The Head, Face, Eyes, Ears, Nose and Throat - PowerPoint Presentation

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The

Head, Face, Eyes, Ears, Nose and ThroatSlide2

Prevention of Injuries to the Head, Face, Eyes, Ears, Nose and Throat

Head and face injuries are prevalent in sport, particularly in collision and contact sports

Education and protective equipment are critical in preventing injuries to the head and face

Head trauma results in more fatalities than other sports injury

Morbidity and mortality associated w/ brain injury have been labeled the silent epidemicSlide3

Figure 26-1Slide4

Figure 26-3Slide5

Assessment of Head Injuries

Brain injuries occur as a result of a direct blow, or sudden snapping of the head forward, backward, or rotating to the side

May or may not result in loss of consciousness, disorientation or amnesia; motor coordination or balance deficits and cognitive deficits

May present as life-threatening injury or cervical injury (if unconscious)Slide6

History

Determine loss of consciousness and amnesia

Additional questions (response will depend on level of consciousness)

Do you know where you are and what happened?

Can you remember who we played last week? (retrograde amnesia)

Can you remember walking off the field (antegrade amnesia)

Does your head hurt?

Do you have pain in your neck?

Do you have tinnitus (ringing in ears)?

Can you move your hands and feet?Slide7

Observation

Is the patient disoriented and unable to tell where he/she is, what time it is, what date it is and who the opponent is?

Is there a blank or vacant stare? Can the patient keep their eyes open?

Is there slurred speech or incoherent speech?

Are there delayed verbal and motor responses?

Gross disturbances to coordination?Slide8

Inability to focus attention and is the patient easily distracted?

Memory deficit?

Does the patient have normal cognitive function?

Normal emotional response?

How long was the patient’s affect abnormal?

Is there any swelling or bleeding from the scalp?

Is there cerebrospinal fluid in the ear canal?Slide9

Palpation

Neck and skull for point tenderness and deformity

Special Tests

Neurologic exam

Assess cerebral testing, cranial nerve testing, cerebellar testing, sensory and reflex testing

Eye function

Pupils equal and reactive to light (PEARL)

Dilated or irregular pupils

Ability of pupils to accommodate to light variance

Eye tracking - smooth or unstable (nystagmus, which may indicate cerebral involvement)

Blurred visionSlide10

Balance Tests

Romberg Test

Assess static balance - determine individual’s ability to stand and remain motionless

Multiple variations (primarily foot position)

Balance Error Scoring System

Quantifiable clinical battery of test that utilizes different stances on both firm and foam surface

Errors are tabulated when the patient opens their eyes, takes hands off hips, steps/stumbles or falls

Coordination tests

Finger to nose, heel-to-toe walking

Inability to perform tests may indicate injury to the cerebellumSlide11

Romberg

Figure 26-4Slide12

Balance Error Scoring System (BESS)

Figure 26-5Slide13

Cognitive Tests

Used to establish impact of head trauma on cognitive function and to obtain objective measures to assess patient status and improvement

On or off-field assessment

Serial 7’s, months in reverse order, counting backwards

Tests of recent memory (score of contest, breakfast game, 3 word recall)

Neuropsychological Assessments

Standardized Assessment of Concussion (SAC) is a brief mental status test

Used to assess orientation, immediate memory recall, concentration, and delayed recall on and off the fieldSlide14

Neuropsychological Assessment (continued)

Other assessment tools have been designed to assess short term memory, working memory, attention, concentration, visual space capacity, verbal learning, information processing speed and reaction time

Computerized neuropsychological testing programs have been developed

Automated Neuropsychological Assessment Metrics (ANAM)

CogState

Concussion Resolution Index (CRI)

Immediate Post Concussion Assessment & Cognitive Testing (ImPACT)Slide15

Recognition and Management of Specific Head InjuriesSlide16

Skull Fracture

Etiology

Most common cause is blunt trauma

Signs and Symptoms

Severe headache and nausea

Palpation may reveal defect in skull

May be blood in the middle ear, ear canal, nose, ecchymosis around the eyes (raccoon eyes) or behind the ear (Battle’s sign)

Cerebrospinal fluid may also appear in ear and nose

Management

Immediate hospitalization and referral to neurosurgeonSlide17

Cerebral Concussions (Mild Traumatic Brain Injuries)

Etiology

Major public health concern, with return to play decisions remaining the most challenging task for any sports medicine clinician

