This document discusses evaluation of facial trauma. It is important to evaluate the airway carefully given the complex anatomy of the face and potential for distortion or obstruction. A thorough history should inquire about vision changes, facial numbness, and malocclusion. Physical exam involves inspection of the face and orbits, as well as palpation for fractures and tenderness. Orbital exam evaluates vision, eye movements, hyphema, and proptosis. Nose exam checks for septal hematoma or CSF rhinorrhea.
Culture. Isn’t just something that grows in the lab (or kitchen)...Gareth Lock
This presentation was given at the Eurotek 2012 technical diving conference and tries to highlight the challenges in changing and developing a safety culture within the sport of recreational and technical diving.
This document discusses Class II division 2 malocclusion, including its definition, classification, clinical features, etiology, diagnosis, and treatment options. Class II division 2 is a type of Class II malocclusion characterized by retroclined maxillary incisors. It can be caused by skeletal factors like mandibular deficiency or maxillary excess, or dental factors like premature tooth loss. Diagnosis involves a problem-oriented approach through data collection and establishing a problem list. Treatment may involve orthodontics alone for mild cases, but more severe cases may require orthodontics combined with orthopedics/growth modification or orthognathic surgery.
GEMC: Near-Drowning and Drowning: Resident TrainingOpen.Michigan
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document provides information on the initial assessment and management of trauma patients using the ABCDE approach. It describes the primary survey process which prioritizes addressing life-threatening issues in the order of: airway and cervical spine protection, breathing and ventilation, circulation, disability, and exposure. Mechanisms of blunt and penetrating trauma are discussed. Specific injuries like tension pneumothorax, hemothorax, and flail chest require interventions like needle decompression or tube thoracostomy during the primary survey to stabilize the patient.
Emergency management of oral and maxillofacial trauma including_100844.pptxNdayishimiyeSamuel1
Oral and Maxillofacial area is a crucial area for respiration, digestive, and esthetic functions. When traumatized, a backup of knowledge and skills is required to restore pleasing look and function. This ppt details how to optimize the emergency and late better outcomes of patients with oral and maxillofacial trauma.
This document provides an overview of condylar and subcondylar fractures, including:
1. The incidence, embryology, surgical anatomy, etiology, classification, clinical examination, and imaging of condylar fractures. Plain radiographs like orthopantomograms and computed tomography are important for evaluation.
2. The goals of treatment include obtaining a stable occlusion, restoring jaw function, and minimizing long-term complications. Treatment options include closed/non-surgical methods or open reduction surgery.
3. Surgical approaches, reduction methods, and special considerations for different patient groups like children and the elderly are discussed. Future directions like TMJ implants and endoscopic techniques are also mentioned.
Spinal injuries are common, with over 200,000 living with spinal cord injuries in the US. Proper immobilization and treatment can minimize further damage. Immobilization with a rigid cervical collar, backboard, and straps is effective for safe transport while limiting movement. Controversial methylprednisolone therapy may provide benefit if administered within 8 hours of acute spinal cord injury. Communication between emergency staff is important to classify patients and ensure prompt evaluation and treatment for spinal injuries.
This document provides an overview of initial assessment and management of trauma patients in remote environments. It discusses the primary survey using CABCDE to rapidly identify life threats, including controlling hemorrhage, maintaining the airway, and assessing breathing and circulation. It also covers the secondary survey, prolonged field care, definitive care, and obtaining a thorough history including mechanism of injury to help predict injuries. The systematic approach outlined aims to stabilize patients and prepare them for evacuation.
Culture. Isn’t just something that grows in the lab (or kitchen)...Gareth Lock
This presentation was given at the Eurotek 2012 technical diving conference and tries to highlight the challenges in changing and developing a safety culture within the sport of recreational and technical diving.
This document discusses Class II division 2 malocclusion, including its definition, classification, clinical features, etiology, diagnosis, and treatment options. Class II division 2 is a type of Class II malocclusion characterized by retroclined maxillary incisors. It can be caused by skeletal factors like mandibular deficiency or maxillary excess, or dental factors like premature tooth loss. Diagnosis involves a problem-oriented approach through data collection and establishing a problem list. Treatment may involve orthodontics alone for mild cases, but more severe cases may require orthodontics combined with orthopedics/growth modification or orthognathic surgery.
