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Athletic Injuries ATC 222 Head, Face, Eyes, Ears, Nose, and Throat Chapter 27. Facial Injuries. Mandible Fracture deformity malocclusion malalignment bleeding around teeth/gums lower lip anesthesia pain with biting Treatment. Facial Injuries. Mandible Dislocation/Subluxation

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facial injuries
Facial Injuries
  • Mandible Fracture
    • deformity
    • malocclusion
    • malalignment
    • bleeding around teeth/gums
    • lower lip anesthesia
    • pain with biting
  • Treatment
facial injuries1
Facial Injuries
  • Mandible Dislocation/Subluxation
    • commonly from lateral force
    • malalignment
    • malocclusion
    • open, locked jaw
dental injuries
Dental Injuries
  • Types
    • fracture
    • dislocation/subluxation
  • Treatment
    • realign subluxation
    • replace/preserve dislocation or fracture
    • 30 minute survival rate
nasal injuries
Nasal Injuries
  • Fracture or Cartilage Separation
    • S/S
      • deformity
      • profuse bleeding
      • immediate swelling
      • crepitus
    • treatment
      • control hemorrhaging
      • referral
      • most return to activity in 3-4 days
nasal injuries1
Nasal Injuries
  • Epistaxis (nosebleed)
    • sit upright
    • ice (nose and ipsilateral carotid)
    • direct pressure on nostril
    • cotton/gauze plug
    • refrain from nose blowing for 2 hours
eye injuries
Eye Injuries
  • Causes and Prevention
  • S/S or Serious Eye Injury
    • prolonged blurred vision
    • loss of part/all of visual field
    • sharp, stabbing, throbbing pain
    • double vision
    • embedded object
    • blood in anterior chamber (hyphema)
treatment of serious eye injury
Treatment of Serious Eye Injury
  • immediate referral
  • cover both eyes with embedded object
  • ice only to surrounding tissue
  • no pressure applied to eyes
orbital blowout fx
Orbital Blowout Fx
  • Blunt trauma
  • Inability to look upward
  • Diplopia
  • Sunken eye
orbital hematoma
Orbital Hematoma
  • “Black Eye”
  • Bleeding in orbit area and poss. Sclera
  • Rule out serious eye injury
foreign body in eye
Foreign Body in Eye
  • Embedded?
  • Removal
    • Close eye
    • eye rinse
    • removal with gauze pad
ear injuries
Ear Injuries
  • Hematoma Auris (cauliflower ear)
    • causes
    • S/S
      • swelling
      • redness, warmth
      • pain
    • treatment
      • ice
      • protection
      • aspirate
otitis media and externa
Otitis Media and Externa
  • Etiology
  • Signs and Symptoms
  • Treatment
neuron nerve cell
Neuron (Nerve Cell)
  • dendrites
  • cell body
  • axon
  • Schwann cells
  • motor end plate
functional classification of neurons
Functional Classification of Neurons
  • Sensory
  • Associational
    • Inter-neurons
  • Motor
    • Upper motor neuron
    • Lower motor neuron
synapse
Synapse
  • Functional connection between 2 neurons
    • chemical or electrical
  • Neurotransmitters
    • acetylcholine
    • norepinephrine
  • Motor Unit
nervous system divisions
Nervous System Divisions
  • Central Nervous System (CNS)
    • Brain
    • Spinal Cord
  • Peripheral Nervous System (PNS)
    • Cranial Nerves
    • Spinal Nerves
      • R.T.D.C.B.
