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Eye, Face, and Neck Trauma

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Presentation on theme: "Eye, Face, and Neck Trauma"— Presentation transcript:

1 Eye, Face, and Neck Trauma
Chapter 33

2 Objectives Review the Anatomy of the Eye, Face, and Neck
Assessment-based Approach: Eye, Face and Neck Discuss Specific Injuries Involving the Eye, Face and Neck

3 The Eye Globe (eyeball) Sclera Cornea Pupil Iris Lens Retina
Conjunctiva Anterior Chamber Aqueous humor Vitreous body Vitreous humor Orbits (eye sockets)

4 The Face Comprised of 14 skull bones – 13 of the facial bones are immovable Extremely vascular Provide minimum protection for airway Allow points of attachment for muscles that control facial expression and manipulation of food Compromise of facial structure can also cause closed or open brain injury Mechanism that causes injury to the face is likely to have injured the spine as well

5 The Neck Body systems within the neck
Cardiovascular – Carotid arteries and jugular veins Musculoskeletal Central nervous Respiratory Digestive Endocrine Major structures Trachea and larynx Major concerns Damages to structure of airway are serious life threats Any neck injury should be automatically assumed to have caused spinal injury

6 Assessment-based Approach
Scene Size-up Think of forces behind injury after dispatch Motor Vehicle crashes – over 50% of all facial trauma Assault Sports related injuries Gather information from bystanders Protect your own safety

7 Primary Assessment Manual in-line stabilization Control major bleeding
Open airway with jaw-thrust and suction vomit Consider ALS Oxygen via 15 lpm Recognize high priority injuries; Eye: Chemical burns, Impaled objects Respiratory distress Severe injuries to face or neck Major bleeding Airway compromise

8 Secondary Assessment Inspect and palpate for injury to eye sockets, cheekbones, nose and jaw Use penlight to examine eyes Record vital signs If severely bleeding, prepare to treat for shock Obtain a history Ask questions about the events leading up to the injury

9 Reassessment Reassess and check interventions
Unstable: every 5 minutes Stable: every 15 minutes Monitor for deterioration

10 Injuries to the Eye Assessment and Care Guidelines
Use a penlight to evaluate; Orbits: bruising, swelling, lacerations, tenderness Lids: bruising, swelling, laceration Conjunctivae: redness, pulsing, foreign bodies Globes: redness, abnormal color, laceration Pupils: Size, shape, equality, reactivity (PEERLS)

11 Assessment and Care Guidelines
Test whether the eyes can follow your finger normally as you move it up, down, left, right Basic rules; Avoid unnecessary manipulation when swollen shut Don’t try to force the eyelid open, unless to wash it out No salve or medication in injured eye Don’t remove blood/blood clots Have patient lie down & be quiet Give nothing by mouth Transport all eye injury patients Never apply direct pressure to an injured eye

12 Foreign Object in the Eye
Determine if anyone has attempted to remove the object Attempt to remove only if in conjunctiva

13 Removing the object - Flushing
Flush with clean water

14 Removing the object Pull down lid while patient looks up, or pull up on lid as patient looks down; remove with sterile gauze or swab Draw upper lid over lower lid, then back, allowing lower lashes to dislodge object Grasp upper lashes to turn lid upward; remove object Pull lower lid down and remove object Do not remove object lodged in globe; bandage both eyes and transport ASAP

15 Injury to the Orbits Establish/maintain spine stabilization
Look for signs/symptoms or orbital fracture; Diplopia – double vision Marked decrease in vision Loss of sensation above eyebrow, over the cheek, or in upper lip Nasal discharge Tenderness to palpation Bony “step off” – detect in smooth contour of bone Paralysis of upward gaze Eyeball uninjured – place cold packs over injured eye, transport in sitting position. Eyeball injured – Don’t use cold packs, transport in supine position

16 Lid Injury Inspect for evidence of injury
Control bleeding with light pressure Use no pressure if eyeball injured Cover lid with sterile gauze soaked in saline to keep from drying Preserve avulsed skin and transport Eyeball uninjured: cover with cold compress Cover uninjured eye with a bandage to decrease movement Transport

17 Injury to the globe Use caution; are best treat at the hospital
Apply patches lightly to both eyes Don’t apply patch if you suspect ruptured eyeball Avoid cold packs If you use an eye shield, be sure it puts no pressure on injury Keep patient supine

18 Chemical Burn to the Eye
Begin treatment immediately! Never irrigate with any chemical antidote (alcohol/sodium bicarbonate) Remove or flush out contact lenses Place patient on their side on stretcher, with basin/towel under the head, continue to irrigate during transport Following irrigation, wash hands thoroughly and clean under your nails with a nail brush.