GEMC: Near-Drowning and Drowning: Resident TrainingOpen.Michigan
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document provides information on the initial assessment and management of trauma patients using the ABCDE approach. It describes the primary survey process which prioritizes addressing life-threatening issues in the order of: airway and cervical spine protection, breathing and ventilation, circulation, disability, and exposure. Mechanisms of blunt and penetrating trauma are discussed. Specific injuries like tension pneumothorax, hemothorax, and flail chest require interventions like needle decompression or tube thoracostomy during the primary survey to stabilize the patient.
Emergency management of oral and maxillofacial trauma including_100844.pptxNdayishimiyeSamuel1
Oral and Maxillofacial area is a crucial area for respiration, digestive, and esthetic functions. When traumatized, a backup of knowledge and skills is required to restore pleasing look and function. This ppt details how to optimize the emergency and late better outcomes of patients with oral and maxillofacial trauma.
This document provides an overview of condylar and subcondylar fractures, including:
1. The incidence, embryology, surgical anatomy, etiology, classification, clinical examination, and imaging of condylar fractures. Plain radiographs like orthopantomograms and computed tomography are important for evaluation.
2. The goals of treatment include obtaining a stable occlusion, restoring jaw function, and minimizing long-term complications. Treatment options include closed/non-surgical methods or open reduction surgery.
3. Surgical approaches, reduction methods, and special considerations for different patient groups like children and the elderly are discussed. Future directions like TMJ implants and endoscopic techniques are also mentioned.
Spinal injuries are common, with over 200,000 living with spinal cord injuries in the US. Proper immobilization and treatment can minimize further damage. Immobilization with a rigid cervical collar, backboard, and straps is effective for safe transport while limiting movement. Controversial methylprednisolone therapy may provide benefit if administered within 8 hours of acute spinal cord injury. Communication between emergency staff is important to classify patients and ensure prompt evaluation and treatment for spinal injuries.
This document provides an overview of initial assessment and management of trauma patients in remote environments. It discusses the primary survey using CABCDE to rapidly identify life threats, including controlling hemorrhage, maintaining the airway, and assessing breathing and circulation. It also covers the secondary survey, prolonged field care, definitive care, and obtaining a thorough history including mechanism of injury to help predict injuries. The systematic approach outlined aims to stabilize patients and prepare them for evacuation.
Condylar fractures /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
1) Blunt abdominal trauma is injury to the abdomen from non-penetrating forces and is a common cause of injury from motor vehicle accidents. 2) Presentation can vary widely from hemodynamic stability with minimal signs to complete shock. Common injuries include injuries to solid organs like the spleen and liver as well as hollow organs. 3) Initial assessment focuses on the ABCDEs with attention to potential for internal bleeding and hemorrhagic shock. History and physical exam aim to identify any signs of intra-abdominal injury.
1) Blunt abdominal trauma is injury to the abdomen from non-penetrating forces and is a common cause of injury from motor vehicle accidents. Symptoms can range from minimal signs to cardiovascular collapse.
2) The spleen, liver, and kidneys are most commonly injured in blunt trauma due to their solid nature. Injuries to hollow organs like the stomach and intestines also occur from shearing forces.
3) Initial assessment focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure. Patients are fully evaluated and stabilized, with two IV lines placed and fluid resuscitation started if indicated. Ongoing monitoring of vitals and input/output is important
The document discusses advanced airway management in pediatrics and for emergency adult patients with severe facial injuries. For pediatric patients, anatomy such as a large tongue, high larynx, large head and short neck can make airway management more difficult and specific techniques are required. Radiological exams may be used for advanced airway assessment in pediatrics. For adults with facial injuries, maintaining the airway is the top priority and specific situations like soft tissue swelling, bone fragments or hemorrhage can obstruct the airway. Various airway devices and techniques are discussed for managing these difficult airway cases, including direct laryngoscopy, video laryngoscopy, blind insertion devices, fiberoptic intubation and surgical airways. Close
Handling the emergencies in radiology and first aid in the x ray departmentAnupam Niraula
1) Emergency departments are designed to treat acute medical issues without appointments and are staffed by trauma physicians. They classify patients into non-urgent, urgent, and acute categories to prioritize care.
2) For trauma patients, MDCT is often the preferred imaging method and should be located near the emergency room along with radiography. Interventional radiology may perform procedures like embolization to stop hemorrhaging.
3) In reaction emergencies, treatments vary based on symptoms but may include oxygen, antihistamines, epinephrine, saline, and moving the patient to stabilize their condition. Staff are trained to recognize and respond to different types and severities of reactions.
