately removed
  2. Left in place unless there is a potential for aspiration
  3. Removed and cleaned vigorously
  4. Transported under the tongue
16. Managing the airway of a patient with facial fractures usually requires:
  1. Orotracheal intubation
  2. Nasotracheal intubation
  3. Surgical airway procedures
  4. Suction and oxygenation
17. Nasotracheal intubation can cause problems if:
  1. The cibriform plate is fractured
  2. Extensive bleeding obstructs the view of the vocal cords
  3. The mandible is fractured
  4. Attempted in a breathing patient
18. The drug most often administered to blunt an elevation in ICP during larynoscopy is:
  1. Etomidate
  2. Lidocaine
  3. Succinylcholine
  4. Fentanyl
19. Which of the following would be recommended?
  1. A cricothyrotomy in a child with facial injuries
  2. Retrograde intubation in the presence of facial deformities
  3. Paralyzing a patient when BVM ventilations are difficult
  4. Administering low-flow oxygen to avoid raising ICP
20. Fentanyl is a good choice for analgesia for trauma patients because it:
  1. Lasts for a long time, providing continual relief
  2. Lowers the patient’s blood pressure and ICP
  3. Causes hypotension less often than morphine
  4. Have amnestic effect as well as analgesic effects

Answers: 1.a, 2.b, 3.a, 4.b, 5.d, 6.b, 7.c, 8.a, 9.d, 10,c, 11.c, 12.b, 13.a, 14.b, 15.b, 16.d, 17.a, 18.b, 19.b, 20.c