Notes – Facial/Dental Trauma

Facial/Dental Trauma

Patient Safety Considerations

  1. Frequent reassessment of airway
  2. Maintenance of a patent airway is the highest priority; therefore, conduct cervical spine assessment for field clearance (per Spinal Care guideline) to enable transport sitting up for difficulty with bleeding, swallowing, or handling secretions

Notes/Educational Pearls

Key Considerations

  1. Airway may be compromised because of fractures or bleeding
  2. After nasal fractures, epistaxis may be posterior and may not respond to direct pressure over the nares with bleeding running down posterior pharynx, potentially compromising airway
  3. Protect avulsed tissue and teeth
    1. Avulsed teeth may be successfully re-implanted if done so in a very short period after injury
    2. Use sterile dressing for ear and nose cartilage

Pertinent Assessment Findings

  1. Unstable facial fractures that can abruptly compromise airway
  2. Loose teeth and retro-pharynx bleeding

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914205 – General-Dental Problems
  • 9914057 – Injury-Facial Trauma
  • 9914099 – Injury-Eye

Key Documentation Elements

  • Airway patency and reassessment
  • Degree and location of hemorrhage
  • Mental status (GCS or AVPU)
  • Technique used to transport tissue or teeth
  • Eye exam documented, when applicable
  • Assessment and management of cervical spine
  • Patient use of anticoagulant medications

Performance Measures

  • Appropriate airway management and satisfactory oxygenation
  • Eye shield applied to eye trauma
  • EMS Compass® Measures (for additional information, see http://www.emscompass.org)
    • PEDS-03: Documentation of estimated weight in kilograms. Frequency that weight or length-based estimate are documented in kilograms
    • Trauma-01: Pain assessment of injured patients. Recognizing that pain is undertreated in injured patients, it is important to assess whether a patient is experiencing pain
    • Trauma-02: Pain re-assessment of injured patients. Recognizing that pain is undertreated in injured patients, it is important to assess whether a patient is experiencing pain
    • Trauma-04: Trauma patients transported to trauma center. Trauma patients meeting Step 1 or 2* or 3** of the CDC Guidelines for Field Triage of Injured Patients are transported to a trauma center
      • *Any value documented in NEMSIS eInjury.03 – Trauma Center Criteria
      • **8 of 14 values under eInjury.04 – Vehicular, Pedestrian, or Other Injury Risk Factor match Step 3, the remaining 6 value options match Step 4.

References

  1. Bord S, Linden J. Trauma to the globe and orbit. Emerg Med Clin N Am. 2008;26(1):97-123.
  2. Patel P, Stanton D, Granquist E. Common dental and orofacial trauma: evaluation and management. Med Clin N Am. 2014;98(6):1261-79.