19 Irrigation Irrigate with clean water or sterile saline
Hold the eyelids open so all chemicals can be washed out. Continue to irrigate for at least 20 minutes – if alkali is involved, at least an hour – until arrival at hospital Use running or continually pour from the inside corner May have to force lids open Take care not to contaminate uninvolved eye

20 Removal of Foreign Object EMT Skill 33-1

21 Impaled Object/Extruded eyeball
Place in supine position, immobilize head and spine Encircle eye and impaled object or extruded eyeball with a gauze dressing. Do not apply pressure; cut a hole in the dressing to accommodate impaled object Place a metal shield, crushed paper cup, or cone over the impaled object Hold cup and dressing in place with a bandage that covers both eyes; close the uninjured eye before bandaging Give patient nothing by mouth, never leave patient alone, and constantly provide assurance Transport immediately

22 Impaled Object in the Eye EMT Skill 33-2

23 Removing Contact Lenses
When to remove; If there has been a chemical burn to the eye If patient is unresponsive and wearing hard lenses If transport time is lengthy or delayed When not to remove; If eyeball is injured (excluding chemical burns) Short transport time

24 Removing Soft Contact Lenses
Place several drops of saline on lens, lift off eye by pinching lens between thumb and forefinger Steps; Pull down lid Place index finger on lower edge of lens, slide lens down to white of eye Compress lens between thumb and forefinger If dehydrated, run sterile saline across it, then slide off cornea, and pinch Store in water or saline solution

25 Removing Hard Contact Lenses
Separate eyelids Position lens over cornea Place thumbs gently on top and bottom of eyelids, open wide Press eyelids down and forward to edge of lens Press lower eyelid slightly harder and move under the bottom edge of lens Moving eyelids toward each other, slide lens out between them Or, use a contact lens removal kit

26 Injuries to the Face Assessment and Care Guidelines
Establish/maintain in-line stabilization Establish/maintain airway Inspect mouth for small fragments of teeth, bits of bone, pieces of flesh or foreign objects, remove as thoroughly as possible If dentures whole, leave in place; broken of loose, remove them, transport with patient Open airway with jaw-thrust Suction blood, vomit, secretions or small debris Request ALS to provide advanced airway management

27 Assessment and Care Guidelines
Oxygen via 15 lpm; if breathing inadequate, PPV with supplemental oxygen Control severe bleeding Cover any exposed nerves, tendons, or blood vessels with moist sterile dressing Treat for shock and transport

28 Avulsed Tooth If tooth is lost, try to find it; may be reimplanted
Rinse tooth with saline and transport in a cup of saline or wrapped in gauze that has been soaked in saline Never handle by the root If you can’t find lost teeth, assume the patient has swallowed or aspirated them Control bleeding from tooth socket with a gauze pad

29 Injuries to Midface, Upper Jaw/Lower Jaw
Signs/Symptoms of fracture or other severe trauma Numbness/pain Distortion of facial features Crepitation Irregularities in facial bones Severe bruising/swelling; black eyes Distance between eyes too wide; not level Bleeding from nose/mouth Diplopia Limited jaw motion Palpable movement to maxilla Teeth not meeting normally Hematoma under the tongue Mouth open or patient unable to open mouth Saliva/blood flowing from mouth, or drooling Painful/difficult speech Missing, loose, or uneven teeth Pain around ears

30 Object Impaled in Cheek
Stabilize with bulky dressing Remove if it has pierced through cheek into mouth or is loose and may fall into mouth; Pull or push out of cheek in opposite direction to which it entered Pack dressing material between patient’s teeth and wound; tape dressing to outside of mouth prevent swallowing Dress and bandage outside of wound Consider ALS Suction mouth and throat frequently throughout transport

31 Injury to the Nose Take care to maintain open airway
Position patient so blood does not drain into the oropharynx or pharynx Never pack injured nose; packing can create dangerous pressure if skull fractured Apply cold compress to reduce swelling, and transport Do not try to remove a foreign object from the nose; reassure and calm the patient and transport

32 Injury to the Ear Save avulsed ear parts, wrap in saline-soaked gauze and transport with patient When dressing an injured ear, place dressing between ear and head Do not probe into the ear Never pack the ear to stop blood flow from ear canal; place a loose, clean dressing across ear opening to absorb blood and fluids Do not attempt to remove a foreign object from the ear; reassure the patient and transport

33 Injuries to the Neck Common causes of neck injuries
Hanging (accidental or intentional) Impact with a steering wheel Knife wound Gunshot wound Running or riding into stretched wire or clothesline Fractured larynx Collapsed trachea Cervical spine injury

34 Signs/Symptoms Obvious swelling, bruising, or hematoma
Difficulty speaking Change in or loss of voice Subcutaneous emphysema in neck Airway obstruction that is not obviously due to other sources Crepitation heard during speaking or breathing Displacement of trachea to one side (also a sign of chest injury)

35 Treatment Use BSI Maintain in-line stabilization
Establish patent airway Provide high-flow, high-concentration oxygen or PPV Control severe bleeding Treat for shock Transport

36 Special consideration for treatment
If jugular vein is lacerated, immediately apply occlusive dressing If a major blood vessel of the neck is severed, follow the guidelines for soft-tissue injuries Never probe open wounds Never use circumferential bandages

37 Emergency Care – Severed Blood Vessel in the Neck EMT Skills 33-8

38 Questions ????

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