Transcript ch 26

Chapter 26 : The Head, Face,
Eyes, Ears, Nose and Throat
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Prevention of Injuries to the Head,
Face, Eyes, Ears, Nose and Throat
• Head and face injuries are prevalent in sport,
particularly in collision and contact sports
• Education and protective equipment are
critical in preventing injuries to the head and
face
• Head trauma results in more fatalities than
other sports injury
• Morbidity and mortality associated w/ brain
injury have been labeled the silent epidemic
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Figure 26-1
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Figure 26-3
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Assessment of Head Injuries
• Brain injuries occur as a result of a direct
blow, or sudden snapping of the head
forward, backward, or rotating to the side
• May or may not result in loss of
consciousness, disorientation or amnesia;
motor coordination or balance deficits and
cognitive deficits
• May present as life-threatening injury or
cervical injury (if unconscious)
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• History
– Determine loss of consciousness and
amnesia
– Additional questions (response will depend
on level of consciousness)
• Do you know where you are and what
happened?
• Can you remember who we played last week?
(retrograde amnesia)
• Can you remember walking off the field
(antegrade amnesia)
• Does your head hurt?
• Do you have pain in your neck?
• Do you have tinnitus (ringing in ears)?
• Can you move your hands and feet?
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• Observation
– Is the patient disoriented and unable to tell
where he/she is, what time it is, what date
it is and who the opponent is?
– Is there a blank or vacant stare? Can the
patient keep their eyes open?
– Is there slurred speech or incoherent
speech?
– Are there delayed verbal and motor
responses?
– Gross disturbances to coordination?
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– Inability to focus attention and is the patient
easily distracted?
– Memory deficit?
– Does the patient have normal cognitive
function?
– Normal emotional response?
– How long was the patient’s affect
abnormal?
– Is there any swelling or bleeding from the
scalp?
– Is there cerebrospinal fluid in the ear
canal?
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• Palpation
– Neck and skull for point tenderness and
deformity
• Special Tests
– Neurologic exam
• Assess cerebral testing, cranial nerve testing,
cerebellar testing, sensory and reflex testing
– Eye function
• Pupils equal and reactive to light (PEARL)
– Dilated or irregular pupils
– Ability of pupils to accommodate to light variance
• Eye tracking - smooth or unstable (nystagmus,
which may indicate cerebral involvement)
• Blurred vision
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– Balance Tests
• Romberg Test
– Assess static balance - determine individual’s ability
to stand and remain motionless
– Multiple variations (primarily foot position)
• Balance Error Scoring System
– Quantifiable clinical battery of test that utilizes
different stances on both firm and foam surface
– Errors are tabulated when the patient opens their
eyes, takes hands off hips, steps/stumbles or falls
– Coordination tests
• Finger to nose, heel-to-toe walking
• Inability to perform tests may indicate injury to
the cerebellum
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Romberg
Figure 26-4
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Balance Error
Scoring
System
(BESS)
Figure 26-5
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– Cognitive Tests
• Used to establish impact of head trauma on
cognitive function and to obtain objective
measures to assess patient status and
improvement
• On or off-field assessment
– Serial 7’s, months in reverse order, counting
backwards
– Tests of recent memory (score of contest, breakfast
game, 3 word recall)
– Neuropsychological Assessments
• Standardized Assessment of Concussion
(SAC) is a brief mental status test
• Used to assess orientation, immediate memory
recall, concentration, and delayed recall on and
off the field