GEMC: A Potpourri of Wound Care Issues: Resident TrainingOpen.Michigan
This is a lecture by Dr. Alexander Rogers from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document discusses various types of birth injuries including skull injuries and soft tissue injuries in newborns. Skull injuries include caput succedaneum, cephalohematoma, scalp injuries, and skull fractures. Soft tissue injuries involve the skin, subcutaneous tissues, muscles, and visceral organs. Intracranial hemorrhages are also described, which can be traumatic, anoxic, or involve the ventricles, subarachnoid space, or brain tissue. Risk factors, clinical features, diagnosis, and management are provided for each type of injury.
The document discusses various types of facial trauma and injuries. It covers the epidemiology, diagnostic strategies, and management principles for soft tissue injuries, fractures, nasal and orbital injuries, and mandibular fractures. Common causes of facial trauma include motor vehicle collisions, assaults, and child abuse. Imaging such as CT scans are important for evaluating bone fractures while management depends on the specific injury and may involve wound care, closed or open reduction, and consultation with specialists.
The document discusses various types of facial and neck trauma. Facial injuries are commonly caused by motor vehicle collisions, assaults, and child abuse. Evaluation involves imaging like CT scans to diagnose fractures. Treatment depends on the type and severity of the injury but may include closed reduction, open reduction, and reconstruction. Neck injuries are serious due to vulnerability of structures like the airway. Proper management of neck trauma aims to rapidly secure the airway and control bleeding.
Malignant glaucoma - Dr Shylesh B DabkeShylesh Dabke
This document discusses malignant glaucoma, a condition characterized by a shallow anterior chamber and elevated intraocular pressure despite a patent iridectomy. It occurs most commonly after glaucoma surgery. Several theories exist for its pathogenesis, involving aqueous misdirection posteriorly due to cilio-lenticular or cilio-vitreal blocks. Clinical features, diagnosis, differential diagnosis, and management approaches are described, including medical therapy with cycloplegics and hyperosmotics, laser treatments, and surgical interventions like vitrectomy. Preventing recurrence in the fellow eye is also addressed.
1) Airway management is a core skill in emergency medicine and the emergency physician has primary responsibility for airway management. Intubation should be considered when the airway cannot be protected or ventilated, or if clinical deterioration is anticipated.
2) Assessing the airway includes evaluating level of consciousness, ability to phonate, handle secretions, and anticipated clinical course. Ventilatory or oxygenation failure are also indications for intubation.
3) Confirmation of endotracheal tube placement includes methods like direct visualization, auscultation, end-tidal CO2 detection, ultrasound, and chest x-ray. Fiberoptic bronchoscopy is the gold standard.
This document discusses traumatic cranial CSF leaks, including their history, classification, causes, symptoms, diagnosis, and management. It focuses on the controversial role of prophylactic antibiotics. While earlier meta-analyses suggested antibiotics may reduce meningitis risk, a 2011 Cochrane review found no evidence to support their use. Proponents argue they may still be warranted given the risks of meningitis, while opponents feel they are ineffective and could increase antibiotic resistance. The conclusion is that the choice to use antibiotics depends on the individual case and managing physician's assessment.
1. The Advanced Trauma Life Support (ATLS) protocol focuses on simultaneously identifying and treating life-threatening injuries within the crucial "Golden Hour" period after trauma.
2. The ATLS protocol involves two surveys - the Primary Survey to address airway, breathing, circulation, disability, and exposure issues, and the Secondary Survey for a full history and physical exam after initial resuscitation is complete.
3. Key components of the Primary Survey include assessing the airway, identifying tension pneumothorax and hemorrhage, and providing spinal immobilization, followed by full exposure to identify all injuries.
Choanal atresia is a congenital condition where the posterior nasal openings are blocked or narrowed. It occurs due to a failure of rupture of the membrane separating the nasal cavity from the oral cavity during embryonic development. Clinically, it presents with nasal obstruction and discharge or cyclic cyanosis in infants. Diagnosis is confirmed with CT scan showing narrowing of the posterior nasal airway. Treatment involves surgical repair through a transnasal or transpalatal approach to reopen the nasal passage, with stenting sometimes needed. Recurrence of narrowing can occur.
The document provides guidance on evaluating and treating polytrauma patients. It outlines the goals of trauma resuscitation which include identifying life-threatening injuries. The Advanced Trauma Life Support (ATLS) approach is recommended as a safe standardized method, beginning with the primary survey of ABCDE (airway, breathing, circulation, disability, exposure). Key assessments include mechanism of injury, vital signs, neurological status, and bleeding control. A thorough secondary survey then involves a full head-to-toe examination. Guidance is given on managing specific injuries such as abdominal trauma, with operative intervention prioritized for unstable patients or those with signs of internal bleeding.
