Eye Face and Teeth Assessment by cuiliqing

VIEWS: 8 PAGES: 29

									                     Facial Injuries

• Soft Tissue Injury
   – Abrasions, Contusions, Lacerations, Avulsions
      • Lots of bleeding - Why?
      • Clean and cover - Why?
   – Epistaxis - Nosebleed
      • DON’T BLOW NOSE - REMOVES CLOT
• Bony Injury
   – Nasal Bone Fracture - most common
   – Nasal Septum Fracture - Cartilage and bone
      • More serious - hematoma may develop
      • Tx: Ice, nose packing, refer
                     Facial Injuries

• Bony Injuries - MOI: direct blows
   – Mandible(Jaw) Fracture - 2nd most common
      • Malocclusion of teeth, bleeding around teeth, lower lip
        numbness
      • Ice, immobilize, Dr.
   – Mandible Dislocation - TMJ joint
      • Locked open, extreme malocclusion
      • DON’T REDUCE, ice, immobilize, Dr.
   – Zygomatic Fracture - 3rd most common
      • Deformity, epistaxis, vision problems(diplopia)
   – Maxillary Fracture - 4th most common
      • Malocclusion, deformity, vision problems, epistaxis
      • LeFort Fractures
                 Eye Anatomy
• Anatomy
  – sit in orbit(bony) protection
  – eyelid
  – lacrimal glands
  – sclera - tough white outer layer
  – cornea, iris, lens
  – pupil
                        Eye injuries
• Injuries
      • Can be very serious, must be evaluated and referred to
        opthamologist if necessary.
• Orbital Hematoma (black eye)
• Foreign Body
      • Pain and disability, tearing
      • DON’T RUB IT OUT - Why?
• Corneal Abrasion
      • Pain, tears, blurred vision
      • Patch, Dr., Flourescein Strips (Blue light)
      • 1-2 days to heal
Corneal abrasion
                                                       Conjunctivitis
•Traumatic iritis/Chronic iritis
     •Inflammed conjunctiva next to cornea over
     iris, photophobia, slow reaction
•Conjunctivitis
     •Viral (“pink eye”) or bacterial (yellow/green)
     •Itchy, burning, reddening, discharge, eyelid
     swelling, blurry, sticky eyes
•Stye – DO NOT SQUEEZE
     •bacterial infection that occurs inside an oil
     gland near the base of your eyelid.
                                                           Stye
                        Eye Injuries
• Hyphema
   – Blood in eye, vision block(full or partial)
   – Patch both eyes, NO ICE, Medical emergency
• Blowout Fracture - orbit of eye is fractured
   – Hit on orbit, hit on eye(inc. pressure=blowout)
   – Discoloration inferior margins, Inability to move eye up, diplopia
     (double vision), pain
• Retinal Detachment
   – Direct blow
   – Specks in vision, “flashes of light”, “curtain falling over
     vision”
• Acute Trauma
   – Be aware of lacrimal gland lacerations and damage to other
     structures
Pencil was in eye
                          “tear drop” iris




                    Blow out fracture
                         Dental Injuries
• Anatomy
       •   Crown
       •   Dentin
       •   Pulp
       •   Root
       •   Enamel
• Injuries
   – Teeth have lowest potential to return to a state of health following
     traumatic injury.
   – Role to athletic trainer - care for athlete and tooth and get athlete to
     dentist if necessary.
       • Do not touch root or tooth
         SAVE A TOOTH




SAVE A TOOTH - balanced solution - Transport Media

    OR

    Milk, Saline, Saliva, Water
                  Dental Injuries
• Tooth Displacement
   – Extrusion or Lateral Luxation
        • Can try to reposition, Dentist
   – Intrusion
        • Don’t try to reposition, mouth closed, Dentist
• Fractured Tooth - crown or root
   – No return, Dentist, save tooth fragment
• Tooth Avulsion
   –   Handle tooth by crown only
   –   Replace in socket if possible
   –   Save tooth - keep moist at all times
   –   Dentist - 1/2-2 hrs.
        • less than 30 mins. = 90% survival rate
        • greater than 2 hrs. = 5 % survival rate
                          Ear Injuries
• Anatomy
   – External Ear, Middle Ear, Internal Ear
• Injuries
   – Swimmer’s Ear - External Otitis
   – Ear Infection – Otitis Medius
   – Hematoma Auris
       • MOI: extreme friction
       • S/S: swelling, hematoma
       • Tx: ice, compression, aspiration, collodian pack
   – Cauliflower Ear
       • Hardened tissue of untreated hematoma auris
       • Keloid tissue is resultant
 Prevention of Facial, Dental, Ear, and
             Eye Injuries
• Protective Equipment
  – Helmets
  – Facemasks
  – Eye Protection
  – Mouthguard
  – Ear Protection
                        History
•   What is the major complaint?
•   What is mechanism of injury?
•   What is its duration?
•   Was the onset of the complaint gradual or sudden?
•   Is there any loss of vision, hearing, taste, smell?
•   Can they swallow and speak without difficulty?
•   Is there any pain?
•   Is the condition improving or getting worse?
•   Is there any history of trauma?
•   Is there any family history of a similar complaint?
               Observation
• Inspect all facial areas
  – Be aware of alignment, bleeding, ecchymosis
    (ruptured blood vessels)
Removing a foreign object
        Inspection/Palpation
• Orbital margin
• Frontal bone, Nasal bone, Zygomatic arch,
  Maxilla, Mandible
• Temporomandibular joint (TMJ)
• Teeth
• Soft tissue – Nasal, Cheeks, Ear
     Functional or Special Tests
• Vision Assessment
   – Snellen Chart
       • Myopia – nearsightedness
       • Hyperopia – farsightedness
   – Visual acuity – photophobia or diplopia
   – Anisocoria – condition of unequal pupils
• Pupil Reaction to Light
   – Pen light
   – PEARL – pupils equal and reactive to light
• Eye Motility
   – “follow my finger but do not move your head”
   – Nystagmus
• Flourescein dye test (if available)
   Functional or Special Tests
• Hearing and Balance
• Smell
• Jaw motion and Teeth alignment
  – Malocclusion (misalignment)
  – Open, Close, Side to Side, Protract
  – Palpation at TMJ – pinkies in ear
• Dermatomes
  – Sensation
            When should I refer?
• Visual field changes
    – Photophobia (light sensitivity) and/or Diplopia (double vision)
    – Cloudy vision
    – Nystagmus
•   Pain/Throbbing intense
•   Crepitus or Laceration
•   Deformity – bony or tooth
•   S/S of serious injury
•   Numbness
•   Hearing or Balance issues
•   Oozing pus or drainage of water

								
To top