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– Neuropsychological Assessment
(continued)
• Other assessment tools have been designed
to assess short term memory, working
memory, attention, concentration, visual
space capacity, verbal learning, information
processing speed and reaction time
• Computerized neuropsychological testing
programs have been developed
– Automated Neuropsychological Assessment
Metrics (ANAM)
– CogState
– Concussion Resolution Index (CRI)
– Immediate Post Concussion Assessment &
Cognitive Testing (ImPACT)
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Recognition and Management
of Specific Head Injuries
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• Skull Fracture
– Etiology
• Most common cause is blunt trauma
– Signs and Symptoms
• Severe headache and nausea
• Palpation may reveal defect in skull
• May be blood in the middle ear, ear canal, nose,
ecchymosis around the eyes (raccoon eyes) or
behind the ear (Battle’s sign)
• Cerebrospinal fluid may also appear in ear and
nose
– Management
• Immediate hospitalization and referral to
neurosurgeon
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• Cerebral Concussions (Mild Traumatic
Brain Injuries)
– Etiology
• Major public health concern, with return to play decisions
remaining the most challenging task for any sports
medicine clinician
• Result of direct blow, acceleration/deceleration forces
producing shaking of the brain
– Signs and Symptoms
•
•
•
•
•
•
Changes in level of consciousness
Posttraumatic amnesia
Glasgow Coma scale
Concentration deficits and attention span difficulties
Balance & coordination problems
Must monitor duration of signs and symptoms
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– Signs and Symptoms
• Two primary symptoms – loss of consciousness and
post-traumatic amnesia
• Variety of scales and return to play criteria have been
examined
– Typically involve LOC or amnesia
• Recent classification systems have included
concentration deficits, attention span difficulties, and
balance and coordination in addition to LOC and amnesia
– Placing more emphasis on all signs and symptoms may be
a more logical approach
• Using signs and symptoms immediate post-injury and 15
minutes post-injury to provide an estimation of injury
severity has also been suggested
• Third approach involves recovery of symptoms,
neuropsychological testing, postural stability testing
– Focus on patient symptomatology
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– Management
• The decision to return any patient to
competition following a brain injury is a difficult
one that takes a great deal of consideration
• If any loss of consciousness occurs the athletic
trainer must remove the patient from
competition
• With any loss of consciousness (LOC) a
cervical spine injury should be assumed
• Objective measures (BESS and SAC) should
be used to determine readiness to play
• A number of guidelines have been established
to in an effort to aid clinicians in their decisions
• Return to normal baseline requires
approximately 3-5 days
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– Management (continued)
• All post-concussive symptoms should be
resolved prior to returning to play -- any return
to play should be gradual
• Recurrent concussions can produce cumulative
traumatic injury to the brain
• Following an initial concussion the chances of a
second episode are 3-6 times greater
• Must be able to determine the need for
physician referral and be able to decide when
the patient should return home vs. being
admitted to hospital
– A system should be in place that allows for
supervision and monitoring of patient when at home
following concussive episode
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– Management (continued)
• In the past rest was deemed the best treatment
• Efficacy of dual task rehabilitation strategies is
being explored
– Involves posture stability and cognitive tasks
• Little evidence available
• Involves divided attention tasks
– Balance training
– Neurocognitive tasks
– Simultaneously performed
• More research is necessary to establish
efficacy of treatment method
– Which patients are best candidates?
– How soon should the technique be introduced?