Maxillofacial trauma evaluation and management (nx power lite) /certified fix...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
GEMC: Upper Extremity Injuries: Shoulder, Elbow and Wrist: Resident TrainingOpen.Michigan
This is a lecture by Dr. Patrick Carter from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/
Maxillofacial trauma /certified fixed orthodontic courses by Indian dental a...Indian dental academy
This document provides an overview of maxillofacial trauma readiness training for dental officers. It covers evaluation and management of maxillofacial injuries in four phases: emergency care, early care, definitive care, and secondary care. Key points of emergency care include airway management, hemorrhage control, shock treatment, and C-spine stabilization. Early care involves initial fracture stabilization, debridement, diagnosis through imaging and examination. Definitive care consists of treating soft tissue injuries and fractures like mandibular and midface fractures through open or closed reduction methods. Midface fractures include Lefort I, II, III patterns. Nasal-orbital-ethmoid fractures often involve multiple midface structures.
Condylar fractures /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
1) Blunt abdominal trauma is injury to the abdomen from non-penetrating forces and is a common cause of injury from motor vehicle accidents. 2) Presentation can vary widely from hemodynamic stability with minimal signs to complete shock. Common injuries include injuries to solid organs like the spleen and liver as well as hollow organs. 3) Initial assessment focuses on the ABCDEs with attention to potential for internal bleeding and hemorrhagic shock. History and physical exam aim to identify any signs of intra-abdominal injury.
1) Blunt abdominal trauma is injury to the abdomen from non-penetrating forces and is a common cause of injury from motor vehicle accidents. Symptoms can range from minimal signs to cardiovascular collapse.
2) The spleen, liver, and kidneys are most commonly injured in blunt trauma due to their solid nature. Injuries to hollow organs like the stomach and intestines also occur from shearing forces.
3) Initial assessment focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure. Patients are fully evaluated and stabilized, with two IV lines placed and fluid resuscitation started if indicated. Ongoing monitoring of vitals and input/output is important
The document discusses advanced airway management in pediatrics and for emergency adult patients with severe facial injuries. For pediatric patients, anatomy such as a large tongue, high larynx, large head and short neck can make airway management more difficult and specific techniques are required. Radiological exams may be used for advanced airway assessment in pediatrics. For adults with facial injuries, maintaining the airway is the top priority and specific situations like soft tissue swelling, bone fragments or hemorrhage can obstruct the airway. Various airway devices and techniques are discussed for managing these difficult airway cases, including direct laryngoscopy, video laryngoscopy, blind insertion devices, fiberoptic intubation and surgical airways. Close
Handling the emergencies in radiology and first aid in the x ray departmentAnupam Niraula
1) Emergency departments are designed to treat acute medical issues without appointments and are staffed by trauma physicians. They classify patients into non-urgent, urgent, and acute categories to prioritize care.
2) For trauma patients, MDCT is often the preferred imaging method and should be located near the emergency room along with radiography. Interventional radiology may perform procedures like embolization to stop hemorrhaging.
3) In reaction emergencies, treatments vary based on symptoms but may include oxygen, antihistamines, epinephrine, saline, and moving the patient to stabilize their condition. Staff are trained to recognize and respond to different types and severities of reactions.
GEMC: A Potpourri of Wound Care Issues: Resident TrainingOpen.Michigan
This is a lecture by Dr. Alexander Rogers from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document discusses various types of birth injuries including skull injuries and soft tissue injuries in newborns. Skull injuries include caput succedaneum, cephalohematoma, scalp injuries, and skull fractures. Soft tissue injuries involve the skin, subcutaneous tissues, muscles, and visceral organs. Intracranial hemorrhages are also described, which can be traumatic, anoxic, or involve the ventricles, subarachnoid space, or brain tissue. Risk factors, clinical features, diagnosis, and management are provided for each type of injury.
The document discusses various types of facial trauma and injuries. It covers the epidemiology, diagnostic strategies, and management principles for soft tissue injuries, fractures, nasal and orbital injuries, and mandibular fractures. Common causes of facial trauma include motor vehicle collisions, assaults, and child abuse. Imaging such as CT scans are important for evaluating bone fractures while management depends on the specific injury and may involve wound care, closed or open reduction, and consultation with specialists.
The document discusses various types of facial and neck trauma. Facial injuries are commonly caused by motor vehicle collisions, assaults, and child abuse. Evaluation involves imaging like CT scans to diagnose fractures. Treatment depends on the type and severity of the injury but may include closed reduction, open reduction, and reconstruction. Neck injuries are serious due to vulnerability of structures like the airway. Proper management of neck trauma aims to rapidly secure the airway and control bleeding.
