Transcript Start Traige

Seattle/King County EMT-B Class
Topics
1
Eye Injuries: Chapter 25
2
Face & Throat Injuries: Chapter 26
3
Chest Injuries: Chapter 27
1
Eye Injuries
1
Eye Injuries
• Can produce severe complications
• Examine pupil for shape and reaction.
1
Appearance of Eye
• In a normal, uninjured eye, the entire circle
of the iris should be visible.
• Pupils should be round, equal in size, react
equally when exposed to light.
• Both eyes should move in same direction
when following a finger.
• Always note patient’s signs and symptoms
including severity and duration.
1
Scene Size-up
1. Scene Size-up
• Observe for hazards.
• Request additional help
early
1
Initial Assessment
1. Scene Size-up
2. Initial
Assessment
• Decide SICK/NOT SICK.
• Eye injuries can cause
permanent disability.
• Can create great anxiety
• Approach patient calmly.
1
Focused History/Physical Exam
1. Scene Size-up
Rapid physical exam
• In bleeding cases, do not
2. Initial
focus just on bleeding.
Assessment
• Quickly assess entire
patient from head to toe.
3. Focused History/
Physical Exam
1
Focused History/Physical Exam
1. Scene Size-up
Focused physical exam
• Begin with eyes and face.
2. Initial
• Assess eyes for equal
Assessment
gaze.
3. Focused History/ • Check pupil shape and
Physical Exam
response to light.
• Assess globe for bleeding.
• If eye is swollen shut, do
not attempt to open.
1
Detailed Physical Exam
1. Scene Size-up
2. Initial
Assessment
3. Focused History/
Physical Exam
4. Detailed Physical
Exam
• Perform if patient is
stable and time allows.
1
Ongoing Assessment
1. Scene Size-up
• With serious injuries,
make sure bandage
2. Initial
covers both eyes and is
Assessment
not putting pressure on
eyeball.
3. Focused History/
• Communication and
Physical Exam
documentation
4. Detailed Physical
Exam
5. Ongoing
Assessment
• Inform hospital in case eye
specialists are available.
• Document the patient’s
vision or changes in vision.
1
Foreign Objects in the Eye
• For small foreign
objects lying on the
surface of the eye,
irrigate with saline.
• Flush from the nose
outward.
1
Removing a Foreign Object
• Never attempt to
remove an object
on the cornea.
• Have the patient
look down.
• Place a cottontipped applicator
on the outer
surface of the
upper lid.
1
Removing a Foreign Object
• Pull the lid
upward and
forward.
• Gently remove the
foreign object
from the eyelid
with a moistened,
sterile applicator.
1
Foreign Objects Impaled in the Eye
• If there is an object
impaled in the eye,
do not remove it.
• Immobilize the
object in place.
• Prepare a doughnut
ring by wrapping a
2” piece of gauze
around your fingers
and thumb.
1
Foreign Objects Impaled in the Eye
• Remove the gauze
from your hand and
wrap remainder of
gauze around ring.
• Carefully place the
ring over the eye
and impaled object,
without bumping the
object.
1
Foreign Objects Impaled in the Eye
• Stabilize the object
with roller gauze.
• Cover the injured
and uninjured eye.
1
Chemical Burns
• Chemicals, heat, and light rays can burn
the eye.
• For chemicals, flush eye with saline
solution or clean water.
• You may have to force eye open to get
enough irrigation to eye.
• With an alkali or strong acid burn, irrigate
eye for about 20 minutes.
• Bandage eye with dry dressing.
1
Irrigating the Eye
1
Thermal Burns
• For thermal burns, cover both eyes with a
moist, sterile dressing.
• Transport patient to a burn center.
1
Light Burns
• Infrared rays, eclipse light, direct
sunlight, and laser burns can damage
the eye.
• Cover each eye with a sterile pad and
eye shield.
• Transport the patient in a supine
position.
1
Common Eye Injuries
Lacerations
• Lacerations to the eyes
require very careful
repair.
• Never exert pressure on
or manipulate the eye.
• If part of the eyeball is
exposed, apply a moist,
sterile dressing.
• Cover the injured eye
with a protective metal
eye shield.
1
Common Eye Injuries, continued
Laceration
Blunt trauma
• Blunt trauma can cause a
number of serious
injuries.
̶
̶
A fracture of the orbit
(blowout fracture)
Retinal detachment
• May range from a black
eye to a severely
damaged globe
1
Common Eye Injuries, continued
Laceration
Blunt trauma
Hyphema
• Bleeding in the anterior
chamber of the eye
• May seriously impair
vision
1
Common Eye Injuries, continued
Laceration
Blunt trauma
Hyphema
Blowout
fracture
• May occur from blunt
trauma caused by a
fracture of the orbit
• Bone fragments may
entrap muscles that
control eye movement,
causing double vision.
1
Common Eye Injuries, continued
Laceration
Blunt trauma
Hyphema
Blowout
fracture
Retina
detachment
• Often seen in sports
injuries
• Produces flashing lights,
specks, or floaters in field
of vision
• Needs prompt medical
attention
1
Contact Lenses and Artificial Eyes
• Contact lenses should be kept in the eyes
unless there is a chemical burn.
