Skip to content

Face, Neck, and Eye Injuries

Category: Trauma Sources: raw/protocols/nm-sop-guidelines-treatment-2022.pdf; UCLA EMT Ultimate Study Guide (2026) Last updated: 2026-05-06

Overview

Injuries to the face, neck, and eyes are common in trauma but easily underestimated. The face and neck house critical airway and vascular structures; seemingly minor facial trauma can produce lethal airway compromise or hemorrhage. Eye injuries require specific management and transport decisions. Neck trauma involving vascular structures or the airway is immediately life-threatening.

Key Points

  • Airway priority: Facial trauma + blood/swelling + altered LOC = immediate airway management; edema develops rapidly
  • Penetrating neck trauma: Do NOT remove impaled objects; seal any sucking neck wound with occlusive dressing
  • Eye injuries: Cover BOTH eyes (consensual movement — moving one eye moves both); patch both to prevent sympathetic movement
  • Chemical eye burns: Immediate copious irrigation — do NOT wait for the hospital
  • Epistaxis (nosebleed): Lean forward, pinch soft part of nose; do NOT lean back (aspiration risk)
  • Dental trauma: Avulsed (knocked-out) tooth — handle by crown only, store in milk or saline, bring to hospital for possible reimplantation

Eye Injuries

Eye Injury Types and Management

Injury Finding Management
Foreign body Pain, tearing, visible object on sclera/cornea Do NOT rub; patch BOTH eyes; transport
Chemical burn Pain, redness, history of chemical exposure Irrigate immediately with water/NS; 20+ minutes; DO NOT DELAY
Thermal burn Flash, flame, or UV exposure Patch BOTH eyes; cover loosely; transport
Blunt trauma Periorbital hematoma, subconjunctival hemorrhage, pain Patch BOTH eyes; assess for globe rupture; transport
Globe rupture (open globe) Mechanism + pain + irregular/deflated appearance Rigid eye shield (NOT pressure patch); patch other eye; transport to ophthalmology
Impaled object Object visible in eye Stabilize in place; rigid cup over object; patch both eyes; transport

KEY DIFFERENTIATOR — Patch Both Eyes: Moving eyes is consensual — both eyes move together (controlled by the same extraocular muscles). If you patch only the injured eye, the uninjured eye moves and drags the injured eye with it, causing further damage. Always patch BOTH eyes for any significant eye injury.

KEY DIFFERENTIATOR — Globe Rupture: A pressure patch over a ruptured globe forces intraocular contents out. Use a rigid eye shield (paper cup, commercial shield) — NOT a pressure patch. Patch the other eye too.

KEY DIFFERENTIATOR — Chemical Burns: Chemical burns to the eyes are a time-critical emergency. Immediate irrigation with the most available clean water is the treatment. Do NOT wait for sterile saline, do NOT let the patient be transported without irrigation. Every minute of contact with the chemical causes more damage.

Ear Injuries

Injury Management
External laceration Direct pressure, sterile dressing
Hematoma (cauliflower ear) Cool compress; do NOT lance; transport
Foreign body in canal Do NOT attempt removal; transport to ED
Suspected basilar skull fracture (Battle's sign, hemotympanum) Do NOT pack canal; assume spinal injury; transport
Blast/barotrauma to ear Transport; expect hearing loss and tinnitus

Neck Injuries

Penetrating Neck Trauma

Life threat: Penetrating neck injuries can involve the carotid artery, jugular vein, airway, esophagus, or spinal cord.

  • Do NOT remove impaled objects — they may be tamponading a major vessel
  • Apply occlusive dressing to any open neck wound (air embolism risk from venous injury — neck veins are at or below atmospheric pressure; air can be sucked into the venous system)
  • Control hemorrhage with direct pressure — avoid circumferential pressure (obstructs airway)
  • Maintain c-spine precautions
  • ALS intercept immediately; rapid transport

KEY DIFFERENTIATOR — Air Embolism from Neck Vein Injury: Large neck veins (jugular) have low pressure — air can be drawn INTO the vein with each inspiration. This creates an air embolism that can reach the heart and cause sudden cardiac arrest. Cover open neck wounds immediately with an occlusive dressing.

Blunt Neck Trauma

  • Mechanism: strangulation, clothesline injury, blow to anterior neck, MVC dashboard strike
  • Injuries: laryngeal fracture, tracheal disruption, vascular injury (carotid dissection), esophageal injury
  • Signs: hoarseness, subcutaneous emphysema (crackling under skin), stridor, expanding hematoma
  • Expanding neck hematoma = impending airway loss — early airway management

Epistaxis (Nosebleed)

Management: 1. Lean patient forward — NOT backward (blood drains into airway/stomach, causes nausea) 2. Pinch the soft part of the nose for 5–15 minutes (not the bony bridge) 3. Cold pack to bridge of nose 4. Do NOT pack with cotton or gauge without Medical Control guidance 5. If severe/uncontrolled: transport; may require packing by physician

Causes of concern: posterior epistaxis (blood from back of throat), epistaxis with hypertension, anticoagulant use, facial trauma

Dental Injuries

Avulsed (knocked-out) tooth: 1. Handle only by the crown (not the root — do not touch the periodontal ligament fibers) 2. Do NOT scrub or clean the root 3. If clean, may gently rinse with saline 4. Store in: milk (preferred), saline, patient's own saliva — NOT tap water 5. Transport immediately — reimplantation success drops dramatically after 1 hour

NREMT Relevance

  • Patch BOTH eyes — consensual movement causes further injury
  • Globe rupture = rigid shield, NOT pressure patch
  • Chemical eye burns = immediate copious irrigation — time-critical
  • Penetrating neck = occlusive dressing (air embolism risk)
  • Do NOT remove impaled objects from neck or eye
  • Epistaxis = lean forward, pinch soft nose — never lean back
  • Avulsed tooth = handle by crown, store in milk, transport rapidly

Sources

  • raw/protocols/nm-sop-guidelines-treatment-2022.pdf — Trauma: Face/Neck/Eye injuries
  • UCLA EMT Ultimate Study Guide (2026) — Eye Injuries, Ear Injuries, Neck Trauma, Epistaxis, Dental Injuries