Pediatric emergency medicine trisk 3286 3286

Stabilization of the airway is the primary concern for children with facial trauma Computerized tomography is the optimal imaging study for suspected facial fractures Prompt recognition of extraocular muscle entrapment associated with orbital floor fractures is critical to prevent muscle ischemia and fibrosis Displaced nasal bone fractures should be repaired within days of injury Fast-absorbing plain gut sutures have demonstrated similar cosmetic performance to nonabsorbable sutures for the repair of facial lacerations GOALS OF EMERGENCY THERAPY Stabilization of the Airway While injuries sustained as a result of facial trauma are rarely life threatening, patients who have sustained enough force to cause significant facial injury may have other associated serious injuries Stabilization of the airway is therefore the primary concern in the management of facial injuries in children Airway obstruction may result from blood in the mouth, loose teeth, and pharyngeal edema Thus, the airway should be cleared and examined for patency Loss of support of subglottic musculature can result from severe mandibular fractures, and the tongue can fall posteriorly and occlude the airway in a patient with a depressed mental status An oral or nasal airway may serve as an adjuvant to positioning in order to achieve airway patency Tracheal intubation may be required if the airway remains unstable Cricothyrotomy or tracheostomy may be necessary if these measures fail to secure the airway but should be attempted only as a last resort because of the technical difficulty and complications associated with such procedures, particularly in young children Cervical Spine Protection Up to 10% of patients with maxillofacial trauma have an associated cervical spine injury Patients with tenderness of the cervical spine, impaired sensorium, focal neurologic deficits, or major distracting injury should be placed in a hard cervical collar until an injury to the cervical spine can be excluded