Malignant glaucoma - Dr Shylesh B DabkeShylesh Dabke
This document discusses malignant glaucoma, a condition characterized by a shallow anterior chamber and elevated intraocular pressure despite a patent iridectomy. It occurs most commonly after glaucoma surgery. Several theories exist for its pathogenesis, involving aqueous misdirection posteriorly due to cilio-lenticular or cilio-vitreal blocks. Clinical features, diagnosis, differential diagnosis, and management approaches are described, including medical therapy with cycloplegics and hyperosmotics, laser treatments, and surgical interventions like vitrectomy. Preventing recurrence in the fellow eye is also addressed.
1) Airway management is a core skill in emergency medicine and the emergency physician has primary responsibility for airway management. Intubation should be considered when the airway cannot be protected or ventilated, or if clinical deterioration is anticipated.
2) Assessing the airway includes evaluating level of consciousness, ability to phonate, handle secretions, and anticipated clinical course. Ventilatory or oxygenation failure are also indications for intubation.
3) Confirmation of endotracheal tube placement includes methods like direct visualization, auscultation, end-tidal CO2 detection, ultrasound, and chest x-ray. Fiberoptic bronchoscopy is the gold standard.
This document discusses traumatic cranial CSF leaks, including their history, classification, causes, symptoms, diagnosis, and management. It focuses on the controversial role of prophylactic antibiotics. While earlier meta-analyses suggested antibiotics may reduce meningitis risk, a 2011 Cochrane review found no evidence to support their use. Proponents argue they may still be warranted given the risks of meningitis, while opponents feel they are ineffective and could increase antibiotic resistance. The conclusion is that the choice to use antibiotics depends on the individual case and managing physician's assessment.
1. The Advanced Trauma Life Support (ATLS) protocol focuses on simultaneously identifying and treating life-threatening injuries within the crucial "Golden Hour" period after trauma.
2. The ATLS protocol involves two surveys - the Primary Survey to address airway, breathing, circulation, disability, and exposure issues, and the Secondary Survey for a full history and physical exam after initial resuscitation is complete.
3. Key components of the Primary Survey include assessing the airway, identifying tension pneumothorax and hemorrhage, and providing spinal immobilization, followed by full exposure to identify all injuries.
Choanal atresia is a congenital condition where the posterior nasal openings are blocked or narrowed. It occurs due to a failure of rupture of the membrane separating the nasal cavity from the oral cavity during embryonic development. Clinically, it presents with nasal obstruction and discharge or cyclic cyanosis in infants. Diagnosis is confirmed with CT scan showing narrowing of the posterior nasal airway. Treatment involves surgical repair through a transnasal or transpalatal approach to reopen the nasal passage, with stenting sometimes needed. Recurrence of narrowing can occur.
The document provides guidance on evaluating and treating polytrauma patients. It outlines the goals of trauma resuscitation which include identifying life-threatening injuries. The Advanced Trauma Life Support (ATLS) approach is recommended as a safe standardized method, beginning with the primary survey of ABCDE (airway, breathing, circulation, disability, exposure). Key assessments include mechanism of injury, vital signs, neurological status, and bleeding control. A thorough secondary survey then involves a full head-to-toe examination. Guidance is given on managing specific injuries such as abdominal trauma, with operative intervention prioritized for unstable patients or those with signs of internal bleeding.
Maxillofacial trauma evaluation and management (nx power lite) /certified fix...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
GEMC: Upper Extremity Injuries: Shoulder, Elbow and Wrist: Resident TrainingOpen.Michigan
This is a lecture by Dr. Patrick Carter from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/
Maxillofacial trauma /certified fixed orthodontic courses by Indian dental a...Indian dental academy
This document provides an overview of maxillofacial trauma readiness training for dental officers. It covers evaluation and management of maxillofacial injuries in four phases: emergency care, early care, definitive care, and secondary care. Key points of emergency care include airway management, hemorrhage control, shock treatment, and C-spine stabilization. Early care involves initial fracture stabilization, debridement, diagnosis through imaging and examination. Definitive care consists of treating soft tissue injuries and fractures like mandibular and midface fractures through open or closed reduction methods. Midface fractures include Lefort I, II, III patterns. Nasal-orbital-ethmoid fractures often involve multiple midface structures.