• Do not attempt to remove a lens from an
injured eye.
• Notify the hospital if the patient has
contact lenses.
• If there is no function in an eye, ask if the
patient has an artificial eye.
1
Contact Lens Removal
• If absolutely
necessary, remove
a hard contact
lens with a small
suction cup,
moistening the
end with saline.
1
Contact Lens Removal, cont'd
To remove a soft
contact lens:
1. Place two drops
of normal saline
in eye.
2. Gently pinch it
between your
gloved thumb
and index finger.
3. Lift it off surface
of eye.
2
Face & Throat Injuries
2
Anatomy of the Head
2
Landmarks of the Neck
2
Injuries to the Face
• Injuries about the face can lead to upper
airway obstructions.
• Bleeding from the face can be profuse.
• Loosened teeth may lodge in the throat.
• If the great vessels are injured,
significant bleeding and pressure may
occur.
2
Soft-Tissue Injuries
• Soft-tissue injuries to
the face and scalp are
common.
• Wounds to the face and
scalp bleed profusely.
• A blunt injury may lead
to a hematoma.
• Sometimes a flap of
skin is peeled back from
the underlying muscle.
2
Hematoma
• Blunt injury that
does not break the
skin may cause a
break in a blood
vessel wall.
2
Care of Soft-Tissue Injuries
• Assess the ABCs and care for life-threatening
injuries.
• Follow proper BSI precautions.
• Blood draining into the throat can lead to
vomiting. Monitor airway constantly.
• Take appropriate precautions if you suspect a
neck injury.
2
Care of Soft-Tissue Injuries
• Control bleeding
by applying direct
pressure.
2
Care of Soft-Tissue Injuries
• Injuries around
the mouth may
obstruct the
airway.
2
Injuries of the Nose
• Blunt trauma to the nose can result in
fractures and soft-tissue injuries.
• Cerebrospinal fluid coming from the
nose is indicative of a basal skull
fracture.
• Bleeding from soft-tissue injuries of the
nose can be controlled with a dressing.
2
Injuries of the Ear
• Place a dressing
between the ear and
scalp when bandaging
the ear.
• For an avulsed ear,
wrap the part in a
moist sterile dressing.
• If a foreign body is
lodged in the ear, do
not try to manipulate
it.
2
Facial Fractures
• A direct blow to the mouth or nose can
result in a facial fracture.
• Severe bleeding in the mouth, loose
teeth, or movable bone fragments
indicate a break.
• Fractures around the face and mouth
can produce deformities.
• Severe swelling may obstruct the
airway.
2
Dislodged Teeth
• Dislodged teeth
should be
transported with
the patient in a
container with
some of the
patient’s saliva or
with some milk to
preserve them.
2
Blunt Injuries of the Neck
• A crushing injury of the
neck may involve the
larynx or trachea.
• A fracture to these
structures can lead to
subcutaneous
emphysema.
• Be aware of complete
airway obstruction and
the need for rapid
transport to the hospital.
2
Penetrating Injuries of the Neck
• They can cause severe
bleeding.
• The airway, esophagus,
and spinal cord can be
damaged from
penetrating injuries.
• Apply direct pressure to
control bleeding.
• Place an occlusive
dressing on a neck
wound.
2
Penetrating Injuries of the Neck
• Secure the dressing
in place with roller
gauze, adding more
dressing if needed.
• Wrap gauze around
and under patient’s
shoulder.
2
Eye Injuries Following a Head Injury
• One pupil larger than the other
• Eyes not moving together or pointing in
different directions
• Failure of the eyes to follow equally
̶ Bleeding under the conjunctiva
̶ Protrusion or bulging of one eye
2
Pupil Size and Head Injury
• Variation in pupil size may indicate a
head injury.
3
Chest Injuries
3
Organs of the Chest
3
Structures of the Chest
3
Mechanics of Ventilation
Inspiration (active process)
• Intercostal muscles contract and
diaphragm flattens.
Expiration (passive process)
• Intercostal muscles and diaphragm relax;
tissues move back to normal position.
3
Mechanics of Ventilation, cont'd
Spinal cord injury below C5
• Loss of ability to move intercostal
muscles
• Diaphragm can still contract; patient can
still breathe.
Spinal cord injury at C3 or higher
• No ability to breathe
3
Spinal Cord Injury Below C5
3
Injuries to the Chest
Closed chest injuries
• Caused by blunt
trauma
Open chest injuries
• Caused by
penetrating
trauma
3
Signs and Symptoms
• Pain at site of injury
• Dyspnea
• Pain aggravated by
increased breathing
• Hemoptysis
• Bruising to chest
wall
• Crepitus with
palpation of chest
• Failure of chest to
expand normally
• Rapid, weak pulse
and low blood
pressure
• Penetrating injury to • Cyanosis around lips
chest
or fingernails
3
Inspection
• Decreased breath sounds usually indicate
significant damage to a lung.
