Ch. 8-Injuries to the Face, Eye, and Throat

1. Ch. 8-Injuries to the Face, Eye, and Throat 1

2. 8.1 Injuries to the Eye • Assessment • See if the eye sockets (orbits) show signs of bruising (ecchymosis), swelling, laceration, or tenderness. • Check the lids for bruising, swelling, and laceration. • Look for redness, pus, and foreign bodies in the linings of the eyelids (conjunctivae). • Determine whether the eyeballs (globes) are red, abnormally colored, or lacerated. • Check the pupils for size, shape, equality, and reaction to light; they should be black, round, equal in size, and they should react to light (get smaller when light is shined on them). • Check eye movements in all directions for abnormal gaze, paralysis of gaze, or pain on movement. 2

3. Basic First Aid Care for Eye Injuries • Do not irrigate an injured eye except in the case of a chemical burn or if there is a foreign object in the eye. • Do not put salves or medicine in an injured eye. • Do not remove blood or blood clots from the eye. • Do not try to force the eyelid open unless you have to wash out chemicals or a foreign object. • Have the victim lie down and keep quiet. • Limit use of the uninjured eye; it is usually best to patch it along with the injured eye. • Give the victim nothing by mouth in case general anesthesia is required at the hospital. • Every victim with an eye injury must be evaluated by a physician. 3

4. Foreign Objects in the Eye 1. Flush the eye gently with clean water, holding the eyelids apart with your fingers. 2. Remove an object lodged under the upper eyelid by drawing the upper lid down over the lower lid; as the upper lid returns to its normal position, the undersurfaces will be drawn over the lashes of the lower lid, removing the foreign object. 3. If the foreign object remains in the eye, grasp the eyelashes of the upper lid and turn the lid up over a cotton swab or similar object. Carefully remove the foreign object from the eyelid with the corner of a piece of sterile gauze. 4. If the foreign object is lodged under the lower lid, pull down the lower lid, exposing the lid’s inner surface, and remove the foreign object with the corner of a piece of sterile gauze or cotton swab. 5. If the object becomes lodged in the eyeball, do not disturb it; place a bandage compress over both eyes and activate the EMS system 4

5. Injuries to the Eye Sockets Signs and symptoms of fracture to the eye sockets include: • Double vision • Markedly decreased vision • Loss of feeling above the eyebrow, over the cheek, or in the upper lip due to nerve damage • Nasal discharge, which may be profuse • Paralysis of upward gaze (the victim’s eyes will not be able to follow your finger upward) • Whenever the eye socket has been fractured, assume there is also head injury 5

6. First Aid care or injury to the eye sockets Activate the EMS system, then: 1. If the eyeball has not been injured, place icepacks over the injured eye for 15 minutes to reduce swelling. Keep the victim in a sitting position until emergency personnel arrive, and do not exert pressure on the eyeball. 2. If you suspect injury to the eyeball, avoid using ice packs. Keep the victim in a supine position until emergency personnel arrive. 6

7. Injuries to the Eyelids Activate the EMS system, then: 1. Control eyelid bleeding with light pressure from a light dressing; use no pressure at all if the eyeball itself is injured. 2. Cover the lid with moistened sterile gauze to keep the wound from drying. If the eyelid skin is torn off the eyelid, preserve it so it can be transported with the victim for later grafting. 3. If the eyeball is not injured, cover the injured lid with cold compresses to reduce swelling. 4. Cover the uninjured eye with a bandage to decrease movement of the injured eye. 7

8. Injuries to the Eyeball Activate the EMS system, then take these steps: 1. Apply light patches to both eyes. Do not use a patch or any kind of pressure if you suspect a ruptured eyeball, because pressure can force eye contents out. 2. Keep the victim lying on his or her back until emergency personnel arrive. 8

9. Chemical Burns of the Eye 1. Holding the eyelids open, continuously and gently irrigate the eye with running water for at least 30 to 60 minutes. 2. Pour the water from the inside corner of the eye across the eyeball to the outside edge. 3. Remove or flush out contact lenses; left in, they will trap chemicals between the contact lens and the cornea. 4. Remove any solid particles from the surface of the eye with a moistened cotton swab. 5. Continue irrigation until emergency personnel arrive. 6. If the arrival of emergency personnel is delayed and you have rinsed the eye with running water for at least 60 seconds, loosely bandage both eyes with cold, wet dressings until emergency help arrives. 9

10. Light Burns of the Eye 1. Move the victim out of the sunlight. If possible, the victim should be in a dark room, away from sources of light. 2. Cover both eyes with gauze pads that have been moistened with cold water. 3. Discourage the victim from rubbing his or her eyes; rubbing will further inflame injured tissues. 10

11. Impaled Objects in theEye and Extruded Eyeball Activate the EMS system, then follow these steps: 1. With the victim lying on his or her back, stabilize the head with sandbags or large pads. 2. Gently cover an eyeball that has been forced out of the socket with a clean, moist dressing—such as sterile gauze that has been moistened with clean water—to help keep the eyeball moist. 3. Place a metal shield, paper cup, or cone over the impaled object or extruded eyeball. Do not use a styrofoam cup, because it can crumble. The impaled object or eyeball should not touch the top or sides of the cup. 4. Hold the cup and dressing in place with a self-adhering bandage compress or roller bandage that covers both eyes 5. Cover the uninjured eye to prevent movement of the injured eye. 6. Treat for shock; give the victim nothing by mouth. 11