Similar to Lecture11 advanced emergencytraumacourse-maxillofacialtrauma (20)
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
1. Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl Seger,
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3. Advanced Emergency
Trauma Course
Facial Trauma
Presenter: Carl Seger, MD
Written By: Andre Crouch, MD
Ghana Emergency Medicine Collaborative
Patrick Carter, MD ∙ Daniel Wachter, MD ∙ Rockefeller Oteng, MD ∙ Carl Seger, MD
4. Facial Trauma
George A. Otis (Wikipedia)
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
5. Facial Trauma - Introduction
Population at risk
• Blunt trauma
• Assault
• Gun shot wound
• Domestic violence
60% of pts with severe facial injuries have
multisystem trauma
• 20-50% have concurrent brain injury
• Facial injuries may distract from C-spine injury or other
major injury
Often not life threatening, but has psychological
sequelae - 25% may develop PTSD
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
6. Facial Trauma - Anatomy
Facial Bones
Encyclopedia Britannica
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
7. Facial Trauma - Anatomy
Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist.
Facial nerves
Parotid gland
Patrick J. Lynch, (Wikipedia)
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
9. Facial Trauma - Evaluation
ABC’s - emphasis on A and C
Airway
• Special considerations:
Anatomy distortion - limits devices such as the LMA
“Flail” mandible
• Mandible broken in two locations ==> obstruction
TMJ dislocation or fracture - will limit mouth opening
Cribriform plate disruption
• Caution with NG tube placement or nasal intubation
Hemorrhage
• Can obstruct view, may need double suction set up
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
10. Facial Trauma - Evaluation
Airway
• Approach:
Sometimes the injury makes intubation easier
Emergent/crash vs. Urgent airway - If it is going to be
a challenging airway, take the time to fully prepare.
RSI vs. The awake look
• Often tone is the only thing keeping the airway patent
• Ketamine and nebulized lidocaine for the awake look
Hemorrhage:
• Double suction
• Control posterior nasopharyngeal bleeding with foley
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
11. Facial Trauma - Evaluation
Airway
• Approach:
LMA? Can be a nice back up
• Anatomy distortion is an issue
• Mouth opening can also be an issue
Nasotracheal intubation? Controversial
• Some authors do not recommend this route because of
risk of nasocranial intubation or nasal hemorrhage
Consider the double prep:
• Plan A: Endotracheal intubation
• Plan B: Crash Cricothyroidotomy with the tray opened
and neck prepped
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
12. Facial Trauma - Evaluation
Breathing
Circulation
• Often the cause of hypotension is elsewhere
Don’t let the obvious facial injury distract you from
other injuries
• Severe hemorrhage from maxillofacial injuries
is rare
Be aware of scalp laceration
Nasopharyngeal bleed
• Control anterior or posterior bleeding
• May manually reduce unstable Le Forte fractures
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
13. Facial Trauma - Evaluation
History: Three key questions
• Vision changes?
Monocular double vision
• Lens disruption, or corneal or retinal injury
Binocular double vision
• Dysfunction of extraocular muscles or nerves
Pain w/ movement = injury to orbit or globe
• Facial numbness
Trigeminal branch nerve injury
• Malocclusion
Fracture or dislocation
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
14. Facial Trauma - Evaluation
Physical Exam
• Inspection
Facial elongation (“Donkey Face”) associated with
high grade Le Forte fractures
Facial asymmetry - neural involvement
Ecchymosis - Raccoon’s eyes or Battle’s sign
• Palpation
Assess for tenderness, crepitus or subcutaneous air
Intraoral exam for zygomatic arch injury and
maxillary stability
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
15. Facial Trauma - Evaluation
Physical Exam
• Orbital examination
Done early before swelling
Pupil reactivity
• Tear drop pupil associated with globe rupture
• Marcus Gunn pupil
Hyphema
Visual acuity
EOM
• Ocular muscle entrapment
• Ocular nerve injury
• Pain can be a clue to associated orbit fractures
Proptosis - consider retrobulbar hematoma
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
16. Facial Trauma - Evaluation
Physical Exam - Orbital
Examination
• Lid Lacerations
Medial third of lower eyelid
• High risk for lacrimal duct
involvement
Upper and Lower Eyelid Gray’s Anatomy (Wikipedia)
• Disruption of tarsal plate or
cartilaginous plate
Eyelid Droop
• Disruption of levator
palpebral muscle
Ghana Emergency Medicine Collaborative Gray’s Anatomy (Wikipedia)
Advanced Emergency Trauma Course
18. Facial Trauma - Evaluation
Physical Exam
• Mandible/Dentition
Malocclusion
Flail mandible - two separate fracture site
TMJ dislocation - typically anterior
Tongue blade test
• Patient bites down on tongue blade and it is twisted
until it breaks:
Unable to break tongue blade indicates
mandibular fracture
• 95% sensitive; 65% specific for mandibular fracture
Loose/chipped teeth
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
19. Facial Trauma - Imaging
Plain films
• Challenging to read
• Approach
Asymmetry
Bony integrity
Subcutaneous air
Sinus opacity
Teardrop sign - orbital fat herniation
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
20. Facial Trauma - Imaging
Plain films
• Waters or occipital-mental view
As sensitive a entire facial series
Examines orbital rims and air/fluid levels
• PA or Caldwell view
Best for upper facial bones
• Cross table or upright lateral view
Not helpful
• Submental-vertex (“jug handle”) view
Best to evaluate for zygomatic arch fractures
• Towne view
Evaluation of mandibular ramus
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
21. Facial Trauma - Waters view
Structures to identify
• Frontal sinus
• Maxillary sinus
• Ethmoid sinus
• Nasal septum
• Orbital rim
• Zygoma
• Zygomatic arch
Net Medicine
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
22. Facial Trauma - Imaging
CT
• Considered by some
to be one of the two
most important
advancements in the
last 20 years.