Result of direct blow, acceleration/deceleration forces producing shaking of the brain

Signs and Symptoms

Changes in level of consciousness

Posttraumatic amnesia

Glasgow Coma scale

Concentration deficits and attention span difficulties

Balance & coordination problems

Must monitor duration of signs and symptomsSlide18

Signs and Symptoms

Two primary symptoms – loss of consciousness and post-traumatic amnesia

Variety of scales and return to play criteria have been examined

Typically involve LOC or amnesia

Recent classification systems have included concentration deficits, attention span difficulties, and balance and coordination in addition to LOC and amnesia

Placing more emphasis on all signs and symptoms may be a more logical approach

Using signs and symptoms immediate post-injury and 15 minutes post-injury to provide an estimation of injury severity has also been suggested

Third approach involves recovery of symptoms, neuropsychological testing, postural stability testing

Focus on patient symptomatologySlide19

Management

The decision to return any patient to competition following a brain injury is a difficult one that takes a great deal of consideration

If any loss of consciousness occurs the athletic trainer must remove the patient from competition

With any loss of consciousness (LOC) a cervical spine injury should be assumed

Objective measures (BESS and SAC) should be used to determine readiness to play

A number of guidelines have been established to in an effort to aid clinicians in their decisions

Return to normal baseline requires approximately 3-5 daysSlide20

Management (continued)

All post-concussive symptoms should be resolved prior to returning to play -- any return to play should be gradual

Recurrent concussions can produce cumulative traumatic injury to the brain

Following an initial concussion the chances of a second episode are 3-6 times greater

Must be able to determine the need for physician referral and be able to decide when the patient should return home vs. being admitted to hospital

A system should be in place that allows for supervision and monitoring of patient when at home following concussive episodeSlide21

Management (continued)

In the past rest was deemed the best treatment

Efficacy of dual task rehabilitation strategies is being explored

Involves posture stability and cognitive tasks

Little evidence available

Involves divided attention tasks

Balance training

Neurocognitive tasks

Simultaneously performed

More research is necessary to establish efficacy of treatment method

Which patients are best candidates?

How soon should the technique be introduced?Slide22

Post-Concussion Syndrome

Etiology

Condition which occurs following a concussion

May be associated w/ those MHI’s that don’t involve a LOC or in cases of severe concussions

Signs and Symptoms

Patient complains of a range of post-concussion problems

Persistent headaches, impaired memory, lack of concentration, anxiety and irritability, giddiness, fatigue, depression, visual disturbances

May begin immediately following injury and may last for weeks to months

Management

Athletic trainer should treat symptoms to greatest extent possible

Return patient to play when all signs and symptoms have fully resolvedSlide23

Second Impact Syndrome

Etiology

Result of rapid swelling and herniation of brain after a second head injury before symptoms of the initial injury have resolved

Second impact may be relatively minimal and not involve contact w/ the cranium

Impact disrupts the brain’s blood auto-regulatory system leading to swelling, increasing intracranial pressure

Signs and Symptoms

Often patient does not have LOC and may looked stunned

W/in 15 seconds to several minutes of injury patient’s condition degrades rapidly

Dilated pupils, loss of eye movement, LOC leading to coma, and respiratory failureSlide24

Second Impact Syndrome (continued)

Management

Life-threatening injury that must be addressed w/in 5 minutes w/ life saving measures performed at an emergency facility

Best management is prevention from the athletic trainer’s perspectiveSlide25

Cerebral Contusion

Etiology

Focal injury to the brain that involves small hemorrhages or intracranial bleeding w/in the cortex, stem or cerebellum

Generally occurs when head strikes a stationary object

Signs and Symptoms

Severity will vary greatly based on the extent of the injury

Will likely experience a LOC followed by a very talkative state

Normal neurological exam; presenting w/ headache, dizziness and nausea

Management

Hospitalization w/ CT and MRI

Treatment will vary according to status of the patient

Return to play occurs when patient is asymptomatic and CT is normalSlide26

Malignant Brain Edema Syndrome

Etiology

Occurs in young population w/in minutes to hours of a head injury

Caused by intracranial clot resulting in diffuse brain swelling w/ little or no brain injury

Swelling is the result of hyperemia or vascular engorgement - results in increased pressure

Signs and Symptoms

Rapid neurologic deterioration that progresses to coma and occasionally death

Management

Life-threatening condition requiring immediate attention at an emergency care facility Slide27

