02 management of facial injury in a multi trauma
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02 management of facial injury in a multi trauma
- 1. MANAGEMENT OF FACIAL INJURY IN A MULTI TRAUMA PATIENT
- 2. FACIAL TRAUMA • MAY BE ISOLATED • MAY BE IN ASSOCIATION WITH MULTIPE TAUMA
- 3. FACIAL TRAUMA • LIFE THREATENING COMPLICATIONS CAN OCCUR • EVIDENT INJURY CAN BE TRIVIAL
- 5. FACIAL TRAUMA • INJURIES CAN BE – FRACTURES – SOFT TISSUE INJURIES – OPHTHALMIC INJURY – PANFACIAL INJURY
- 6. FACIAL TRAUMA • ASSOCIATED INJURIES CAN BE – ANTERIOR NECK INJURIES – SPINAL INJURIES – HEAD INJURY – INJURIES RESULTING IN PROFUSE BLOOD LOSS – PERIPHERAL INJURIES – FACTURES
- 7. FACIAL TRAUMA MANAGEMENT • PRIMARY SURVEY • RESUSCITATION
- 8. FACIAL TRAUMA MANAGEMENT • PRIMARY SURVEY AIMS TO – IDENTIFY ANY LIFE THREATENING CONDITIONS • RESUSCITATION – TO STABILISE THE PATIENT
- 9. FACIAL TRAUMA MANAGEMENT • NORMALLY IN A CASE OF FACIAL TRAUMA THE PATIENT IS TO BE KEPT SEMIPRONE • IN A CASE OF MULTI-TRAUMA THE C-SPINE HAS TO BE IMMOBALIZED AND THE AIRWAY ALSO CONTROLLED
- 10. AIRWAY CONTROL • HIGH INDEX OF SUSPICION FOR OBSTRUCTING AIRWAY • FREQUENT RE-ASSESSMENT • AIRWAY STARTS FROM MOUTH AND UPTO THE LARYNX
- 12. AIRWAY CONTROL • OBSTRUCTION MAY OCCUR DUE TO – DROWSINESS • ALCOHOL • HEAD INJURY – FOREIGN BODY • GUMS SWEETS DENTURES TEETH – BLOOD / VOMITUS
- 13. AIRWAY CONTROL • IDENTIFY ORAL OR NASAL BLEEDING • IF THE NECK IS IMMOBALISED • PRESENCE OF AN EXPERIENCED ANAESTHETIST
- 15. AIRWAY CONTROL • CAN THE PATIENT SIT UP? – IN AN AGGRESSIVE PATIENT – EITHER RULE OUT SPINAL INJURY OR – KEEP THE NECK IN A RIGID CERVICLE COLLAR – CAREFUL MONITORING
- 16. AIRWAY CONTROL • FRACTURES AND SOFT TISSUES SWELLING – BILATERAL FRACTURE MANDIBLE – MIDFACE FRACTURE – PANFACIAL INJURIES – SOFT TISSUE INJURY TO THE NECK • MAY TAKE HOURS TO DEVELOP
- 18. AIRWAY CONTROL • ANTERIOR NECK INJURY LOOK FOR – HOARSE VOICE – HAEMOPTYSIS – SURGICAL EMPHYSEMA – FRACTURE CREPITUS
- 21. AIRWAY CONTROL • CAREFULLY PALPATE THE – GREAT VESSELS – HYOID BONE – LARYNX – LOOK FOR EXTERNAL SWELLING
- 22. THE CERVICLE SPINE • ALWAYS ASSUME CERVICLE SPINAL INJURY TO BE PERSENT • UNSTABLE LIGAMENTOUS INJURY CAN BE PRESENT DESPITE NORMAL BONY STRUCTURE
- 24. AIRWAY MAINTAINENCE TECHNIQUES • SUCTION • JAW THRUST • CHIN LIFT • OROPHARYNGEAL AIRWAY • LMA • ENDOTRACHEAL INTUBATOIN
- 26. AIRWAY MAINTAINENCE TECHNIQUES • SURGICAL AIRWAY – NEEDLE CRICOTHYROIDOTOMY – SURGICAL CRICOTHYROIDOTOMY – TRACHEOSTOMY • NOT SUITABLE FOR EMERGENCY SETTINGS
- 27. BREATHING • ESTABLISHED AS SOON AS POSSIBLE • ALL FOREIGN BODIES HAVE TO BE REMOVED
- 29. CIRCULATION • ANY COLD AND TACHYCARDIAC PATIENT SHOULD BE CONSIDERED TO BE IN HYPOVOLEMIC SHOCK • FACIAL INJURIES UNLIKELY THE SOLE CAUSE
- 30. CIRCULATION • SEVERE FACIAL HAEMORRHAGE REPORTED TO BE IN 1 IN 10 FATAL INJURIES • SEVERE MID FACE AND PANFACIAL INJURIES
- 31. CIRCULATION • CONTROL OF HAEMORRHAGE • I/V ACCESS • SURGICAL INTERVENTION
- 32. CIRCULATION • HAEMOSTASIS • PACKING • STABILISING FACIAL FRACTURES – IMF – PLATING – SPLINTS • LIGATION OF MAJOR VESSELS
- 34. THANK YOU