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189
A. Perform Complete Head and Neck Exam at
Presentation
1. Eyes
All perioccular injuries mandate an ophthalmology consultation to
assess vision, occular pressures, corneal integrity, the anterior and
posterior chambers, the lacrimal system, and the retina.
y
y Assess vision and light perception, gross visual acuity, pupillary
reflexes, and extraoccular muscle function. Restricted mobility and
subconjunctival hemorrhage are suggestive of orbital fractures. Blood
in the anterior chamber (hyphema) is an occular emergency.
y
y Assess lid function and structural integrity.
2. Ears
Hemotympanum, canal lacerations, and Battle’s sign are all indicative of
temporal bone fracture.
y
y Examine for pinna and canal lacerations, for blood in the canal or the
middle ear, and for auricular hematomas.
y
y If lacerations are present, determine the extent of cartilage
involvement.
3. Nose
y y Examine lacerations and determine their depth, cartilage involve-
ment, and any violation of the mucosal lining.
y y Assess for stability of the nasal skeleton to include nasal bone and
septal fractures.
y y Examine the septum to rule out septal hematoma.
4. Mouth
y
y Examine lips for evidence of laceration.
y
y Look for intraoral bleeding to uncover tongue or mucosal lacerations.
y
y Ensure the stability of the palate.
y
y Assess dentition for occlusion and dental fractures or tooth loss.
These foreshadow maxillomandibular fractures, and missing teeth
present a risk of airway blockage by a foreign body.
5. Neck
y
y Examine for lacerations and even small wounds that could be
considered puncture wounds. See Chapter 7 on the management
of penetrating neck trauma.
y
y Examine for crepitus that may portend airway injury.
6. Scalp
y
y Palpate hair-bearing scalp and examine it for evidence of bleeding
where injuries may be concealed. Hematomas may also be present
and require evacuation.