Epidural Hematoma

Etiology

Blow to head or skull fracture which tears meningeal arteries

Blood pressure, blood accumulation and creation of hematoma occur rapidly (minutes to hours)

Signs and Symptoms

LOC followed by period of lucidity, showing few signs and symptoms of serious head injury

Gradual progression of S&S

Head pains, dizziness, nausea, dilation of one pupil (same side as injury), deterioration of consciousness, neck rigidity, depression of pulse and respiration, and convulsion

Management

Requires urgent neurosurgical care; CT may be necessary for diagnosis

Must relieve pressure to avoid disability or deathSlide28

Subdural Hematoma

Etiology

Result of acceleration/deceleration forces that tear vessels that bridge dura mater and brain

May be:

Acute (rapidly progressing)

In association with other brain/skull injury

Chronic (Due to venous bleeding – slow bleed, w/out serious intracranial pressure)

Signs and Symptoms

With a simple subdural hematoma LOC generally does not occurSlide29

Subdural Hematoma (continued)

Signs and Symptoms

Complicated subdural hematoma’s result in LOC, dilation of one pupil

Both will show signs of headache, dizziness, nausea or sleepiness

Management

Immediate medical attention

CT or MRI is necessary to determine extent of injurySlide30

Figure 26-6

Subdural Hematoma

Epidural Hematoma

Intracerebral HematomaSlide31

Migraine Headaches

Etiology

Disordered characterized by recurrent attacks of severe headache

Seen in those that have had repeated head trauma

Exact cause unknown (believed to be vascular)

Triggers could include food, medications, sensory stimuli (lights, odors), lifestyle changes, changes in estrogen levels

Signs and Symptoms

Sudden onset w/ possible visual or gastrointestinal problemsSlide32

Migraines (continued)

Signs and Symptoms

Flashes of light, blindness (half field vision), paresthesia

Throbbing pain, located on one side of head

Sensitivity to light, sound or smells

May experience tingling sensations or numbness in arms or legs, or even dizziness

Management

Prevention is key

Prescription medications have a high success rateSlide33

Scalp Injuries

Etiology

Blunt trauma or penetrating trauma tends to be the cause

Can occur in conjunction with serious head trauma

Signs and Symptoms

Patient complains of blow to the head

Bleeding is often extensive (difficult to pinpoint exact site)

Management

Clean w/ antiseptic soap and water (remove debris)

Cut away hair if necessary to expose area

Apply firm pressure or astringent to reduce bleeding

Wounds larger than 1/2 inch in depth should be referred

Smaller wounds can be covered w/ protective covering and gauze (use extra adherent)Slide34

Recognition of Jaw and Facial InjuriesSlide35

Figure 26-7Slide36

Mandible Fractures

Etiology

Direct blow (generally fractures at frontal angle)

Signs and Symptoms

Deformity, loss of occlusion, pain with biting, bleeding around teeth, lower lip anesthesia

Management

Temporary immobilization w/ elastic wrap followed by reduction and fixation

Figure 26-8Slide37

Mandibular Dislocation

Etiology

Involves TMJ joint

MOI is generally a blow to an open mouth from the side

Signs and Symptoms

Dislocated jaw presents in locked-open position w/ ROM minimal along w/ poor occlusion

Management

Cold application, elastic wrap immobilization and reduction

Follow-up w/ soft diet, NSAID’s and analgesics w/ a gradual return to activity 7-10 days following acute period

Can be recurrent or result in malocclusion, or TMJ dysfunction Slide38

Temporomandibular Joint Dysfunction

Etiology

Disk condyle derangement (disk is positioned anteriorly)

Signs and Symptoms

Headaches, earaches, vertigo, inflammation, neck pain, muscle guarding and trigger points

Hyper- or hypomobility, muscle dysfunction, limited ROM, clicking and popping

Management

Treat with custom designed, removable mouth piece

Treat problem w/ either strengthening or stretching

If corrective measures fail, referral to a dentist will be necessarySlide39

Zygomatic complex (cheekbone) fracture

Etiology

MOI = direct blow

Signs and Symptoms

Deformity, or bony discrepancy, nosebleed, diplopia, and numbness in cheek

Management

Cold application to control edema and immediate referral to a physician

Healing will take 6-8 weeks and proper protective gear will be required upon return to playSlide40

Maxillary fracture

Etiology

MOI = blow to upper jaw

Signs and Symptoms

Pain with chewing, malocclusion, nosebleed, double vision, numbness of lip and cheek region