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• Post-Concussion Syndrome
– Etiology
• Condition which occurs following a concussion
• May be associated w/ those MHI’s that don’t involve a
LOC or in cases of severe concussions
– Signs and Symptoms
• Patient complains of a range of post-concussion
problems
– Persistent headaches, impaired memory, lack of
concentration, anxiety and irritability, giddiness, fatigue,
depression, visual disturbances
• May begin immediately following injury and may last for
weeks to months
– Management
• Athletic trainer should treat symptoms to greatest
extent possible
• Return patient to play when all signs and symptoms
have fully resolved
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• Second Impact Syndrome
– Etiology
• Result of rapid swelling and herniation of brain
after a second head injury before symptoms of the
initial injury have resolved
• Second impact may be relatively minimal and not
involve contact w/ the cranium
• Impact disrupts the brain’s blood auto-regulatory
system leading to swelling, increasing intracranial
pressure
– Signs and Symptoms
• Often patient does not have LOC and may looked
stunned
• W/in 15 seconds to several minutes of injury
patient’s condition degrades rapidly
– Dilated pupils, loss of eye movement, LOC leading to
coma, and respiratory failure
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• Second Impact Syndrome (continued)
– Management
• Life-threatening injury that must be addressed
w/in 5 minutes w/ life saving measures
performed at an emergency facility
• Best management is prevention from the
athletic trainer’s perspective
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• Cerebral Contusion
– Etiology
• Focal injury to the brain that involves small hemorrhages
or intracranial bleeding w/in the cortex, stem or cerebellum
• Generally occurs when head strikes a stationary object
– Signs and Symptoms
• Severity will vary greatly based on the extent of the injury
• Will likely experience a LOC followed by a very talkative
state
• Normal neurological exam; presenting w/ headache,
dizziness and nausea
– Management
• Hospitalization w/ CT and MRI
• Treatment will vary according to status of the patient
• Return to play occurs when patient is asymptomatic and
CT is normal
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• Malignant Brain Edema Syndrome
– Etiology
• Occurs in young population w/in minutes to
hours of a head injury
• Caused by intracranial clot resulting in diffuse
brain swelling w/ little or no brain injury
• Swelling is the result of hyperemia or vascular
engorgement - results in increased pressure
– Signs and Symptoms
• Rapid neurologic deterioration that progresses
to coma and occasionally death
– Management
• Life-threatening condition requiring immediate
attention at an emergency care facility
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• Epidural Hematoma
– Etiology
• Blow to head or skull fracture which tears meningeal
arteries
• Blood pressure, blood accumulation and creation of
hematoma occur rapidly (minutes to hours)
– Signs and Symptoms
• LOC followed by period of lucidity, showing few signs
and symptoms of serious head injury
• Gradual progression of S&S
– Head pains, dizziness, nausea, dilation of one pupil (same
side as injury), deterioration of consciousness, neck rigidity,
depression of pulse and respiration, and convulsion
– Management
• Requires urgent neurosurgical care; CT may be
necessary for diagnosis
• Must relieve pressure to avoid disability or death
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• Subdural Hematoma
– Etiology
• Result of acceleration/deceleration forces that
tear vessels that bridge dura mater and brain
• May be:
– Acute (rapidly progressing)
– In association with other brain/skull injury
– Chronic (Due to venous bleeding – slow
bleed, w/out serious intracranial pressure)
– Signs and Symptoms
• With a simple subdural hematoma LOC
generally does not occur
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• Subdural Hematoma (continued)
– Signs and Symptoms
• Complicated subdural hematoma’s result in
LOC, dilation of one pupil
• Both will show signs of headache, dizziness,
nausea or sleepiness
– Management
• Immediate medical attention
• CT or MRI is necessary to determine extent of
injury
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Intracerebral
Hematoma
Epidural
Hematoma
Subdural
Hematoma
Figure 26-6
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• Migraine Headaches
– Etiology
• Disordered characterized by recurrent attacks
of severe headache
• Seen in those that have had repeated head
trauma
• Exact cause unknown (believed to be vascular)
• Triggers could include food, medications,
sensory stimuli (lights, odors), lifestyle
changes, changes in estrogen levels
– Signs and Symptoms
• Sudden onset w/ possible visual or
gastrointestinal problems
