8.6. FACIAL/TEENTH INJURY

Related titles

Absent.

Purpose of assistance

1. Preservation of airway patency.
2. Preservation of sight.
3. Preservation of the dentition

Description of the patient

Inclusion criteria

Isolated facial trauma, including trauma to the eyes, nose, ears, mid-face area, jaw, and dentition.

Exclusion criteria

1. General injury (see the guideline “General injury”).
2. Cares (see the guide “Cares”).

Management of the patient

Status assessment

1. The patient’s use of drugs with special attention to the use of blood thinners/antiplatelet drugs.

2. A review of the ABC algorithm with a focus on assessing the ability to independently control the airways:

a) stability of the middle zone of the face;
b) stability of the jaw;
c) stability of the dentition (poorly fixed teeth need attention to prevent possible aspiration).

3. Bleeding (can be serious – epistaxis, trauma to the oral cavity, cuts on the face).

4. Pain or sensitivity in the cervical region of the spine (see the guideline “Help for spinal injuries”).

5. Assessment of the state of consciousness to detect a possible TBI (see the guideline “Head injury”).

6. Macroscopic assessment of vision.

7. Dental avulsion.

8. Any hanging pieces of skin or teeth should be picked up.

9. Lost teeth, which were not found at the scene, may be in the respiratory tract.

10. General assessment of the injury.

11. Re-examination focused on airway and adequate ventilation.

Treatment and intervention

1. Administer oxygen therapy to achieve saturation at 94-98% – use ETSO2 to help monitor hypoventilation and apnea.

2. Provide IV access as needed for infusion of fluids and medications.

3. Analgesia according to the instruction “Pain control”.

4. Traumatic tooth dislocation:

a) do not touch the root of the hanging tooth, do not pull out the tooth;
b) lift the crown, if it is contaminated – rinse with cold water for 10 seconds;
c ) put in a container with milk or saline solution. Alternatively, a conscious patient can hold the tooth in the mouth with saliva as a storage medium.

5. Eye injury:

a) use a protective shield;
b) if the eyeball is detached, do not try to reattach it. Cover with a bandage moistened with physiological solution and put in a bowl around it.

6. Unstable jaw:

a) expect to be unable to spit/swallow effectively, so have a suction device ready;
b) transport in a sitting position with the spit tray in place (unless spinal injuries are suspected, see . guideline “Help with spinal cord injury”).

7. Epistaxis – pinch the nostrils (or ask the patient to do it himself) for 10-15 minutes.

8. Avulsion of the nose/ears:

a) collect the remaining tissues, if this does not increase the time of stay at the scene;
b) transport the collected tissues wrapped in a dry sterile bandage and placed in a plastic bag, which keep on ice;
c) serious wounds of the nose and ears can be bandaged with wet sterile bandages.

Patient safety

1. Periodic examination of airway patency.
2. Maintaining airway patency is the highest priority; accordingly, review for cervical spine injuries (see Spinal Injury Care) to ensure transportation in a seated position for complications due to bleeding, swallowing problems, or secretion control.

Useful information for training

Key points

1. Disturbance of airway patency can be caused by fractures or bleeding.
2. Due to a broken nose, bleeding can occur on the back wall of the nasopharynx, so pinching the nostrils will not have a noticeable effect, as the blood will flow down to the pharynx, creating potential problems of airway patency.
3. Protect hanging tissues and teeth:

a) avulsed teeth can be successfully implanted back if the procedure is performed in a short period after the injury;
b) use sterile bandages for ear and nasal cartilages.

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Corresponding evaluation results

1. Unstable facial fractures that can dramatically disrupt the patency of the respiratory tract.
2. Loose teeth and retro-pharyngeal bleeding.

Key elements of documentation

1. Airway patency and re-examination.
2. Degree and place of bleeding.
3. State of consciousness (AVPU or SHKG).
4. Method of transporting tissues or teeth.
5. Description of eye examination results.
6. Examination and control of the cervical spine.
7. Use of anticoagulants by the patient.

Criteria for the effectiveness of aid provision

1. Appropriate airway control and satisfactory oxygenation.
2. Using a protective shield in case of an eye injury.