Management

Due to severe bleeding, airway must be maintained

Must be aware of possible brain injury

Transport hospital immediately, upright and leaning forward if conscious

Allows for external drainage of saliva and blood

Fracture reduction, fixation and immobilizationSlide41

Facial Lacerations

Etiology

Result of a direct impact, and indirect compressive force or contact w/ a sharp object

S&S

Pain, substantial bleeding,

Management

Apply pressure to control bleeding

Referral to a physician will be necessary for stitchesSlide42

Dental and Nasal InjuriesSlide43

Figure 26-10Slide44

Prevention of Dental Injuries

When engaged in contact/collision sports mouth guards should be routinely worn

Greatly reduces the incidence of oral injuries

Practice good dental hygiene

Dental screenings should occur yearly

Cavity prevention

Prevention of abscess development, gingivitis, and periodontitisSlide45

Recognition and Management of Specific Dental InjuriesSlide46

Tooth Fractures

Etiology

Impact to the jaw, direct trauma

Signs and Symptoms

Uncomplicated fractures produce fragments w/out bleeding

Complicated fractures produce bleeding, w/ the tooth chamber being exposed w/ a great deal of pain

Root fractures are difficult to determine and require follow-up w/ X-ray

Figure 26-11Slide47

Management

Uncomplicated and complicated crown fractures do not require immediate attention

Fractured pieces can be placed in a bag and if not sensitive to air or cold, follow-up can wait for 24-48 hours

Bleeding can be controlled via gauze

Cosmetic reconstruction of tooth

In instances of root fractures, the patient can continue to play but must follow-up immediately following competition

Tooth repositioning may be required, along with bracing and the use of mouthpieces in the future

Mandibular fractures and concussions must also be ruled out

Figure 26-12Slide48

Tooth Subluxation, Luxation and Avulsion

Etiology

Direct blow

Signs and Symptoms

Tooth may be slightly loosened, dislodged

When subluxed tooth may be loose w/in socket w/ little or no pain

With luxations, no fracture has occurred, however, there is displacement

W/ an avulsion, the tooth is completely knocked from the oral cavity

Management

For a subluxed tooth, referral should occur w/in the first 48 hours

With a luxated tooth, repositioning should be attempted along w/ immediate follow-up

Avulsed teeth should not be re-implanted except by a dentist (use a Save a Tooth Kit, milk or saline)Slide49

Nasal Injuries

Nasal Fractures and Chondral Separation

Etiology

Direct blow

Signs and Symptoms

Separation of frontal processes of maxilla, separation of lateral cartilage or combination

Profuse bleeding and hemorrhaging, immediate swelling and deformity

Figure 26-14Slide50

Management

Control bleeding and refer to a physician for X-ray, examination and reduction

Uncomplicated and simple fractures will pose little problem for the athlete’s quick return

Splinting may be necessary

Figure 26-14Slide51

Deviated Septum

Etiology

Compression or lateral trauma

Signs and Symptoms

Bleeding and in some instances a septal hematoma will form

Patient will complain of nasal pain

Management

At the site of the hematoma, compression will be required (and if present, drained immediately)

Following drainage, a wick is inserted to allow for further drainage

Packing will be necessary to prevent a return of the hematoma

A neglected hematoma will result in formation of an abscess along with bone and cartilage loss and deformitySlide52

Epistaxis (Nosebleed)

Etiology

Result of a direct blow, a sinus infection, high humidity, allergies, a foreign body or some other serious facial injury

Signs and Symptoms

Generally bleeding from the anterior aspect of the septum

Generally presents with minimal bleeding and resolves spontaneously

More severe bleeding may require more medical attentionSlide53

Management

W/ acute bleeding, sit upright w/ a cold compress over the nose, pressure on the affected nostril and the ipsilateral carotid artery

Also gauze between the upper lip and gum - limits blood supply

If bleeding does not cease in 5 minutes, an astringent or styptic may need to be applied along with a gauze/cotton nose plug to encourage clotting

After bleeding has ceased, the patient can return to play but should be reminded not to blow the nose under any circumstances for at least 2 hours after the initial insultSlide54

Injuries and Conditions of the EarSlide55

Figure 26-15Slide56

Recognition and Management of Specific Ear Injuries

Auricular Hematoma (Cauliflower Ear)

Etiology

Occurs either from compression or shear injury to the ear (single or repeated)

