Travel Reference
In-Depth Information
Brain injuries, skull fractures, and fractures of the neck frequently accompany facial
fracturesandmustberecognizedandtreated.Fracturesshouldbesuspectedafteranyforce-
ful blow to the face that produces pain, tenderness, swelling, or discoloration. Survivable
fractures rarely cause any obvious deformity, except for some fractures of the nose or jaw.
Some discontinuity of the bones can occasionally be felt. A broken nose usually bleeds
profusely. Double vision is a sign of fractures of the bones about the eye.
A broken jaw can be splinted with a bandage that passes under the chin and over the
top of the head, binding the lower jaw to the upper. However, individuals splinted in this
manner may have difficulty breathing, particularly if they are stuporous or comatose. Frac-
tures of the jaw should not be splinted if the person needs to breathe through the mouth.
Furthermore, the splint has to be instantly removable should vomiting occur.
The maintenance of an open airway in a person with facial fractures may require dili-
gence and perseverance. A finger must be swept through the mouth of an unconscious in-
dividual with a broken upper or lower jaw to remove tooth or bone fragments and prevent
themfromenteringtheairway.Ifatracheostomycannotbeperformedandanoralairwayis
unavailable or not tolerated, the person may have to be transported in a face-down (prone)
position, particularly if severe bleeding or swelling is present. Obviously, the face must be
keptfreeofpillows,sleeping bags,andthestretcher whiletheindividual isinthisposition.
Nosebleeds
Nosebleedsareverycommonfollowingminorinjuriestothenose.Fracturesofthenasal
bones are usually accompanied by rather severe bleeding. Nosebleeds without any ante-
cedent trauma are even more common and may be severe. Anyone with repeated or severe
nosebleeds should consult a physician since such incidents may be signs of a serious disor-
der.
Anindividualwithanosebleedshouldbeseatedorstandinginanuprightpositionwhile
leaning forward. Leaning backward or lying down permits blood to drain back into the
throat where it is swallowed, which often produces nausea and vomiting.
Many different maneuvers for stopping nosebleeds have been devised. Almost all are
equally ineffective. However, most nosebleeds stop spontaneously, with no specific treat-
ment.
Havingtheindividualblowoutanyclots,sprayinggenerouslywithadecongestantspray
thatcontractsthebloodvessels,andpinchingthenostrilstogetheralongtheirfulllengthfor
ten minutes without releasing the pressure is probably as effective as any other maneuver
and usually controls the bleeding from nasal fractures.
If bleeding persists, a small, flat absorbent cotton pad (pledget) can be moistened with
phenylephrine nose drops or spray and formed into an elongated roll. After both nostrils
havebeenblownclearofclotsormucus,thecottonrollshouldbeinsertedinthenostrilthat
is bleeding. The nose should be held closed with gentle pressure for three to five minutes.
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