• If both sides of chest do not have equal rise
and fall, chest muscles have lost ability to
work properly.
• If one section of chest moves in opposite
direction from the rest of the chest
(paradoxical motion), this is a life threat.
3
Immediate Interventions
• Decide SICK/NOT SICK.
• Provide complete spinal immobilization.
• Apply an occlusive dressing to any
penetrating chest injury.
• Stabilize paradoxical motion with a large
bulky dressing and 2'' tape.
• Apply oxygen via non-rebreathing mask.
• Provide positive pressure ventilations if
breathing is inadequate.
• Control bleeding/treat for shock.
3
Circulation
•
•
•
•
Assess patient’s pulse.
Consider aggressive treatment for shock.
Internal bleeding can quickly cause death.
Pay attention to subtle clues such as:
– Skin signs
– Level of consciousness
– Sense of impending doom
3
Complications of Chest Injuries
A pneumothorax occurs when air leaks into
the space between the pleural surfaces.
3
Pneumothorax
• Air enters through a
hole in the chest
wall.
– The lung may
collapse in a few
seconds or a few
minutes.
• An open or
penetrating wound
to the chest is
called a sucking
chest wound.
3
Care for Open Pneumothorax
• Clear and manage
the airway.
• Provide oxygen.
• Seal an open wound
with an occlusive
dressing.
• Depending on local
protocol, tape down
all four sides or
create a flutter
valve.
3
Spontaneous Pneumothorax
• Some people are born with or develop
weak areas on the surface of the lungs.
• Occasionally, the area will rupture
spontaneously, allowing air into the pleural
space.
• Patient experiences sudden chest pain and
trouble breathing.
• Consider a spontaneous pneumothorax for
a patient with chest pain without cause.
3
Tension Pneumothorax
Can occur:
• from sealing all four sides of the
dressing on a sucking chest wound.
• from a fractured rib (closed injury)
puncturing the lung or bronchus.
• as a result from a spontaneous
pneumothorax.
3
Tension Pneumothorax, cont'd
3
Tension Pneumothorax, cont'd
Signs and Symptoms include:
• Respiratory distress
• Distended neck veins
• Tachycardia
• Low blood pressure
• Cyanosis
• Decreased lung sounds
• Tracheal deviation
3
Care for Tension Pneumothorax
• If a tension pneumothorax develops
from sealing an open chest wound,
partly remove the dressing to let the
air escape.
• If there is no open wound, follow local
protocol.
3
Hemothorax
• Collection of blood in the pleural space
• Suspect if the following are seen:
– Signs and symptoms of shock
– Decreased breath sounds on affected side
• If both air and blood are present in the
pleural space, it is a hemopneumothorax.
3
Hemothorax, continued
3
Rib Fractures
• They are very common in the older
people.
• A fractured rib may lacerate the surface of
the lung.
• Patients will avoid taking deep breaths
and breathing will be rapid and shallow.
• The patient often holds the affected side
to minimize discomfort.
• Administer oxygen.
3
Flail Chest
• Segment of chest wall detached from rest
of thoracic cage
• Occurs when:
– Three or more ribs are fractured in two
or more places.
– Sternum is fractured along with several
ribs.
• Creates paradoxical motion (asymmetrical
and opposite movement of the chest
during inspiration/expiration)
3
Flail Chest, continued
3
Care for Flail Chest
• Maintain airway.
• Provide respiratory
support with BVM
if needed.
• Perform ongoing
assessments for
pneumothorax and
other respiratory
complications.
• Immobilize flail
segment.
3
Pulmonary Contusions
• Bruising of the lung.
• Develops over hours.
• Alveoli fill with blood, and edema
accumulates in the lung, causing hypoxia.
• Provide oxygen and ventilatory support.
3
Traumatic Asphyxia
• Sudden, severe compression of chest,
i.e.: (crushed by a car that fell of the
jack)
• Produces rapid increase in pressure
within chest
• Results in neck vein distention, cyanosis,
and bleeding into the eyes
• Provide supplemental oxygen and
monitor vital signs.
• Transport immediately.
3
Blunt Myocardial Injury
• Bruising of heart muscle.
• Pulse is often irregular.
• There is no prehospital treatment for
this condition.
• Check patient’s pulse and note
irregularities.
• Provide supplemental oxygen and
transport immediately.
3
Pericardial Tamponade
• Blood or other fluids collect in the pericardium.
3
Pericardial Tamponade, cont'd
Signs and symptoms include:
• Very soft and faint heart tones
• Weak pulse
• Low blood pressure
• Decrease in difference between systolic
and diastolic blood pressure
• Jugular vein distention (JVD)
Provide oxygen and transport quickly.
3
Laceration of the Great Vessels
• The superior vena cava, inferior vena cava,
pulmonary arteries and veins, and aorta
are contained in the chest.
• Injury to these vessels can cause fatal
hemorrhage.
• Treatment includes:
• Ventilatory support
• Supplemental oxygen
• CPR
• Transport immediately.
Questions
• What questions do you have?
To review this presentation, go to:
http://www.emsonline.net/emtb