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• Migraines (continued)
– Signs and Symptoms
• Flashes of light, blindness (half field vision),
paresthesia
• Throbbing pain, located on one side of head
• Sensitivity to light, sound or smells
• May experience tingling sensations or
numbness in arms or legs, or even dizziness
– Management
• Prevention is key
• Prescription medications have a high success
rate
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• Scalp Injuries
– Etiology
• Blunt trauma or penetrating trauma tends to be the
cause
• Can occur in conjunction with serious head trauma
– Signs and Symptoms
• Patient complains of blow to the head
• Bleeding is often extensive (difficult to pinpoint
exact site)
– Management
•
•
•
•
Clean w/ antiseptic soap and water (remove debris)
Cut away hair if necessary to expose area
Apply firm pressure or astringent to reduce bleeding
Wounds larger than 1/2 inch in depth should be
referred
• Smaller wounds can be covered w/ protective
covering and gauze (use extra adherent)
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Recognition of Jaw and Facial
Injuries
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Figure 26-7
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• Mandible Fractures
– Etiology
• Direct blow (generally
fractures at frontal
angle)
– Signs and Symptoms
• Deformity, loss of
occlusion, pain with
biting, bleeding around
teeth, lower lip
anesthesia
– Management
• Temporary
immobilization w/ elastic
wrap followed by
reduction and fixation
Figure 26-8
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• Mandibular Dislocation
– Etiology
• Involves TMJ joint
• MOI is generally a blow to an open mouth from
the side
– Signs and Symptoms
• Dislocated jaw presents in locked-open position
w/ ROM minimal along w/ poor occlusion
– Management
• Cold application, elastic wrap immobilization and
reduction
• Follow-up w/ soft diet, NSAID’s and analgesics
w/ a gradual return to activity 7-10 days following
acute period
• Can be recurrent or result in malocclusion, or
TMJ dysfunction
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• Temporomandibular Joint Dysfunction
– Etiology
• Disk condyle derangement (disk is positioned
anteriorly)
– Signs and Symptoms
• Headaches, earaches, vertigo, inflammation, neck
pain, muscle guarding and trigger points
• Hyper- or hypomobility, muscle dysfunction, limited
ROM, clicking and popping
– Management
• Treat with custom designed, removable mouth
piece
• Treat problem w/ either strengthening or stretching
• If corrective measures fail, referral to a dentist will
be necessary
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• Zygomatic complex (cheekbone)
fracture
– Etiology
• MOI = direct blow
– Signs and Symptoms
• Deformity, or bony discrepancy, nosebleed,
diplopia, and numbness in cheek
– Management
• Cold application to control edema and
immediate referral to a physician
• Healing will take 6-8 weeks and proper
protective gear will be required upon return to
play
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• Maxillary fracture
– Etiology
• MOI = blow to upper jaw
– Signs and Symptoms
• Pain with chewing, malocclusion, nosebleed,
double vision, numbness of lip and cheek region
– Management
• Due to severe bleeding, airway must be
maintained
• Must be aware of possible brain injury
• Transport hospital immediately, upright and
leaning forward if conscious
– Allows for external drainage of saliva and blood
• Fracture reduction, fixation and immobilization
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• Facial Lacerations
– Etiology
• Result of a direct impact, and indirect compressive
force or contact w/ a sharp object
– S&S
• Pain, substantial bleeding,
– Management
• Apply pressure to control bleeding
• Referral to a physician will be necessary for stitches
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Dental and Nasal Injuries
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Figure 26-10
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Prevention of Dental Injuries
• When engaged in contact/collision sports
mouth guards should be routinely worn
– Greatly reduces the incidence of oral injuries
•
•
•
•
Practice good dental hygiene
Dental screenings should occur yearly
Cavity prevention
Prevention of abscess development,
gingivitis, and periodontitis
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Recognition and Management
of Specific Dental Injuries
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• Tooth Fractures
– Etiology
• Impact to the jaw, direct trauma
– Signs and Symptoms
• Uncomplicated fractures produce fragments w/out bleeding
• Complicated fractures produce bleeding, w/ the tooth
chamber being exposed w/ a great deal of pain
• Root fractures are difficult to determine and require follow-up
w/ X-ray
Figure 26-11
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• Management
– Uncomplicated and complicated
