Head and Facial Injuries
Surgical Emergencies 223Make sure an ongoing record is kept of all vital signs and clinical findings, and
keep re-examining the patient regularly.
FURTHER DIAGNOSIS AND MANAGEMENT OF
MULTIPLE INJURIES: DEFINITIVE CARE
This is considered under the following headings:
● Head and facial injuries.
● Neck injuries.
● Chest injuries.
● Abdominal and pelvic trauma.
● Additional orthopaedic injuries.
HEAD AND FACIAL INJURIES
DIAGNOSIS AND MANAGEMENT
1 Scalp
(i) Look for lacerations, haematomas, penetrating wounds and
foreign bodies.
(ii) Palpate for evidence of deformity and fracture.
(iii) Assess the level of consciousness if a major head injury is
suspected, and manage as described on p. 29.
2 Face
(i) Check the integrity of the airway again, and remember the
possibility of an unrecognized neck injury.
(ii) Look for bruising, swelling or deformity suggesting orbital, nasal,
malar or mandibular fractures (see p. 430).
(iii) Look for parotid and facial nerve damage in injuries to the face in
the area in front of the ear.
(iv) Clean and evaluate all facial lacerations. They will require
meticulous debridement and formal closure when the patient’s
condition is stable, and all serious injuries have been dealt with.
3 Eyes
(i) Inspect the eyes for evidence of penetrating or blunt injury. Look
for specific conditions such as iris prolapse, hyphaema, lens
dislocation and traumatic mydriasis (see p. 415).
(ii) Assess the pupil size and reactions, and examine the fundi for
evidence of vitreous or retinal haemorrhage and retinal detachment.
(iii) Check the visual acuity and eye movements.