United States Department of Transportation

National Highway Traffic Safety Administration

Paramedic: National Standard Curriculum

(Reprinted with permission)

http://www.nhtsa.dot.gov/people/injury/ems/

Trauma: 4

Facial and Head Trauma: 5

UNIT TERMINAL OBJECTIVE

4-5 At the completion of this unit, the paramedic student will be able to integrate pathophysiological principles and the assessment findings to formulate a field impression and implement a treatment plan for the trauma patient with a suspected head injury.

COGNITIVE OBJECTIVES

At the completion of this unit, the paramedic student will be able to:

4-5.1 Describe the incidence, morbidity, and mortality of facial injures. (C-1)

4-5.2 Explain facial anatomy and relate physiology to facial injuries. (C-1)

4-5.3 Predict facial injuries based on mechanism of injury. (C-1)

4-5.4 Predict other injuries commonly associated with facial injuries based on mechanism of injury. (C-2)

4-5.5 Differentiate between the following types of facial injuries, highlighting the defining characteristics of each: (C-3)

a. Eye

1. Ear

2. Nose

3. Throat

4. Mouth

4-5.6 Integrate pathophysiological principles to the assessment of a patient with a facial injury. (C-3)

4-5.7 Differentiate between facial injuries based on the assessment and history. (C-3)

4-5.8 Formulate a field impression for a patient with a facial injury based on the assessment findings. (C-3)

4-5.9 Develop a patient management plan for a patient with a facial injury based on the field impression. (C-3)

4-5.10 Explain the pathophysiology of eye injuries. (C-1)

4-5.11 Relate assessment findings associated with eye injuries to pathophysiology. (C-3)

4-5.12 Integrate pathophysiological principles to the assessment of a patient with an eye injury. (C-3)

4-5.13 Formulate a field impression for a patient with an eye injury based on the assessment findings. (C-3)

4-5.14 Develop a patient management plan for a patient with an eye injury based on the field impression. (C-3)

4-5.15 Explain the pathophysiology of ear injuries. (C-1)

4-5.16 Relate assessment findings associated with ear injuries to pathophysiology. (C-3)

4-5.17 Integrate pathophysiological principles to the assessment of a patient with an ear injury. (C-3)

4-5.18 Formulate a field impression for a patient with an ear injury based on the assessment findings. (C-3)

4-5.19 Develop a patient management plan for a patient with an ear injury based on the field impression. (C-3)

4-5.20 Explain the pathophysiology of nose injuries. (C-1)

4-5.21 Relate assessment findings associated with nose injuries to pathophysiology. (C-3)

4-5.22 Integrate pathophysiological principles to the assessment of a patient with a nose injury. (C-3)

4-5.23 Formulate a field impression for a patient with a nose injury based on the assessment findings. (C-3)

4-5.24 Develop a patient management plan for a patient with a nose injury based on the field impression. (C-3)

4-5.25 Explain the pathophysiology of throat injuries. (C-1)

4-5.26 Relate assessment findings associated with throat injuries to pathophysiology. (C-3)

4-5.27 Integrate pathophysiological principles to the assessment of a patient with a throat injury. (C-3)

4-5.28 Formulate a field impression for a patient with a throat injury based on the assessment findings. (C-3)

4-5.29 Develop a patient management plan for a patient with a throat injury based on the field impression. (C-3)

4-5.30 Explain the pathophysiology of mouth injuries. (C-1)

4-5.31 Relate assessment findings associated with mouth injuries to pathophysiology. (C-3)

4-5.32 Integrate pathophysiological principles to the assessment of a patient with a mouth injury. (C-3)

4-5.33 Formulate a field impression for a patient with a mouth injury based on the assessment findings. (C-3)

4-5.34 Develop a patient management plan for a patient with a mouth injury based on the field impression. (C-3)

4-5.35 Describe the incidence, morbidity, and mortality of head injures. (C-1)

4-5.36 Explain anatomy and relate physiology of the CNS to head injuries. (C-1)

4-5.37 Predict head injuries based on mechanism of injury. (C-2)

4-5.38 Distinguish between head injury and brain injury. (C-3)

4-5.39 Explain the pathophysiology of head/ brain injuries. (C-1)

4-5.40 Explain the concept of increasing intracranial pressure (ICP). (C-1)

4-5.41 Explain the effect of increased and decreased carbon dioxide on ICP. (C-1)

4-5.42 Define and explain the process involved with each of the levels of increasing ICP. (C-1)

4-5.43 Relate assessment findings associated with head/ brain injuries to the pathophysiologic process. (C-3)

4-5.44 Classify head injuries (mild, moderate, severe) according to assessment findings. (C-2)

4-5.45 Identify the need for rapid intervention and transport of the patient with a head/ brain injury. (C-1)

