(b) Only one pupil fixed indicates the third cranial nerve involvement in
an early stage.
Both pupils fixed indicates the third cranial nerve involvement in a
(d) A drooping eyelid when the eye is open (ptosis) indicates third
cranial nerve involvement.
i. Secondary Survey: Maxillofacial Trauma. If the airway is not obstructed,
treat any injuries to the upper jaw and face after you have treated life-threatening
Facial lacerations. Treat as necessary.
(2) Abrasions and contusions. Follow general treatment procedures.
Anesthetize the site, if necessary. Cleanse and debride the wound, removing foreign
bodies if necessary. Suture, then dress the wound with a topical antibiotic.
(3) Facial fractures. Treatment for these fractures can be delayed up to 10
days without serious consequences.
(4) Nasal fractures. Blunt trauma to the front or side of the nose is usually
the cause of nasal fractures.
(5) Maxillary mid-face fracture. Severe blunt trauma to the face usually from
automobile accidents with occupants not wearing seat belts cause these fractures of the
j. Secondary Survey: Cervical Spine/Neck Injury. Assume a patient with an
injury above the collarbone has a cervical spine/neck injury. Immobilize the patient's
spine completely and ensure that there is minimum movement.
k. Secondary Survey: Chest. Check the breath sounds. Check for narrow
pulse pressure. Narrow pulse pressure may indicate cardiac tamponade, a condition in
which blood leaks into the pericardial sac.
l. Secondary Survey: Abdomen. Observe the patient's abdomen closely.
Evaluate frequently if there is a possibility of blunt trauma to the abdomen.
m. Secondary Survey: Rectum. Check for blood and sphincter tone.
n. Secondary Survey: Fractures. Check for any broken bones. Splint broken