The EM Educator Series: Trauma to the Face, Challenging Airway, and Other Considerations

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome to this week’s EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case #1:

A 42-year-old male comes in with severe facial trauma after a motorcycle crash. When we comes in to your resuscitation bay, his VS are HR 128, BP 82/49, RR 28, Sats 82% on blow-by.

Case #2:

A 19-year-old male presents after assault. He reports being hit repeatedly with fists followed by a baseball to the face. He has severe swelling and ecchymoses to his face. His VS are otherwise normal.

Considerations:

• How do you evaluate and manage the airway in the patient with severe facial trauma?
• When should you consider other potential injuries: Head / C-spine / Chest / Abdomen?
• How do you evaluate and manage the following eye injuries:
  1. muscle entrapment +/- nerve
  2. retrobulbar hematoma and/or significant emphysema
  3. globe rupture
  4. hyphema
  5. lens dislocation
  6. retinal detachment
  7. vitreous hemorrhage
  8. corneal abrasion?

• And what about these other injuries?
  1. Mandible
  2. Dental trauma
  3. Zygoma fractures
  4. Le Fort fractures
  5. Basilar skull fracture
  6. Nasal fracture / nasal septal hematoma
  7. Auricular hematoma
• Are antibiotics required for facial fractures?
• When should you consider intimate partner violence and elder abuse?

Dr. Katy Hanson has a great breakdown of the fractures in one place, from Hanson’s Anatomy:

Suggested Resources:

• Articles:
  • emDOCs – The Sphincter Series: A Scary Airway Review
  • emDOCs – Mandibular Fracture: Pearls and Pitfalls
  • emDOCs – Managing Dental Trauma in the Emergency Department
  • emDOCs – HEENT: Tips for Addressing Your Next Procedure
  • LITFL – Airway in Maxillofacial Trauma
  • LITFL – Facial Trauma
  • LITFL – Blown out
  • LITFL – Blunt Trauma to the Eye
  • LITFL – Base of Skull Fracture
  • LITFL – Elder abuse
  • WikEM – Zygomatic arch fracture
  • WikEM – Zygomaticomaxillary (tripod) fracture
  • WikEM – Le Fort Fractures
  • Radiopaedia – Mandibular fracture
  • EM Blog Mayo Clinic – Save face: Managing facial trauma in the emergency department
  • Taming the SRU: Antibiotics for Facial Fractures

• Podcasts/Video:
  • CORE EM – Tongue Blade Test
  • EM Cases – BCE 65 Intimate Partner Violence – A Silent Epidemic