SAEM Trauma

An 18 year old hockey player is hit in the mouth with a puck, fracturing a maxillary canine tooth. He brings the severed piece of tooth with him. On physical exam, the tooth is fractured halfway between the tip and the gumline. The root of the tooth is still firmly intact. The exposed fracture site has a yellowish tinge without blood. Of the following choices, which is the most appropriate management for this patient? A. Application of calcium hydroxide, placement of aluminum foil, and dental follow-up B. Placement of tooth fragment in saline gauze, outpatient dental follow-up C. No specific treatment required D. Immediate dental consult to avoid abscess formation E. Replace fractured piece and place acrylic splint correct answerThe answer is D. Ellis II dental fracture involves enamel and dentin. The fracture site typically has a yellowish tinge. Ellis III dental fractures are characterized by exposure of pinkish pulp and often blood. These fractures require immediate dental consultation to prevent abscess formation. A 22 year old man is punched in the nose during a fight. He presents to the emergency department with obvious nasal bone deformity. Pressure controls the bleeding. Physical exam reveals no maxillary bone or orbital rim tenderness, intact vision and extraocular movement. The oropharynx and mandible are unremarkable. Nasal inspection reveals a swollen, ecchymotic, tender nasal septum. Which of the following is the most appropriate initial step? A. Incision and drainage of the septal hematoma followed by nasal packing B. Needle aspiration of the septal hematoma C. Plastic surgery consult for immediate reduction of nasal fracture D. Facial CT scan to rule out more serious facial fractures E. Outpatient follow-up with an ENT specialist to surgically correct a deviated septum correct answerA. Incision and drainage of the septal hematoma followed by nasal packing A 24 year old woman is playing racquetball and sustains a direct blow from the ball to the right eye. She presents to the emergency department complaining of eye pain and double vision. On exam, her right eye does not track properly with upward gaze. This finding suggests which of the following injuries? A. Zygomatic arch fracture B. Ethmoid fracture C. Inferior orbital wall fracture D. Inferior orbital rim fracture