crown fractures do not require
immediate attention
• Fractured pieces can be placed in a bag
and if not sensitive to air or cold, followup can wait for 24-48 hours
• Bleeding can be controlled via gauze
• Cosmetic reconstruction of tooth
– In instances of root fractures, the
patient can continue to play but must
follow-up immediately following
competition
• Tooth repositioning may be required,
along with bracing and the use of
mouthpieces in the future
– Mandibular fractures and
concussions must also be ruled out
Figure 26-12
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• Tooth Subluxation, Luxation and Avulsion
– Etiology
• Direct blow
– Signs and Symptoms
• Tooth may be slightly loosened, dislodged
• When subluxed tooth may be loose w/in socket w/ little or
no pain
• With luxations, no fracture has occurred, however, there
is displacement
• W/ an avulsion, the tooth is completely knocked from the
oral cavity
– Management
• For a subluxed tooth, referral should occur w/in the first
48 hours
• With a luxated tooth, repositioning should be attempted
along w/ immediate follow-up
• Avulsed teeth should not be re-implanted except by a
dentist (use a Save a Tooth Kit, milk or saline)
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Nasal Injuries
• Nasal Fractures and
Chondral Separation
– Etiology
• Direct blow
– Signs and Symptoms
• Separation of frontal
processes of maxilla,
separation of lateral
cartilage or combination
• Profuse bleeding and
hemorrhaging, immediate
swelling and deformity
Figure 26-14
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• Management
– Control bleeding and
refer to a physician
for X-ray,
examination and
reduction
– Uncomplicated and
simple fractures will
pose little problem
for the athlete’s
quick return
– Splinting may be
necessary
Figure 26-14
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• Deviated Septum
– Etiology
• Compression or lateral trauma
– Signs and Symptoms
• Bleeding and in some instances a septal hematoma
will form
• Patient will complain of nasal pain
– Management
• At the site of the hematoma, compression will be
required (and if present, drained immediately)
• Following drainage, a wick is inserted to allow for
further drainage
• Packing will be necessary to prevent a return of the
hematoma
• A neglected hematoma will result in formation of an
abscess along with bone and cartilage loss and
deformity
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• Epistaxis (Nosebleed)
– Etiology
• Result of a direct blow, a sinus infection, high
humidity, allergies, a foreign body or some
other serious facial injury
– Signs and Symptoms
• Generally bleeding from the anterior aspect of
the septum
• Generally presents with minimal bleeding and
resolves spontaneously
• More severe bleeding may require more
medical attention
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– Management
• W/ acute bleeding, sit upright w/ a cold
compress over the nose, pressure on the
affected nostril and the ipsilateral carotid artery
– Also gauze between the upper lip and gum - limits
blood supply
• If bleeding does not cease in 5 minutes, an
astringent or styptic may need to be applied
along with a gauze/cotton nose plug to
encourage clotting
• After bleeding has ceased, the patient can
return to play but should be reminded not to
blow the nose under any circumstances for at
least 2 hours after the initial insult
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Injuries and Conditions of the
Ear
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Figure 26-15
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Recognition and Management
of Specific Ear Injuries
• Auricular Hematoma
(Cauliflower Ear)
– Etiology
• Occurs either from
compression or shear
injury to the ear (single
or repeated)
• Causes subcutaneous
bleeding
Figure 26-16
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• Auricular Hematoma (Cauliflower Ear)
– Signs and Symptoms
• Tearing of overlying tissue away from cartilage
• Hemorrhaging and fluid accumulation
• If unattended - coagulation, organization and
fibrosis occurs
– Appears as elevated, white, rounded nodular
formation, that is firm and resembles cauliflower
– Management
• To prevent, wear proper ear protection
• Cold application will minimize hemorrhaging
• If swelling occurs, measures must be taken to
prevent fluid solidification
– Physician aspiration, packing, pressure
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• Rupture of Tympanic
Membrane
– Etiology
• Fall or slap to the unprotected
ear or sudden underwater
pressure variation can result in a
rupture
– Signs and Symptoms
• Complaint of loud pop, followed
by pain in ear, nausea, vomiting,
and dizziness
• Hearing loss, visible rupture
(seen through otoscope)
– Management
Figure 26-17
• Small to moderate perforations
usually heal spontaneously in 12 weeks
• Infection can occur and must be