4-5.46 Describe and explain the general management of the head/ brain injury patient, including pharmacological and non-pharmacological treatment. (C-1)

4-5.47 Analyze the relationship between carbon dioxide concentration in the blood and management of the airway in the head/ brain injured patient. (C-3)

4-5.48 Explain the pathophysiology of diffuse axonal injury. (C-1)

4-5.49 Relate assessment findings associated with concussion, moderate and severe diffuse axonal injury to pathophysiology. (C-3)

4-5.50 Develop a management plan for a patient with a moderate and severe diffuse axonal injury. (C-3)

4-5.51 Explain the pathophysiology of skull fracture. (C-1)

4-5.52 Relate assessment findings associated with skull fracture to pathophysiology. (C-3)

4-5.53 Develop a management plan for a patient with a skull fracture. (C-3)

4-5.54 Explain the pathophysiology of cerebral contusion. (C-1)

4-5.55 Relate assessment findings associated with cerebral contusion to pathophysiology. (C-3)

4-5.56 Develop a management plan for a patient with a cerebral contusion. (C-3)

4-5.57 Explain the pathophysiology of intracranial hemorrhage, including: (C-1)

a. Epidural

5. Subdural

6. Intracerebral

7. Subarachnoid

4-5.58 Relate assessment findings associated with intracranial hemorrhage to pathophysiology, including: (C-3)

a. Epidural

b. Subdural

8. Intracerebral

9. Subarachnoid

4-5.59 Develop a management plan for a patient with a intracranial hemorrhage, including: (C-1)

a. Epidural

10. Subdural

11. Intracerebral

12. Subarachnoid

4-5.60 Describe the various types of helmets and their purposes. (C-1)

4-5.61 Relate priorities of care to factors determining the need for helmet removal in various field situations including sports related incidents. (C-3)

4-5.62 Develop a management plan for the removal of a helmet for a head injured patient. (C-3)

4-5.63 Integrate the pathophysiological principles to the assessment of a patient with head/ brain injury. (C-3)

4-5.64 Differentiate between the types of head/ brain injuries based on the assessment and history. (C-3)

4-5.65 Formulate a field impression for a patient with a head/ brain injury based on the assessment findings. (C-3)

4-5.66 Develop a patient management plan for a patient with a head/ brain injury based on the field impression. (C-3)

DECLARATIVE

I. Facial Injury

A. Introduction

1. Incidence

2. Morbidity and mortality

3. Risk

B. Review of anatomy/ physiology of the face

1. Arteries and nerves

2. External carotid

a. Temporal artery

b. Mandibular artery

c. Maxillary artery

3. Nerves

a. 5th cranial nerve - trigeminal

b. 7th cranial nerve - facial

4. Bones

a. Nasal

b. Zygoma/ zygomatic arch

c. Maxilla

d. Mandible

C. Common mechanisms of injury

1. Blunt

a. Motor vehicular crashes

b. Falls

c. Body-to-body contact

d. Augmented force (i.e. sticks, clubs, etc.)

2. Penetrating

a. Gun shot wound, stabbing

b. Bites - dog, human, biting tongue

D. Other common associated injuries

1. Airway compromise

2. Cervical spine injury

3. Brain injury

4. Dental trauma or avulsion

E. Types of facial injuries

1. Bony injury

a. Mandible

(1) Fracture

(2) Dislocation

b. Maxillary fracture

(1) LeFort I, II and III

c. Zygomatic fracture

d. Orbital fracture

(1) Eye

(2) Ear

(3) Nose

(4) Throat

(5) Mouth

e. Nasal fracture

2. Soft tissue

a. Face

b. Mouth and oropharynx and tongue

c. Ear

d. Eye

F. Assessment

1. Airway patency and adequate ventilation

2. Cervical spine integrity

3. Adequate perfusion

4. Associated injury

a. Head injury

(1) Increased ICP

(2) Presence of CSF

b. Bony injury

(1) Malocclusion

(2) Depressed zygoma

(3) Facial asymmetry

(4) Diplopia/ blurred vision

c. Soft tissue injury

(1) Open wounds

(2) Hematomas

d. Broken or missing teeth

G. History

1. Mechanism of injury

2. Events leading up to the injury

3. Time it occurred

4. Associated medical problems

5. Allergies

6. Medications

7. Last intake

H. Management

1. Airway patency and adequate ventilations a priority

a. Suctioning

b. Intubating

c. Positioning

d. Ventilating

2. Assuring adequate circulation

3. Assuring cervical spine integrity

II. Throat injuries

A. Introduction

1. Incidence

2. Morbidity and mortality

3. Risk

B. Review of anatomy/ physiology of the throat

1. Critical structures

a. Airway

(1) Oropharynx