Transcript Neck Trauma

Eye Injuries
Temple College
EMS Professions
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Eye Anatomy
Sclera
Iris
Choroid
Pupil
Cornea
Retina
Lens
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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
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Foreign Body
• Extraocular foreign body
– Object on conjunctiva or cornea
• Intraocular foreign body
– Object has penetrated cornea or sclera
• Contact lenses
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Extraocular Foreign Body
• Signs and Symptoms
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Pain, foreign body sensation
Excessive tearing
Reddening of conjunctiva
Decreased visual acuity
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Extraocular Foreign Body
• Management
– Inspect conjunctiva
– Inspect surface of lower eyelid
– Evert upper eyelid and inspect inner surface
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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
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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
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Intraocular Foreign Body
• Management
– Cover eyes
– Avoid pressure
– Cover large object with cup
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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
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Burns
• Heat Burns
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Usually due to flash of heat, flame
Eyes close reflexively, not usually burned
Don’t pry lids apart
Cover with sterile dressings and transport
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Burns
• Chemical Burns
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TRUE OCULAR EMERGENCY!
Flush with large amounts of water or saline
Wash all the way to hospital
Wash medial to lateral
Wash out contacts
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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
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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
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Burns
• Light Burns
– Patch eyes with opaque dressing
– Transport
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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
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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
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Penetrating Trauma
• Globe Laceration
– Cover with moist sterile dressings
– NO pressure
– Cover both eyes
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Blunt Trauma
• Subconjunctival hemorrhage
– Bruised eye
– Blood between conjunctiva and sclera; stops at
margin of cornea
– No emergency
– Heals like any other bruise
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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
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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
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Blunt Trauma
• Management
– Cover both eyes
– NO pressure
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Blunt Trauma
• Extruded eye
– Pressure from blow pushes eye partially out of
orbit
– Management
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Do NOT attempt to replace
Keep eye surface moist
Cover with cup
NO pressure
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Face and Neck Trauma
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Face and Neck Trauma
• Attracts attention because of:
– Bleeding
– Swelling and deformity
– Psychological impact
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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
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Airway Obstruction
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Bleeding
Displaced teeth, dental appliances
Deformity from fractures
Edema from soft tissue trauma
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Facial Trauma Management
• Open Airway
– Use jaw thrust
– C-spine injury should be suspected
– If necessary pull mandible, tongue forward to
clear airway
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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
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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
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Neck Trauma
• Large number of very vital structures
compressed into very small area:
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Trachea
Larynx
Carotid arteries
Jugular veins
Cervical spine, spinal cord
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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
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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
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Neck Trauma
• Blunt injury
– May crush larynx, trachea
– Airway obstruction
• Leakage of air can produce subcutaneous
emphysema
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Neck Trauma
• Blunt injury
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Stabilize cervical spine
Administer O2
Assist ventilations gently with BVM
Consider ALS intercept for endotracheal
intubation or surgical airway
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