Emt Face Eye Trauma

Eye Injuries Temple College EMS Professions 1 Eye Anatomy Sclera Iris Pupil Choroid Cornea Retina Lens 2 Eye Anatomy • Aqueous humor: watery fluid which occupies the space between cornea and lens (anterior chamber) • Vitreous humor: jelly-like fluid which fill space behind lens (posterior chamber) • Conjunctiva: smooth membrane that covers front of eye 3 Foreign Body • Extraocular foreign body – Object on conjunctiva or cornea • Intraocular foreign body – Object has penetrated cornea or sclera • Contact lenses 4 Extraocular Foreign Body • Signs and Symptoms – – – – Pain, foreign body sensation Excessive tearing Reddening of conjunctiva Decreased visual acuity 5 Extraocular Foreign Body • Management – Inspect conjunctiva – Inspect surface of lower eyelid – Evert upper eyelid and inspect inner surface 6 Extraocular Foreign Body • Management – If object is over sclera or inside of eyelid, wash out gently or remove with cotton tip applicator – Gently wash corneal bodies, do not touch – Cover both eyes – TRANSPORT – Evaluation for possible corneal abrasion needed 7 Intraocular Foreign Body • Signs and Symptoms – Pain/foreign body sensation – History of sudden eye pain following explosion or metal-on-metal near eyes – Distorted light reflex over cornea or decreased visual acuity – Peaked pupil 8 Intraocular Foreign Body • Management – Cover eyes – Avoid pressure – Cover large object with cup 9 Contact Lenses • Do NOT remove • Move off cornea onto sclera • Ensure receiving personnel are aware of contact lens presence • Wash out only with chemical burns to eyes 10 Burns • Heat Burns – – – – Usually due to flash of heat, flame Eyes close reflexively, not usually burned Don’t pry lids apart Cover with sterile dressings and transport 11 Burns • Chemical Burns – – – – – TRUE OCULAR EMERGENCY! Flush with large amounts of water or saline Wash all the way to hospital Wash medial to lateral Wash out contacts 12 Burns • Chemical Burns – NEVER wash with anything other than water or a balanced salt solution (NS or LR) – Do NOT introduce chemical “antidotes” into eye 13 Burns • Light Burns – Superficial (sunburn, welding torches) • Aching, severe pain • Redness • Eyelid spasms – Deep (laser, looking directly at sun) • Blank spots in visual field • May be permanent 14 Burns • Light Burns – Patch eyes with opaque dressing – Transport 15 Penetrating Trauma • Lid injuries – Moderate pressure control bleeding – Cover with moist dressing – Should be seen by ophthalmologist • Lacerations of inner one-third of lid may damage tearduct system • Lacerations involving lid margins may cause notching • Horizontal lacerations may damage levator muscle 16 Penetrating Trauma • Globe Laceration – Dark spots or streaks on sclera – “Jelly-like” material on eye or face If in doubt, assume trauma to orbital area involves globe 17 Penetrating Trauma • Globe Laceration – Cover with moist sterile dressings – NO pressure – Cover both eyes 18 Blunt Trauma • Subconjunctival hemorrhage – Bruised eye – Blood between conjunctiva and sclera; stops at margin of cornea – No emergency – Heals like any other bruise 19 Blunt Trauma • Hyphema – Blood in anterior chamber – First bleed usually disappears rapidly – Second bleed more severe; fills entire anterior chamber – Increased intraocular pressure can cause blindness 20 Blunt Trauma • Blow out fracture – Eye pushed through floor of orbit into maxillary sinus – Facial asymmetry, sunken eye, paralysis of upward gaze,double vision, runny nose on injured side, numbness of lip on injured side 21 Blunt Trauma • Management – Cover both eyes – NO pressure 22 Blunt Trauma • Extruded eye – Pressure from blow pushes eye partially out of orbit – Management • • • • Do NOT attempt to replace Keep eye surface moist Cover with cup NO pressure 23 Face and Neck Trauma 24 Face and Neck Trauma • Attracts attention because of: – Bleeding – Swelling and deformity – Psychological impact 25 Face and Neck Trauma • Do NOT allow drama of facial injury to distract you from true problems such as: – Airway obstruction – Cervical spine injury – Intracranial trauma 26 Airway Obstruction • • • • Bleeding Displaced teeth, dental appliances Deformity from fractures Edema from soft tissue trauma 27 Facial Trauma Management • Open Airway – Use jaw thrust – C-spine injury should be suspected – If necessary pull mandible, tongue forward to clear airway 28 Facial Trauma Management • Clear blood, vomitus, other debris • Save loose teeth, dental appliances – Teeth may be reimplanted – Teeth not accounted for must be assumed to have been aspirated – Dental appliances necessary to provide support to jaws for reconstruction 29 Facial Trauma Management • Apply pressure inside and outside of oral cavity to control bleeding • Give O2, assist ventilations as needed • Stabilize neck • Monitor LOC, vital signs • Transport 30 Neck Trauma • Large number of very vital structures compressed into very small area: – – – – – Trachea Larynx Carotid arteries Jugular veins Cervical spine, spinal cord 31 Neck Trauma • Penetrating Injury – Massive bleeding is significant problem – Apply direct pressure – If large veins involved: • Apply bulky occlusive dressings • Reduce possibility of air embolism 32 Neck Trauma • Penetrating Trauma – Injury to submental area (area under chin) = Extreme caution! – Penetration of root of tongue can lead to: • Massive bleeding into tongue • Airway obstruction 33 Neck Trauma • Blunt injury – May crush larynx, trachea – Airway obstruction • Leakage of air can produce subcutaneous emphysema 34 Neck Trauma • Blunt injury – – – – Stabilize cervical spine Administer O2 Assist ventilations gently with BVM Consider ALS intercept for endotracheal intubation or surgical airway 35