Causes subcutaneous bleeding

Figure 26-16Slide57

Auricular Hematoma (Cauliflower Ear)

Signs and Symptoms

Tearing of overlying tissue away from cartilage

Hemorrhaging and fluid accumulation

If unattended - coagulation, organization and fibrosis occurs

Appears as elevated, white, rounded nodular formation, that is firm and resembles cauliflower

Management

To prevent, wear proper ear protection

Cold application will minimize hemorrhaging

If swelling occurs, measures must be taken to prevent fluid solidification

Physician aspiration, packing, pressure Slide58

Rupture of Tympanic Membrane

Etiology

Fall or slap to the unprotected ear or sudden underwater pressure variation can result in a rupture

Signs and Symptoms

Complaint of loud pop, followed by pain in ear, nausea, vomiting, and dizziness

Hearing loss, visible rupture (seen through otoscope)

Management

Small to moderate perforations usually heal spontaneously in 1-2 weeks

Infection can occur and must be continually monitored

Figure 26-17Slide59

Otitis Externa (Swimmer’s Ear)

Etiology

Infection of the ear canal caused be a gram-negative bacillus

Water becomes trapped by a cyst, bone growths, earwax plugs or swelling caused by allergies

May be a problem for an individual that is travelling via airplane if they have an existing infection

Pressure changes could result in tympanic rupture

Signs and Symptoms

Pain and dizziness, itching, discharge and even partial hearing lossSlide60

Management

Prevent by drying ear with a soft towel, use ear drops with boric acid and alcohol before and after swimming

Avoid things that might cause infection, overexposure to cold wind or sticking foreign objects into the ear

Physician referral will be necessary for antibiotics, acidification of the environment to kill bacteria and to rule out tympanic membrane ruptureSlide61

Otitis Media (Middle Ear Infection)

Etiology

Accumulation of fluid in the middle ear caused by local and systemic infection and inflammation

Signs and Symptoms

Intense pain in the ear, fluid drainage from the ear canal, transient hearing loss

Systemic infection may also cause a fever, headaches, irritability, loss of appetite, and nausea

Tympanic membrane may appeared bulging and/or bleeding

Management

Fluid withdrawal may be necessary to determine the appropriate antibiotics

Analgesics for pain

Generally resolves in 24 hours while pain may last for 72 hoursSlide62

Impacted Cerumen

Etiology

Excessive wax may accumulate, clogging the ear canal

Signs and Symptoms

Degree of muffled hearing or hearing loss

Generally little or no pain because no infection is involved

Management

Initial attempts should be made to irrigate the canal with warm water

Do not try to remove with cotton swab, as it may increase the degree of impaction

May require physician removal with a curetteSlide63

Eye Injuries

Figure 26-18Slide64

Preventing Eye Injuries

Protective devices must provide protection from front and lateral blows

Goggles with high impact-resistant polycarbonate lenses for refraction

Unfortunately, goggles may distort peripheral vision and/or become fogged under certain conditionsSlide65

Assessment of the Eye

Must utilize extreme caution in evaluating and caring for eye injuries

Multiple conditions require immediate referral for additional care to be provided

Transportation to hospital should take place with patient in recumbent position

Eyes should be covered together

Movement of unaffected eye will cause movement in affected eyeSlide66

History

What was the mechanism of injury?

Was loss of vision gradual or immediate?

What was the visual status before injury?

Was there a LOC?

Observation

External ocular structures for swelling discoloration, penetrating objects, movement of the lid

Inspect the globe for lacerations, foreign bodies, hyphema or deformity

Inspect conjunctiva and sclera for hemorrhaging, deformity, or foreign bodiesSlide67

Figure 26-19Slide68

Palpation

Orbital rim for point tenderness and deformity

Special Test

Pupillary response

Dilation and accommodation

Visual acuity

Clarity, blurred vision, diplopia, floating black spots, flashes of light

Ophthalmoscope

Instrument used for observing the interior of the eye (retina)

Figure 26-20 & 21Slide69

Recognition and Management of Specific Eye Injuries

Orbital Hematoma (Black Eye)

Etiology

Blow to the area surrounding the eye which results in capillary bleeding

Signs and Symptoms

Signs of a more serious condition may be displayed as a subconjunctival hemorrhage

Swelling and discolorationSlide70

Management

Cold application for at least 30 minutes, 24 hours of rest if patient has distorted vision

