Large bore suction (preferably two sources) is invaluable. Significant hemorrhage, whether venous or arterial, can result from facial fractures. In the case of significant facial trauma, this usually directs attention to securing the airway if necessary.Ĭareful examination of the airway can provide valuable information as to what challenges may be faced. The primary survey provides a framework to quickly assess and intervene on immediate life threats. 2 ,3 This, when considered alongside the importance of the face in appearance, speech, vision, mastication, and sensation, suggests a significant risk of morbidity with these important aspects of the primary survey in patients with maxillofacial trauma as well as the evaluation and management of frontal, orbital, nasal, midface, and mandibular injuries.Īirway and Breathing – Examination and Preparation 1 In these severe cases, case series have shown an associated incidence of 44% for intracerebral hemorrhage, 6% for vision loss, and a 9% mortality rate. 1 Of the more severe cases, as many as 42% will require intubation, requiring cautious and expeditious airway management. While injuries to the head, face, neck account for nearly 5% of emergency department visits, the majority are not severe and are discharged home. The burden of disease can range from minor facial lacerations to life-threatening airway compromise. Traumatic injuries to the face present a broad set of challenges to emergency physicians. Prehospital vital signs are maximal heart rate 119 beats per minute, lowest blood pressure 135/80 mmHg, respiratory rate 26 breaths per minute, SpO 2 94% on 15L non-rebreather, GCS is 9 (E1V2M6) as he follows commands but is intermittently combative. Breath sounds are rhonchus but symmetric and there is no other obvious external bleeding or evidence of trauma. On arrival, he has obvious facial injury, with active bleeding from the midface/nares and oral gurgling blood. On the scene, he was placed in a cervical collar and transported by EMS. He was unrestrained and there was ejection into a guardrail. He was traveling approximately 50 mph when he lost control of the vehicle. Authors: Forrest Turner, MD (PGY-3, Emergency Medicine, Carolinas Medical Center) Bryant Allen, MD Attending Physician, Emergency Medicine, Carolinas Medical Center) // Reviewed by Marina Boushra, MD Alex Koyfman, MD Brit Long, MD Case:Ī 42-year-old male presents following a front-end high-speed motor vehicle collision.
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