12. Removing Hard Contact Lenses 1. Separate the eyelids; manipulate them to position the lens over the cornea. 2. Place your thumbs gently on the top and bottom eyelids, and gently press the eyelids down and forward to the edges of the lens. 3. Press the lower eyelid slightly harder, and move it under the bottom edge of the lens. 4. Moving the eyelids toward each other, slide the lens out between them. 12

13. Removing Soft Contact Lenses 1. With your middle fingertip on the lower lid, pull the lid down. With the other hand, pull the upper lid up. 2. Place your index fingertip on the lower edge of the lens, then slide the lens down to the white of the eye. 3. Compress the lens gently between your thumb and index finger, allowing air to get underneath it, and remove it from the eye. If the lens has dehydrated on the eye, run sterile saline across the eye surface, slide the lens off the cornea, and pinch the lens up to remove it. 13

14. PROGRESS CHECK 1. All victims of eye injuries require ____________. (rapid treatment/evaluation by a physician/surgery) 2. Use ice packs or cold compresses unless the ____________ is injured. (eyelid/eye socket/eyeball) 3. In case of a chemical burn to the eye, irrigate the eye with clean water for at least ____________ minutes.(10/20/30) 4. The goal of first aid for an impaled object in the eye is to ____________ it. (stabilize/remove/shorten) 5. In most eye injuries, you should patch____________. (the injured eye only/both eyes/neither eye) 14

15. 8.2 Injuries to the Face 1. Establish an airway. 2. Completely immobilize the neck to prevent aggravation of possible spinal neck injuries (cervical spine injuries). 3. Control bleeding 4. If nerves, tendons, or blood vessels have been exposed, cover them with a moist, sterile dressing. 5. Make sure you inspect both the outside and the inside of the cheek. 15

16. Fractures of the Face and Jaw Activate the EMS system, then follow these steps: 1. Clear the airway; remove any debris from the mouth. 2. Immobilize the neck if you suspect spinal injuries, then position the victim to allow for drainage. 3. Control bleeding; place bandages carefully to allow for vomiting and drainage of blood. 4. If you suspect lower jaw fracture, carefully immobilize the lower jaw with a cervical collar or cravats. 5. If you suspect a fracture of the nose, control nosebleed. Apply an ice pack to the nose for as long as 20 minutes to reduce swelling and relieve pain. Never try to straighten the nose. 16

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18. Objects Impaled in the Cheek To remove, activate the EMS system; then follow these steps: 1. Pull or push the object out of the cheek in the same direction in which it entered the cheek. Never pull the object through to the inside of the mouth. 2. Pack dressing material between the victim’s teeth and the wound; leave some of the dressing outside the mouth and tape it there to prevent the victim from swallowing the dressing. 3. Dress and bandage the outside of the wound to control bleeding. 18

19. Injuries of the Throat Activate the EMS system; then follow these steps: 1. Open the airway; if necessary, give rescue breathing. 2. Keep the victim lying down to lessen the chance of air entering the blood vessels. 3. Control bleeding with slight to moderate pressure and bulky dressings. 4. Treat for shock. 19

20. 8.3 Dental Emergencies Broken Tooth 1.Use a clean cloth and water to gently clean blood, dirt and other debris away from the broken teeth. 2. If the jaw is not injured, have the victim gently rinse the mouth with warm water to thoroughly clean it. 3. Apply an ice pack or cold compress to the victim’s face over the broken teeth to relieve pain and reduce swelling. Knocked-Out Tooth 1. Have the victim rinse his or her mouth gently with warm water to wash out blood, dirt, and debris. 2. Place a rolled sterile gauze pad against the socket and have the victim bite firmly on it to help control bleeding. 3. Handling the tooth gently and by the crown only, immerse it in the solution found in the commercial Save-a-Tooth™ kit. 4. If you don’t have access to a commercial kit, immerse the tooth in either saliva or cold milk (which contains and concentration of calcium and magnesium) in a closed container. 20

21. PROGRESS CHECK 1. The priority in treating injuries to the face is to ___________. (maintain the airway/prevent shock/control bleeding) 2. ___________ often accompanies trauma to the mouth and jaw. (Severe bleeding/Spinal injury/Severe pain) 3. A knocked-out tooth can almost always be reimplanted if the procedure is done within ___________. (30 minutes/1 hour/24 hours) 4. To protect a knocked-out tooth, always handle it by ___________. (the root/the crown) 5. To increase the odds of successful reimplantation, keep a knocked-out tooth ___________. (wet/dry/cold/warm) 6. To transport a knocked-out tooth, immerse it in ___________. (water/mouthwash/milk) 21

22. Vocabulary Ocular- Having to do with the eye Orbit- The bony socket that holds the eyeball Conjunctiva- The transparent mucous membrane lining the eyelids and covering the outer surface of the eyeball Globe- The eyeball Extruded- Forced out of position; an extruded eyeball has been forced out of the socket. Sclera- The white of the eye Maxilla- The upper jaw Mandible- The lower jaw 22