Do not blow nose after acute eye injury

Figure 26-22Slide71

Orbital Fracture

Etiology

Blow to the eyeball forcing it posteriorly, compressing the orbital fat until a blowout rupture occurs to the floor of the orbit (muscle and fat can herniate)

Signs and Symptoms

Diplopia, restricted eye movement, downward displacement of the eye, soft-tissue swelling and hemorrhaging

Numbness associated with infraorbital nerve on the floor of the orbit

Management

X-ray will be necessary to confirm fracture

Antibiotics to decrease risk of infection (due to proximity of maxillary sinus and bacteria)

Treat surgically or allow to resolve spontaneouslySlide72

Foreign Body in the Eye

Etiology

Frequent occurrence in sports and can be dangerous

Signs and Symptoms

Foreign object produces considerable pain, and disability

No attempt should be made to remove by rubbing or by recovering with fingers

Management

Close eye and determine location (upper or lower lid)

Pull upper lid over lower lid to cause tearing

Wash eye with saline; use petroleum jelly to relieve soreness

If object is embedded, close and patch eye and refer to a physicianSlide73

Figure 26-23Slide74

Corneal Abrasions

Etiology

Patient attempts to remove foreign object from eye by rubbing - cornea becomes abraded

Signs and Symptoms

Severe pain, watering of the eye, photophobia, and spasm of the orbicular muscle of the eyelid

Management

Patch eye and refer to a physician

Diagnosis will require use of fluorescein strip (stains abrasion bright green)

Once diagnosed, further dilation is necessary for further assessment

Antibiotic ointment is applied with a semi-pressure patch over the closed eyelidSlide75

Hyphema

Etiology

Blunt blow to the eye

Major eye injury that can lead to serious problems with the lens, choroid or retina

Signs and Symptoms

Causes collection of blood to collect in anterior chamber of the eye

Visible reddish tinge in anterior chamber (blood may turn pea green)

Vision is partially or completely blockedSlide76

Management

Refer to physician

Bed rest and elevation (30-40 degrees); both eyes patched; sedation; and medication to reduce anterior chamber pressure

Occasionally additional bleeding will occur

Figure 26-24Slide77

Rupture of the Globe

Etiology

Blow to the eye by an object smaller than the eye

If globe is not ruptured it still could result in blindness

Signs and Symptoms

Severe pain, decreased visual acuity, diplopia, irregular pupils, increased intraocular pressure and orbital leakage

Management

Immediate rest, eye protection, with a shield, antiemetic medication to avoid increasing pressure

Referral to an ophthalmologist Slide78

Retinal Detachment

Etiology

Blow to the eye can partially or completely separate the retina from the underlying retinal pigment epithelium

Signs and Symptoms

Painless, however, early signs include specks floating before the eye, flashes of light, or blurred vision

As it progresses, “curtain falling” over the field of vision occurs

Management

Immediate referral to an ophthalmologist

Bed rest, patches for both eyesSlide79

Acute Conjunctivitis

Etiology

Caused by bacteria or allergens

Conjunctival irritation caused by wind, dust, smoke, air pollution

Associated with common cold or upper respiratory conditions

Signs and Symptoms

Eyelid swelling w/ purulent discharge; itching associated with an allergy; burning or itching

Management

Highly infectious

10% solution of sodium sulfacetamide is often the treatment of choice

Figure 26-25Slide80

Hordeolum (Sty)

Etiology

Infection of the sebaceous gland at the edge of the eyelid (staphylococcal organism)

Blepharitis is an infection of an eye lash follicle

Signs and Symptoms

Erythema of the eye; localizes into a painful pustule w/in a few daysSlide81

Hordeolum (Sty)

Management

Application of moist compresses

Antibiotics and ointments are not necessary unless lid becomes inflamed or infected

Patient should avoid squeezing site to drain

Recurrent sties require the attention of a physician

Figure 26-26Slide82

Throat Injuries

Contusions

Etiology

Direct blow (clothes-lining)

Could result in trauma to the carotid artery (clotting), impacting blood flow to the brain (serious injury could result)

Signs and Symptoms

Severe pain w/ spasmodic coughing, speaking w/ a hoarse voice, and complaining of difficulty with swallowing

Fractured cartilage may be indicative of an inability to breathe and expectoration of frothy blood; cyanosis may be presentSlide83

Contusions (continued)

Management

Airway integrity - first

If breathing is compromised, referral to the emergency room is necessary

Most situations will require intermittent cold application

Severe neck contusion may require stabilization w/ a well-padded collar