• Helps guide surgical
management
RadiologyInfo.org
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
23. Facial Trauma - Specific Injuries
Frontal skull injuries
• Thick part of skull - if injured here likely has injury
elsewhere
• Anterior aspect of sinus
Pain control
Surgery if depressed defect
Outpatient treatment if isolated
• Posterior aspect of sinus
Concern for CSF leak/risk of meningitis
Neurosurgical consultation and admission
IV antibiotics - benefit questionable
• Consider 1st gen cephalosporin or other coverage for sinus
pathogens
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
24. Facial Trauma -Specific Injuries
Orbital injuries
• Blowout fractures
Physical Exam
• Enophthalmos or sunken globe - indication for surgery
• Infraorbital anesthesia - infraorbital nerve contusion or injury
• Diplopia of upward gaze - inferior rectus entrapment
• Step off deformity or subcutaneous emphysema
• Visual impairment - compromise of optic nerve
Imaging
• CT or plain films
Treatment
• Surgery
Indicated w/ enophthalmos or diplopia
Severity of fracture seen on CT scan - varies with different
surgeons
• IV antibiotics - 1st or 2nd gen cephalosporin
• Don’t blow your nose
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
26. Facial Trauma - Specific Injuries
Lateral cantholysis:
• Inject 1 mL of 1% lidocaine w/ epinephrine into the
lateral canthus
• Use a straight hemostat to crimp the skin of the lateral
corner down to orbital rim
• Use scissor to make 1-2 cm incision extending
laterally
• If pressure still elevated retract inferior lid downward
to visualize lateral canthus tendon
• Dissect the inferior crux of the lateral canthus tendon
and cut it
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
28. Facial Trauma -Specific Injuries
Zygoma injuries
• 2 fracture patterns
Arch - most common
Tripod - most severe
• Involves: Zygomatic arch, maxillary sinus, and
lateral orbital wall
• Be aware of entrapment and vision changes
• Treatment:
Arch - pain control as an out patient
Tripod - Admission for ORIF and antibiotics
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
30. Facial Trauma - Specific Injuries
Maxillary fractures
• High energy
Usually associated with other
injuries
• Le Forte I - Transverse
• Le Forte II - Pyramidal
• Le Forte III - Craniofacial
dislocation
Le Fort fracture of skull (Wikipedia)
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
31. Facial Trauma - Specific Injuries
Le Fort fracture of skull (Wikipedia) Le Fort fracture of skull (Wikipedia)
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
32. Facial Trauma -Specific Injuries
Le Fort fracture of skull (Wikipedia)
Le Fort fracture of skull (Wikipedia)
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
33. Facial Trauma - Specific Injuries
Le Fort fracture of skull (Wikipedia)
Le Fort fracture of skull (Wikipedia)
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
34. Facial Trauma - Specific Injuries
Maxillary fractures
• Treatment
Le Forte II and III - admission for
stabilization and management
Antibiotics commonly given even though
efficacy has not been proven
Be aware of visual deficits
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
35. Facial Trauma - Specific Injuries
Mandibular fractures
• Common mechanism is assault or fall onto chin
• Often fracture in multiple locations
• Intraoral laceration indicates open fracture
• Ecchymosis under tongue is sensitive for
mandibular fracture
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
36. Facial Trauma - Specific Injuries
Mandibular fractures
• Treatment
If open - admission and IV antibiotics
• 1st gen cephalosporin, PCN, or clindamycin
If closed
• May consider out patient care with consultation
Surgical intervention depending on the degree
of displacement.