continually monitored
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• Otitis Externa (Swimmer’s Ear)
– Etiology
• Infection of the ear canal caused be a gramnegative bacillus
• Water becomes trapped by a cyst, bone growths,
earwax plugs or swelling caused by allergies
• May be a problem for an individual that is travelling
via airplane if they have an existing infection
– Pressure changes could result in tympanic rupture
– Signs and Symptoms
• Pain and dizziness, itching, discharge and even
partial hearing loss
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– Management
• Prevent by drying ear with a soft towel, use ear
drops with boric acid and alcohol before and
after swimming
• Avoid things that might cause infection,
overexposure to cold wind or sticking foreign
objects into the ear
• Physician referral will be necessary for
antibiotics, acidification of the environment to
kill bacteria and to rule out tympanic membrane
rupture
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• Otitis Media (Middle Ear Infection)
– Etiology
• Accumulation of fluid in the middle ear caused by local
and systemic infection and inflammation
– Signs and Symptoms
• Intense pain in the ear, fluid drainage from the ear
canal, transient hearing loss
• Systemic infection may also cause a fever, headaches,
irritability, loss of appetite, and nausea
• Tympanic membrane may appeared bulging and/or
bleeding
– Management
• Fluid withdrawal may be necessary to determine the
appropriate antibiotics
• Analgesics for pain
• Generally resolves in 24 hours while pain may last for
72 hours
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• Impacted Cerumen
– Etiology
• Excessive wax may accumulate, clogging the
ear canal
– Signs and Symptoms
• Degree of muffled hearing or hearing loss
• Generally little or no pain because no infection
is involved
– Management
• Initial attempts should be made to irrigate the
canal with warm water
• Do not try to remove with cotton swab, as it
may increase the degree of impaction
• May require physician removal with a curette
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Eye Injuries
Figure 26-18
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Preventing Eye Injuries
• Protective devices must provide
protection from front and lateral blows
• Goggles with high impact-resistant
polycarbonate lenses for refraction
• Unfortunately, goggles may distort
peripheral vision and/or become fogged
under certain conditions
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Assessment of the Eye
• Must utilize extreme caution in
evaluating and caring for eye injuries
• Multiple conditions require immediate
referral for additional care to be
provided
• Transportation to hospital should take
place with patient in recumbent position
• Eyes should be covered together
– Movement of unaffected eye will cause
movement in affected eye
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• History
– What was the mechanism of injury?
– Was loss of vision gradual or immediate?
– What was the visual status before injury?
– Was there a LOC?
• Observation
– External ocular structures for swelling
discoloration, penetrating objects,
movement of the lid
– Inspect the globe for lacerations, foreign
bodies, hyphema or deformity
– Inspect conjunctiva and sclera for
hemorrhaging, deformity, or foreign bodies
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Figure 26-19
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• Palpation
– Orbital rim for point
tenderness and deformity
• Special Test
– Pupillary response
• Dilation and
accommodation
– Visual acuity
• Clarity, blurred vision,
diplopia, floating black
spots, flashes of light
– Ophthalmoscope
• Instrument used for
observing the interior of
the eye (retina)
Figure 26-20 & 21
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Recognition and Management
of Specific Eye Injuries
• Orbital Hematoma (Black Eye)
– Etiology
• Blow to the area surrounding the eye which
results in capillary bleeding
– Signs and Symptoms
• Signs of a more serious condition may be
displayed as a subconjunctival hemorrhage
• Swelling and discoloration
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• Management
– Cold application for at least 30 minutes, 24
hours of rest if patient has distorted vision
– Do not blow nose after acute eye injury
Figure 26-22
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• Orbital Fracture
– Etiology
• Blow to the eyeball forcing it posteriorly,
compressing the orbital fat until a blowout rupture
occurs to the floor of the orbit (muscle and fat can
herniate)
– Signs and Symptoms
• Diplopia, restricted eye movement, downward
displacement of the eye, soft-tissue swelling and
hemorrhaging
• Numbness associated with infraorbital nerve on the
floor of the orbit
– Management
• X-ray will be necessary to confirm fracture
• Antibiotics to decrease risk of infection (due to
