Athletic Injuries ATC 222 Head, Face, Eyes, Ears, Nose, and Throat Chapter 27

1. Athletic Injuries ATC 222Head, Face, Eyes, Ears, Nose, and ThroatChapter 27

2. Facial Injuries • Mandible Fracture • deformity • malocclusion • malalignment • bleeding around teeth/gums • lower lip anesthesia • pain with biting • Treatment

3. Facial Injuries • Mandible Dislocation/Subluxation • commonly from lateral force • malalignment • malocclusion • open, locked jaw

4. Dental Injuries • Types • fracture • dislocation/subluxation • Treatment • realign subluxation • replace/preserve dislocation or fracture • 30 minute survival rate

5. 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

6. 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

7. 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)

8. Treatment of Serious Eye Injury • immediate referral • cover both eyes with embedded object • ice only to surrounding tissue • no pressure applied to eyes

9. Orbital Blowout Fx • Blunt trauma • Inability to look upward • Diplopia • Sunken eye

10. What is wrong with this picture?

11. Orbital Hematoma • “Black Eye” • Bleeding in orbit area and poss. Sclera • Rule out serious eye injury

12. Foreign Body in Eye • Embedded? • Removal • Close eye • eye rinse • removal with gauze pad

13. The ole finger in the eye play!!!!

14. Ear Injuries • Hematoma Auris (cauliflower ear) • causes • S/S • swelling • redness, warmth • pain • treatment • ice • protection • aspirate

15. Otitis Media and Externa • Etiology • Signs and Symptoms • Treatment

16. Neurological System and Evaluation

17. Neuron (Nerve Cell) • dendrites • cell body • axon • Schwann cells • motor end plate

18. Functional Classification of Neurons • Sensory • Associational • Inter-neurons • Motor • Upper motor neuron • Lower motor neuron

19. Synapse • Functional connection between 2 neurons • chemical or electrical • Neurotransmitters • acetylcholine • norepinephrine • Motor Unit

20. Nervous System Divisions • Central Nervous System (CNS) • Brain • Spinal Cord • Peripheral Nervous System (PNS) • Cranial Nerves • Spinal Nerves • R.T.D.C.B.

21. PNS • Somatic NS • Autonomic NS • sympathetic • parasympathetic • enteric NS

22. Somatic Nervous System • Functions • voluntary control of skeletal muscle • convey conscious/unconscious sensory (afferent) information • vision, pain, touch, unconscious muscle sense

23. 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

24. 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

25. 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

26. Enteric Nervous System • innervates GI tract, pancreas, gall bladder

27. CNS • Gray matter = nerve cell bodies • White matter = axons • Efferent neurons • motor neurons • Afferent neurons • sensory neurons

28. 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

29. 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

30. Cerebrum • Basal Ganglia • Limbic system

31. 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)

32. 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

33. Diencephalon • epithalamus • thalamus • hypothalamus • subthalamus

34. Thalamus/Hypothalamus • Thalamus • receives input from every sensory system • sensory and motor integration • Hypothalamus • homeostasis (temp), hunger, thirst, emotions

35. Cerebellum • Coordination • control of timing, speed, and direction of movement • Equilibrium • balance, posture

36. 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

37. Movie TimeRated PG

38. 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)

39. Vestibular Nuclei • located in brain stem • receive input from labyrinthine system, reticular formation, and cerebellum • controls/interprets balance, head control, and eye tracking

40. 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

41. 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

43. 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

44. 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

45. 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.

46. 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

47. 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

48. 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?)

49. 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

50. Movie TimeRated PG