Facial Trauma

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 25 September 2016

⏱️ 10 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

There are 6 major areas/injuries to the face.

Basic Approach to Facial Injury

* Step 1: Airway* Indications for intubation after trauma* Burns to the airway* Rapidly expanding hematoma* GCS <8* Step 2: CT Maxillofacial Without Contrast* Step 3: Supportive Care* Stop bleeding* Apply pressure* Control epistaxis* Caution advised with packing if patient has basilar skull fracture* Ice* Analgesics* Step 4: Antibiotics* Common indications* Fractures of a sinus* Open fractures* Step 5: Consider Consulting the Appropriate Specialist* Eye trauma -> Ophthalmology* ENT trauma -> ENT* Oral/Dental trauma -> Oral/maxillofacial surgery or dentistry

Six Key Facial Injuries

* Frontal bone* Fractures of the INTERNAL frontal sinus wall = BAD* Eyes and orbits* “Blowout” fractures with entrapment of the extra-occular muscles = BAD* Nose* Septal hematoma = BAD* Zygoma (Cheekbone)* Zygomaticomaxillary complex fracture (aka Tripod fracture) = BAD* Maxilla (Upper jaw)* Le Fort fractures = BAD* Mandible (Lower jaw)* Open fractures (intraoral laceration) = BAD

Additional Reading

* Trauma Basics (EM Clerkship)* CORE EM: Facial Fractures (emDOCs)

Transcript

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0:00.0	Hello, med students.
0:02.0	My name is Zach Olson, and thank you for downloading this episode of the EM Clerkship
0:07.9	Podcast.
0:10.4	Today we are continuing our trauma series.
0:13.1	We did head injuries last time, and we're going to keep moving our way down today.
0:18.1	Here's our case.
0:25.6	We're going to get our way down. down today, here's our case. University of hospital is AMIL 48 with a drama alert.
0:28.6	I have a 25-year-old male.
0:30.1	It's going to be in the big of a battery.
0:32.1	Patient is ANR times three.
0:34.4	Patient has the extended macro facial injuries as a result of being struck with a baseball bat.
0:39.3	This patient is making an airway at this time.
0:41.3	We do have a line established for pain medication.
0:44.3	Vitals are otherwise stable, bleeding as control.
0:47.3	This one happened relatively close to you guys.
0:49.3	We're approximately two minutes out. Baseball bat to the face. Good case. This is trauma 101 facial injuries.
1:06.5	Before we get started, what I want you to do, and this sounds silly, but just do it for me.
1:11.4	Look in the mirror, and I want you to look at your face.
1:15.7	I want you to look at the different anatomical parts and landmarks of your face.
1:20.0	I want you to count them, think about them, look at them.
1:24.1	I'm serious. Pause it here. This is going to help you learn.
1:27.3	Look in the mirror and look at your face.
	...

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