Barton bandage
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
37. Facial Trauma -Specific Injuries
TMJ dislocation
• Anterior dislocation most common
Can occur with impact as little as a yawn
Posterior, lateral, and superior also
possible
• Usually associated with other injuries
• Present with acute pain, tragus pain,
malocclusion, and palpable defect
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
38. Facial Trauma -Specific Injuries
TMJ dislocation
• Treatment
Anesthesia
• Conscious sedation
• Local: 2 mL of 2% lidocaine in the preauricular depression
anterior to the tragus
Protect the thumbs - tongue depressor or gauze
Thumbs apply downward and backward pressure to
the occlusal surface of the mandibular molars
Post reduction care:
• Soft diet
• Don’t open mouth wider than 2 cm for 2 weeks
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
39. Facial Trauma - Specific Injuries
Nasal fractures
• Most common facial fracture
• Always asses for septal hematoma
• Treatment:
Hemostasis
Drain septal hematoma if present
Surgical intervention only if cosmetic defect
exists after swelling subsides.
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
40. Facial Trauma - Specific Injuries
Scalp Lacerations
• Close the galea w/ 4-0 nylon
• Close the muscle w/ 4-0 braided absorbable
suture
• Close the skin w/ staples or 4-0 nylon
• Hemostasis is key - can have life threatening
blood loss from scalp hematoma
• Do not shave head
• Remove staples in 7-10 days
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
41. Facial Trauma - Specific Injuries
Forehead and eyebrow lacerations
• Extra caution to align the eyebrows and skin
tension lines for cosmetic repair
• Use 6-0 nylon for the skin, or
• 6-0 fast absorbing gut in children
• 6-0 absorbable braided suture such as vicryl
can be used for a deep layer to wounds under
tension
• Do not shave eyebrows
• Remove sutures in 5 days
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
42. Facial Trauma - Specific Injuries
Eyelid lacerations
• Be especially aware of
following injuries
Inner surface of lid
Lid margins
Lacrimal duct
Ptosis
Extension into the
tarsal plate
• Any of the above
specialty assistance Gray’s Anatomy (Wikipedia)
recommended
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
43. Facial Trauma - Specific Injuries
Lips and oral mucosa
• Line up the vermillion border!
• 6-0 nylon for the skin
• 5-0 plain gut for the mucosa
• 4-0 braided absorbable (vicryl) for the muscle
• Remove sutures from skin in 5 days
• Only repair oral mucosa if it is gaping - at risk
of food getting caught
• Be aware of potential damage to parotid duct
or facial nerve
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
44. Facial Trauma - Specific Injuries
Regional anesthesia: Infraorbital Block
• Locate the infraorbital foramen
Approx 1 cm below the orbital rim
In line with the pupil
• Insert the needle via the superior labial
sulcus at the apex of the canine fossa
• Inject approx 2 cm of anesthetic near,
but not within, the foramen
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
46. Facial Trauma - Specific Injuries
Regional anesthesia: Mental Block
• Locate the mental foramen - in line with the
pupil
• Insert the needle via the inferior labial sulcus
at the apex of the first bicuspid
• Inject approx 2 mL of anesthetic
• Note: topical anesthetic can be used prior to
insertion of needle
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
49. References
Hasan N, Colucciello SA. Maxillofacial Trauma.
InTintinalli JE, et al, editor. Emergency Medcine: A
Comprehensive Study Guide, sixth ed. 2004. The
McGraw-Hill Compaines Inc, New York. 1583-1589.
Burton JH, Armellina N. In Adams JG, et al,
Emergency Medicine, first ed. 2008. Saunders,
Philadelphia. 783-796.
Editor's Notes
Note the location of the frontal sinus and maxillary sinus. Does not handle frontal impact well
Trigeminal nerve - important for nerve blocks Facial nerve - not shown: important for facial motor fxn Important consideration is parotid duct disruption with lacerations
Remember other causes of hypotension: chest, abd, pelvis, thigh, blood loss to street, neurogenic shock, potential medical issues
Marcus Gunn pupil = afferent defect, damage to optic nerve or retina
Injuries to tarsal plate and levator palpebral muscle require special cosmetic considerations
An opportunity to practice: Frontal sinus, maxillary sinus, ethmoid sinus, nasal septum, orbit rim, zygoma and zygomatic arch
The other big advancement being the use of small plates and screws instead of wire fixation for repair