Page 293 - Critical Care Nursing Demystified

278 CRITICAL CARE NURSING DeMYSTIFIED

The patient can be at risk for developing meningitis from fractures of the cra-
nium and dura mater as oral bacterial flora can enter the CSF.

Prognosis
Some MFIs are minor, rarely resulting in increased mortality if treatment is
rendered. However, high-impact facial fractures can be life threatening if involv-
ing the head, neck, and chest. Major soft tissue injuries may be more difficult
to treat and have poorer outcomes. Severe hemorrhage and airway obstruction
can result in death.
MFIs require multiple disciplinary coordinated team management as more
than 50% of these patients have other multisystem trauma. The prognosis for
severe facial injuries is improving as rapid treatment and transport to trauma
centers that can evaluate and treat these injuries is improving.

Interpreting Test Results
Halo ring test should be done when inspecting the nasal and auditory canals
for actual drainage of cerebrospinal fluid. A light yellow color at the edge of
a spot of clear drainage or sanguineous CSF also has a high sugar content and
can also be tested for the presence of glucose.
Specific facial and head/neck x-rays are also required for the accurate diag- Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
nosis of maxillofacial fractures.
CBC every 4 hours to follow hemoglobin and hematocrit if excessive bleed-
ing or hemorrhagic shock is suspected.
Electrolyte panels.
Blood type and cross match.
Coagulation studies.

Hallmark Signs and Symptoms
Changes in breathing rate, rhythm, dyspnea, and stridor if airway is
compromised.
Hemorrhage from torn facial arteries may be prevalent as well as epistaxis
with any fracture that communicates with the nose.
Pain, swelling, asymmetry, and deformity in the location of the fractures/
trauma.

Malocclusion, intraoral ecchymosis.
Periorbital edema/ecchymosis.
Crepitus with resultant air leak.
Lost or broken teeth.