proximity of maxillary sinus and bacteria)
• Treat surgically or allow to resolve spontaneously
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• Foreign Body in the Eye
– Etiology
• Frequent occurrence in sports and can be dangerous
– Signs and Symptoms
• Foreign object produces considerable pain, and
disability
• No attempt should be made to remove by rubbing or
by recovering with fingers
– Management
• Close eye and determine location (upper or lower lid)
– Pull upper lid over lower lid to cause tearing
• Wash eye with saline; use petroleum jelly to relieve
soreness
• If object is embedded, close and patch eye and refer
to a physician
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Figure 26-23
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• Corneal Abrasions
– Etiology
• Patient attempts to remove foreign object from
eye by rubbing - cornea becomes abraded
– Signs and Symptoms
• Severe pain, watering of the eye, photophobia,
and spasm of the orbicular muscle of the eyelid
– Management
• Patch eye and refer to a physician
• Diagnosis will require use of fluorescein strip
(stains abrasion bright green)
• Once diagnosed, further dilation is necessary
for further assessment
• Antibiotic ointment is applied with a semipressure patch over the closed eyelid
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• Hyphema
– Etiology
• Blunt blow to the eye
• Major eye injury that can lead to serious problems
with the lens, choroid or retina
– Signs and Symptoms
• Causes collection of blood to collect in anterior
chamber of the eye
• Visible reddish tinge in anterior chamber (blood
may turn pea green)
• Vision is partially or completely blocked
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• Management
– Refer to physician
– Bed rest and elevation (30-40 degrees); both
eyes patched; sedation; and medication to
reduce anterior chamber pressure
– Occasionally additional bleeding will occur
Figure 26-24
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• Rupture of the Globe
– Etiology
• Blow to the eye by an object smaller than the
eye
• If globe is not ruptured it still could result in
blindness
– Signs and Symptoms
• Severe pain, decreased visual acuity, diplopia,
irregular pupils, increased intraocular pressure
and orbital leakage
– Management
• Immediate rest, eye protection, with a shield,
antiemetic medication to avoid increasing
pressure
• Referral to an ophthalmologist
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• Retinal Detachment
– Etiology
• Blow to the eye can partially or completely
separate the retina from the underlying retinal
pigment epithelium
– Signs and Symptoms
• Painless, however, early signs include specks
floating before the eye, flashes of light, or
blurred vision
• As it progresses, “curtain falling” over the field
of vision occurs
– Management
• Immediate referral to an ophthalmologist
• Bed rest, patches for both eyes
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• Acute Conjunctivitis
– Etiology
• Caused by bacteria or allergens
• Conjunctival irritation caused by
wind, dust, smoke, air pollution
• Associated with common cold or
upper respiratory conditions
– Signs and Symptoms
• Eyelid swelling w/ purulent
discharge; itching associated
with an allergy; burning or
itching
Figure 26-25
– Management
• Highly infectious
• 10% solution of sodium
sulfacetamide is often the
treatment of choice
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• Hordeolum (Sty)
– Etiology
• Infection of the sebaceous gland at the edge of
the eyelid (staphylococcal organism)
• Blepharitis is an infection of an eye lash follicle
– Signs and Symptoms
• Erythema of the eye; localizes into a painful
pustule w/in a few days
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• Hordeolum (Sty)
– Management
• Application of moist
compresses
• Antibiotics and ointments
are not necessary unless
lid becomes inflamed or
infected
• Patient should avoid
squeezing site to drain
• Recurrent sties require the
attention of a physician
Figure 26-26
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Throat Injuries
• Contusions
– Etiology
• Direct blow (clothes-lining)
– Could result in trauma to the carotid artery (clotting),
impacting blood flow to the brain (serious injury could
result)
– Signs and Symptoms
• Severe pain w/ spasmodic coughing, speaking
w/ a hoarse voice, and complaining of difficulty
with swallowing
• Fractured cartilage may be indicative of an
inability to breathe and expectoration of frothy
blood; cyanosis may be present
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• Contusions (continued)
– Management
• Airway integrity - first
– If breathing is compromised, referral to the
emergency room is necessary
• Most situations will require intermittent cold
application
• Severe neck contusion may require
stabilization w/ a well-padded collar
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