27.2b | Head, Eyes, Ears, Nose, Mouth, and Neck Examination

scalp is extremely vascular and lacks protective vasospasm mechanism to help control bleeding

even the most minor lacerations to the head tend to bleed profusely because …

direct pressure dressing

if you detect uncontrolled bleeding from the scalp, apply a … immediately

depressed skull fracture

an indentation in the skull could suggest a …

doing so can push a broken piece of bone into the brain

if you feel a depression, stop palpating it because …

stabilize it in place with bulky dressings

if you find an impaled object, …

serious emergency

if Pt presents w/ AMS and any abnormality in the structure of the skull, consider it a …

periorbital ecchymosis

a bluish discoloration around the bony orbits of the eye

basilar skull fracture

periorbital ecchymosis and discoloration of the mastoid process are classic signs of a …

horizontal defect

loss of vision in the upper or lower half of an eye

bitemporal hemianopsia

loss of vision in the outside half of each eye

homonymous hemianopsia

loss of vision in the same half of both eyes

homonymous quadrantic defect

loss of vision in the same quadrant of both eyes

proptosis

eye protrusion

ptosis

eyelid drooping

stye

reddened swelling of the inner eyelid

allergic or infectious conjunctivitis

redness in the conjunctiva or a cobblestone appearance suggests an …

hemorrhage under the conjunctiva

bright red blood in a sharply defined area surrounded by normal tissue, not extending into the iris, suggests …

jaundice of liver disease

a yellow sclera suggests the …

glaucoma

a shadow on the iris could suggest …

dilation

enlargening of the pupil

constriction

shrinking of the pupil

anisocoria

unequal pupils

benign

if the difference in pupil size is less than 2 mm and they react normally to light, anisocoria is …

pressure on the oculomotor nerve from increased ICP

a sluggish pupil suggests …

global hypoxia to the brain tissue or an adverse drug reaction

bilateral sluggishness can indicate …

opiate overdose

constricted pupils suggest an …

brain death

fixed and dilated pupils usually mean …

near response

the pupils constricting when focusing on a near object

accomodation

eyes converging on a moving object as the pupils constrict

conjugate

eyes moving together

nystagmus

a fine jerking of the eyes

cutaneous cysts or keloids

lumps on or near the ear can indicate a benign process, such as …

squamous cell or basal cell carcinoma

lumps on or near the ear can indicate a malignant process, such as …

gout or rheumatoid arthritis

lumps on or near the ear can be a local sign of a systemic process such as …

otitis or mastoiditis

pain or tenderness in the helix, tragus, or mastoid process suggests an infection such as …

Battle's sign

discoloration of the mastoid process, late sign of basilar skull fracture

sinus problems, infected tooth or abscess, TMJ pain, common cold, sore throat, cervical spine pain

sources of referred pain in the ear can arise from …

otorrhea

discharge from the ear canal

ruptured eardrum

a … can result from sticking a sharp object into the ear canal or from a pressure wave caused by an explosion

otoscope

to examine more deeply into the external canal, use an …

ossicles

middle ear bones

intranasal cocaine abuse

erosion of the nasal septum suggests …

rhinitis

runny nose

infection

if rhinitis discharge is thick and yellow, suspect an …

epistaxis

nosebleed

trauma or a septal defect

epistaxis can be caused by …

abnormal obstructions

a deviated septum, foreign body, excessive secretions, or mucosal edema can cause …

dehydration, wind damage

dry, cracked lips are caused by …

infection, allergic reaction, burns

swelling/edema of the lips is caused by …

infection, irritation, skin cancer

lesions on the lips can be caused by …

anemia, shock

pallor of the lips can be caused by …

respiratory or cardiac insufficiency

cyanosis of the lips can be caused by …

periodontal disease

suspect … if the gums are swollen, bleed easily, and are separated from the teeth by large crevices that trap food

dehydration

coating of the tongue indicates …

upper GI bleed

coffee-grounds-like material in the mouth suggests…

acute pulmonary edema

pink-tinged sputum indicates …

respiratory infection

green or yellow phlegm suggests a …

damage to the trachea or major blood vessels

examine any penetrating injuries to the neck closely for …

occlusive dressing

immediately cover any open wounds with an … to prevent air from entering a lacerated jugular vein during inspirations

upright and at a 45-degree incline

look for jugular vein distention while the patient is sitting …

malignancy

hard or fixed lymph nodes in the neck suggests a …

subcutaneous emphysema

presence of air just below the skin

tear in the tracheobronchial tree or a pneumothorax

subcutaneous emphysema suggests a …