slide21
PNS
  • Somatic NS
  • Autonomic NS
    • sympathetic
    • parasympathetic
    • enteric NS
somatic nervous system
Somatic Nervous System
  • Functions
    • voluntary control of skeletal muscle
    • convey conscious/unconscious sensory (afferent) information
      • vision, pain, touch, unconscious muscle sense
autonomic nervous system
Autonomic Nervous System
  • Functions
      • convey sensory input from visceral organs, glands and cardiovascular system
      • involuntary control of smooth and cardiac muscle
      • maintain homeostasis
  • Divisions of ANS
    • Sympathetic Nervous System
      • thoracolumbar
    • Parasympathetic Nervous System
      • craniosacral
    • Enteric Nervous System
sympathetic nervous system
Sympathetic Nervous System
  • Dominates in stress conditions
    • physical and psychological
    • very rapid effects
  • “Fight or Flight” theory
    • increased sweating, HR, RR
    • blood diverted to skeletal muscles
    • pupil dilation
    • conversion of glycogen to glucose
parasympathetic nervous system
Parasympathetic Nervous System
  • Opposite actions of sympathetic nervous system
  • dominates in relaxed states
    • decreased HR and RR
    • increased peristalsis
    • increased saliva and intestinal secretions
    • pupil constriction
enteric nervous system
Enteric Nervous System
  • innervates GI tract, pancreas, gall bladder
slide27
CNS
  • Gray matter = nerve cell bodies
  • White matter = axons
  • Efferent neurons
    • motor neurons
  • Afferent neurons
    • sensory neurons
meninges
Meninges
  • Dura Mater
    • tough, inelastic membrane
    • adheres to inner part of cranium
  • Arachnoid Mater
    • delicate, web-like tissue
    • avascular
  • Pia Mater
    • thin, delicate tissue hugging brain
    • no space between pia mater and brain
    • capillary rich to supply brain with blood
meninges cont
Meninges Cont.
  • Epidural Space
    • “potential space”
    • between cranium and dura mater
    • space created due to epidural hematoma
    • middle meningeal artery
  • Subdural Space
    • filled with a serous lubricant
    • prevents dura mater and arachnoid from adhering to each other
  • Subarachnoid Space
    • relatively large
    • filled with cerebrospinal fluid
    • ventricles
cerebrum
Cerebrum
  • Basal Ganglia
  • Limbic system
cerebrum1
Cerebrum
  • general appearance and behavior
  • level of consciousness (loc)
  • intellectual performance
    • short term memory (STM)
    • long term memory (LTM)
      • amnesia?
    • calculation
    • reasoning
  • emotional control
  • language skills
  • voluntary movement (cerebral cortex)
basal ganglia and limbic system
Basal Ganglia and Limbic System
  • Basal Ganglia
    • part of extra-pyramidal system
    • inter-connects several part of CNS
    • fine tune motor control
  • Limbic System
    • emotion, hunger, biological rhythms, smell
diencephalon
Diencephalon
  • epithalamus
  • thalamus
  • hypothalamus
  • subthalamus
thalamus hypothalamus
Thalamus/Hypothalamus
  • Thalamus
    • receives input from every sensory system
    • sensory and motor integration
  • Hypothalamus
    • homeostasis (temp), hunger, thirst, emotions
cerebellum
Cerebellum
  • Coordination
    • control of timing, speed, and direction of movement
  • Equilibrium
    • balance, posture
brain stem
Brain Stem
  • midbrain
    • eye tracking; voluntary movement
  • medulla
    • decussation of UMN
  • pons
    • relay info. from cortex to cerebellum; respiration
  • medulla oblongata
    • reflexes for vomiting, swallowing, coughing, salivation, pupils
  • cranial nerves III, IV, V, VI, VII, VIII, IX, X, XI, XII
reticular formation
Reticular Formation
  • Extends throughout the length of the brain stem
  • Reticular activating system
    • wakefulness
    • modification of sensory input
    • controls motor function via reticulospinal tract
