Download AEMT Transition - Unit 34

TRANSITION SERIES
Topics for the Advanced EMT
CHAPTER
34
Emergencies Involving the
Eyes, Ears, Nose, and Throat
Objectives
• Review the epidemiology of facial
injuries.
• Discuss pathophysiologic changes that
occur with facial emergencies.
• Review pertinent questions and
physical findings of facial injuries.
• Discuss proper use of Morgan Lens kit.
• Indentify proper prehospital treatment.
Introduction
• Facial injuries can cause significant
injuries and emotional stress.
• Airway patency is always a concern
with trauma to the face.
• Associated injuries to the neck and
spine may also occur.
Epidemiology
• Greater than 1 million facial injuries per
year.
• 50% of high-impact fractures also have
other major injuries.
• Associated cervical injury occurs up to
6% of the time.
Types of facial fractures
Common neck and throat injuries
Pathophysiology
• Dispersion of kinetic energy during
deceleration produces the forces that
result in injury.
Pathophysiology (cont’d)
• Eye injuries
– Irrigation may be necessary.
– Chemical burns require flushing >20
minutes.
– Alkali burns require flushing till arrival
at hospital.
Pathophysiology (cont’d)
• Epistaxis
– Anterior bleeding
– Posterior bleeding
– Control by pinching nostrils together for
10 minutes
Controlling a nosebleed: Have the patient sit and lean forward.
Controlling a nosebleed: Pinch the fleshy part of the nostrils together.
Assessment Findings
• General assessment considerations
– Consider maintaining cervical spinal
immobilization during assessment.
– Assess and treat any threats to ABCs
first.
– Determine answers to specific questions
regarding consciousness, vision
problems, hearing problems,
malocclusion of teeth, drainage from
ears, or open neck trauma.
Assessment Findings (cont’d)
• General findings
– History consistent with trauma
– Structural damage to facial structures
– Open hemorrhage and/or oral
hemorrhage
– Punctures, penetrations, lacerations to
head, face, or neck
– Pain to cervical vertebrae, possible
neuromuscular deficits from cord injury
Emergency Medical Care
• Take spinal precautions.
• Ensure airway, suction as needed.
• Provide oxygen based on need.
– Apply oxygen to keep SpO2 >95%.
– NRB or PPV based on breathing
adequacy.
Emergency Medical Care (cont’d)
• Control external hemorrhage as
appropriate.
• Initiate transport
Case Study
• You are called for a motor vehicle
versus pedestrian incident on a busy
city street. Upon arrival a crowd has
gathered around a motionless victim
lying supine in the road. At the
patient's side, you see facial trauma
with hemorrhaging, the right arm is
abnormally angled, and breathing
seems labored.
Case Study (cont’d)
• Scene Size-Up
– Scene is safe, controlled by PD.
– Standard precautions taken.
– Patient is 17 year old female, 120 lbs.
– Entry and egress from site is
unobstructed.
– MOI is traumatic incident.
– No additional resources needed.
Case Study (cont’d)
• Primary Assessment Findings
– Patient unresponsive.
– Blood and broken teeth in airway.
– Breathing labored and tachypneic.
– Peripheral perfusion intact.
– Patient not responding to painful
stimuli.
Case Study (cont’d)
• Is this patient a high or low priority?
• What kind of differentials for the
unresponsiveness exist?
• What care should be initiated
immediately?
Case Study (cont’d)
• Medical History
– Unknown
• Medications
– Unknown
• Allergies
– Unknown
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings
– Pupils equal but sluggish to respond.
– Airway established by EMS, now patent.
– Perfusion intact peripherally, pulse
rapid.
– Breathing spontaneously adequate.
– No major bleeds to the body.
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings (continued)
– Right arm angulation to be managed by
back board.
– SpO2 95% on room air, 99% on oxygen.
– No further findings contributory to this
report.
Case Study (cont’d)
• Care provided:
– Patient fully immobilized.
– Airway maintained with suctioning and
manual technique.
– Oxygen via NRB mask with adequate
breathing.
Case Study (cont’d)
• Care provided:
– Arm angulation immobilized by back
board.
– Transport initiated to ED with Paramedic
intercept planned en route.
Summary
• Facial injuries can result in lifethreatening conditions.
• Associated injuries to the brain and
spinal cord may occur as well.
• Assessment and management should
focus on maintenance of the airway,
breathing, and circulation functions.