1. EMERGENCY EYE CARE FROM THE HEART CARE OF CHEMICAL INJURY TO THE EYES Presented by the Registered Nurses Wills Eye At Jefferson Emergency Department

2. DATA GATHERING -Patient presents in ER with chemical injury to eyes - Gather brief history of incident -Determine kind of chemical splashed

3. ASSESSMENT/ PLANNING -Nurse’s role: - Assess patient’s eyes by inspection using pen light - Check pH with Litmus paper and read immediately - Apply one drop of Ophthetic to each affected eye (per MD order) and as needed while irrigating. - Record pH and notify physician for order to initiate irrigation

4. IMPLEMENTATION - Have patient change into gown -Place chux pad under patient’s head and neck and wrap over shoulders -Place towel roll to side of head being irrigated. -Assemble IV ( 1L of NSS) and tubing ( using high flow tubing 10 gtts./ml ). -Place Ophthetic ( Proparacaine) gtt in each affected eye ; begin irrigating eye maintaining steady stream while holding upper and lower lids open

5. Implementation continues -May be necessary for nurse to flip ( evert) lids to examine and irrigate, observe for foreign bodies and particulate. -After first liter, have physician notified to sweep the lids and fornices with glass rod -Nurses provide emotional support throughout the irrigation, answer any questions and allow short breaks at patient requests for comfort. -Allay anxiety of patient

6. Implementation continues - While irrigating ask medical history of patient, to be documented later or - Have second nurse, if available, record and document on ER record medical history, medication list and pertinent information -Irrigation may take 1-20 Liter bags of Saline to change the pH - pH should be checked no sooner than 5 minutes after cessation of irrigation, but preferably after 20 minutes of infusion. The pH should be equal or close to 7.

7. EVALUATION & OUTCOMES -pH level decreased to normal range of 7 -Patient comfort level improves, relief from pain -Eyes appear less irritated or patient able to open eyes -Nurse to complete triage and obtain visual acuity and prioritize based on acuity of injury according to triage protocol. -Physician able to examine patient at slit lamp -Patient’s vision may be preserved from prompt action of irrigation due to immediate nursing intervention.

8. PREVENTATIVE MEASURES Wear safety glasses or goggles when working with chemicals Flush eyes immediately if exposed or splashed with chemicals- flush with copious amounts of water from faucet or eye flush station at work or shower at home Bring bottle or solution of chemical to ER Wash hands when dealing with chemicals

9. EXAMPLES OF CHEMICALS ACIDIC (pH < 7) Batteries ( Sulfuric) Bleach ( Sulfurous) Glass polishing (hydrofluoric) Vinegar ( Acetic acid) ALKALINE ( pH > 7) Ammonia (fertilizer) Lye ( drain cleaners) Lime ( plaster, cement) MgOH ( fireworks)

10. EMERGENCY PREPAREDNESS In regard to Bioterrorism- any mass casuality of chemical injuries or exposure to eyes will need multiple eye flush/ irrigation stations Consider possible use of Morgan Lens for irrigation of eyes