    • receives input from hypothalamus and limbic system (emotion)
vestibular nuclei
Vestibular Nuclei
  • located in brain stem
  • receive input from labyrinthine system, reticular formation, and cerebellum
  • controls/interprets balance, head control, and eye tracking
spinal cord
Spinal Cord
  • Function
    • pathway for efferent and afferent nerve fibers
      • ascending and descending spinal tracts
    • connects peripheral and spinal nerves to brain
    • center for spinal (monosynaptic) reflexes
  • Location
    • foramen magnum to app. L2
  • Gives rise to 31 pair of spinal root nerves
  • Cauda equina
    • lumbrosacral plexus from L2 on down
spinal nerves
Spinal Nerves
  • 31 pair
    • dorsal spinal root = afferent = sensory
    • ventral spinal root = efferent = motor
  • Doral and ventral root join to form the peripheral nerve
  • Spinal nerves exit below respective vertebral level except for cervical
  • Myotome
    • voluntary muscle group receiving motor innervation from a specific spinal nerve
  • Dermatome
    • section of skin that receives sensory innervation from a specific spinal nerve
    • adjacent dermatomes overlap
    • partial loss = peripheral complete loss = cord
descending tracts motor
Descending Tracts“Motor”
  • corticospinal (Pyramidal Tract)
    • voluntary skilled movement in extremities
  • reticulospinal
    • facilitate or inhibit motor neurons;
    • posture
  • tectospinal
    • postural reflexes of head for vision
  • rubrospinal
    • facilitate/inhibit motor neurons
    • posture
  • vestibulospinal
    • facilitate/inhibit postural muscles of abdomen, back, neck
ascending tracts
Ascending Tracts
  • Exteroceptive, Proprioceptive, and Interoceptive
  • ventral and lateral spinothalamic
    • pain and temperature
  • spinocerebellar
    • proprioceptive and exteroceptive
    • vestibular nuclei and joint receptors
  • spinoreticular
    • muscle, joints, and skin
  • gracile and cuneate
    • touch, pressure, conscious joint sense
cranial nerves
Cranial Nerves
  • Sensory and/or Motor Function
    • 12 pairs
  • On Old Olympus’ Towering Top A Fin And German Viewed Some Hops
  • Oh Oh Oh To Touch and Feel a Girl/Guy Very Sexy and Hot
  • Motor and/or Sensory Function
    • Some say marry money but my brother says bad boys marry money.
cranial nerves1
Cranial Nerves
  • I. Olfactory
      • function: smell
      • testing: identify common odors
  • II. Optic
      • function: vision
      • testing: check visual fields, check vision
  • III. Oculomotor
      • function: eye movement, pupil reflex
      • testing: tracking, direct/consensual pupil reflex, accommodation, nystagmus, drooping eyelid
  • IV. Trochlear
      • function: eye movement
      • testing: tracking, nystagmus
cranial nerves cont
Cranial Nerves Cont.
  • V. Trigeminal
      • function: muscles of mastication, facial sensation, corneal reflex
      • testing: check facial sensation, muscles of mastication
  • VI. Abducens
      • function: eye movement
      • testing: tracking, nystagmus
  • VII. Facial
      • function: muscles of facial expression, taste to anterior tongue
      • testing: facial expressions, taste
  • VIII. Vestibulocochlear
      • function: hearing, equilibrium
      • testing: hearing, check for tinnitus, check balance
cranial nerves cont1
Cranial Nerves Cont.
  • IX. Glossopharyngeal
      • function: taste to posterior tongue, muscles of larynx/pharynx
      • testing: taste, gag reflex, speak/swallowing, coughing
  • X. Vagus
      • function: swallowing, phonation, taste
      • testing: speak/swallowing, gag reflex, taste, cough
  • XI. Spinal Accessory
      • function: motor control of upper trap and sternocleidomastoid
      • testing: SMT/DMT of trap and SCM
  • XII. Hypoglossal
      • function: tongue movement
      • testing: tongue protrusion (deviation?)
cranial nerve quick test
Cranial Nerve Quick Test
  • Vision
  • Visual Fields
  • Eye Tracking
  • Facial Sensation
  • Muscles of Facial Expression
  • Muscles of Mastication
  • Hearing/Balance
  • Swallowing
  • Upper Trap/SCM Strength
  • Tongue Protrusion
  • Pupil Reflexes
proprioception
Proprioception
  • The awareness of posture, movement, muscle length/tension, changes in equilibrium, weight, resistance of objects, and speed/range,angle of movement
  • Proprioceptors
    • muscle spindle
    • Golgi tendon organ (GTO)
    • mechanoreceptors
muscle spindle
Muscle Spindle
  • Detects length and rate of length
  • Extrafusal vs. Intrafusal fibers
      • extrafusal = skeletal muscle fibers
        • innervated by alpha motor neurons
      • intrafusal = muscle spindle fibers
        • innervated by gamma motor neurons
muscle spindles
Muscle Spindles
  • Intrafusal fibers
    • located within muscle belly
    • stretching a muscle also stretches the muscle spindle
    • most sensitive to rapid stretching
  • Types
    • Nuclear Bag 1 (Dynamic)
      • rate of change in length
      • Ia afferent; fires rapidly but adapts quickly
    • Nuclear Chain (Static)
      • overall length
      • II afferent; slow firing and non-adapting
golgi tendon organ
Golgi Tendon Organ
  • located within tendons
  • Ib afferent
    • slow firing and non-adapting
  • most sensitive to excessive stretch
  • sensitive to excessive tension due to muscle contraction
  • excessive tension will cause a reflexive inhibition of alpha mn
myotatic or stretch reflexes
Myotatic or Stretch Reflexes
  • Deep Tendon Reflex
    • biceps brachii: C5-C6
    • brachioradialis: C5-C6
    • triceps brachii: C7
    • infrapatellar: L3-L4
    • posterior tibialis: L5
    • achilles: S1
  • Jendrassik Maneuver
    • increases facilitative activity of spinal cord
superficial reflexes
Superficial Reflexes
  • Abdominal
    • upper: T6-T9
    • lower: T9-T12
  • Cremasteric: L1-L2
  • Plantar: S1-S2
  • Gag
  • Corneal
visceral reflexes
Visceral Reflexes
  • Pupillary reflex
    • direct
    • consensual
    • accommodation
  • Blink reflex
pathological reflexes
Pathological Reflexes
  • Babinski sign
  • Oppenheim sign
  • Decorticate rigidity **
  • Decerebrate rigidity **
  • ** due to lack of cortical/cerebral control
lower motor neuron lesions
Lower Motor Neuron Lesions
  • weakness/paralysis/paresis of a voluntary motor group
  • decreased tone (flaccidity) of involved motor group
  • decreased/absent deep tendon reflex (hyporeflexia or areflexia)
  • atrophy of muscle/muscle group
  • radicular pain specific to a spinal nerve path
  • decreases/absent sensation of specific dermatomes (hypoesthesia or anesthesia)
upper motor neuron lesion
Upper Motor Neuron Lesion
  • pathological reflex present (eg: Babinski sign)
  • weakness distal to lesion
  • hemiplegia/paraplegia
  • increased deep tendon reflex (hypereflexia) **
  • hypertonicity
    • spasticity
    • rigidity
  • decreased/absent superficial reflexes
  • ** due to lack of cortical control
reflex grading scale
Reflex Grading Scale
  • 0 = Absent
  • 1+ = Decreased (elicited with reinforcement)
  • 2+ = Normal
  • 3+ = Increased
  • 4+ = Clonus
head injuries
Head Injuries
  • Incidence of serious injury has decreased
    • neck injuries?
    • protective gear
  • Appr. 250,000 concussions/year
  • Focal vs. Diffuse Injuries
concussion
Concussion
  • Definition
    • clinical syndrome characterized by immediate and transient impairment of normal neurological function
  • Causes
    • coup Vs. contrecoup
  • Grades
  • Return to Play Criteria
  • Post-concussion Syndrome
  • Second Impact Syndrome
intracranial hemorrhaging
Intracranial Hemorrhaging
  • Epidural hematoma
    • arterial bleeding
    • rapid onset (poss. 10-20 min.)
  • Subdural hematoma
    • venous/capillary bleeding
    • slow onset
  • Intracerebral hematoma
    • compressive mechanism/aneurysm
    • rapid onset
evaluation process
Evaluation Process
  • Primary Assessment?
    • ABC’s
  • Secondary Assessment
    • Mental Status
    • Cranial Nerve Exam
    • Motor System Exam
    • Proprioception, balance, and coordination
    • Sensory Exam
    • Reflex Examination
cranial nerve exam
Cranial Nerve Exam
  • Test for:
    • Vision
    • Tracking
    • Visual Fields
    • Pupil Reflex
    • Hearing
    • Swallowing
    • Shoulder Shrug
    • Facial Sensation
    • Facial Expression
    • Tongue Protrusion
    • Mastication
other signs and symptoms
Other Signs and Symptoms
  • headache
  • nausea, vomiting
  • seizures
  • unequal pupils
  • tinnitus
  • unusual drowsiness
treatment
Treatment
  • Recheck athlete on regular basis
  • Refer if in doubt or in more severe cases
  • Monitor throughout the night
  • No alcohol, aspirin, ibuprofen
  • No activity until asymptomatic
  • No new s/s or no worsening of current s/s