Chapter 28 EMT Basic

cornea

protects eye and alters light for focus

iris

muscle that dilates or constricts based on brightness

retina

multilayered tissue on eyeball's surface helps the brain form a picture

optic nerve

neural impulses from the eye to brain sends info to thalamus where brain will carry out info

pupil

adjustable opening of eye allowing light to pass through depending on object it looks at

lens

transparent structure which changes shape to ensure that image is always on the retina

sclera

white portion of the eye and might show color change before skin color change

protects inner surface of the eye

what parts of the body are vulnerable to injury

face and neck

what can open injury lead to

air embolism

what can penetrating trauma to the neck lead to

severe bleeding

what types of injuries are common in face and neck injuries

soft tissue injuries and fractures

occiput

posterior portion of the brain

where to feel superficial temporary artery

anterior to the ear in temporal region

six major bones in the face

nasal 2 zygomas 2 maxillae mandible

how is the orbit created

lower edge of frontal bone of skull

zygoma

maxilla

nasal bone

function of orbit

protect eye from injury

pinna

catches sound waves and sends into the ear canal

three exposed parts of the ear

pinna, tragus, superficial temporal artery

tragus

fleshy bulge immediately anterior to ear canal

mastoid proces

1 inch posterior to the external opening of the ear

tempromandibular joint

motion of mandible

what doese the mandible form

jaw and chin

where to find carotid arteries

found on either side of the trachea

thyroid gland

cannot be palpated unless enlarged on either side of lower larynx and upper trachea

most promiment spine

C7

sternocleeidomastoid muscles

orginate from mastoid process and allow head movement

globe

eyeball -> keeps global shape as a result of pressure of fluid contained in eye

vitreous humor

clear, jellylike fluid near back of eye

aqueous humor

fluid in front of lens that can leak out in penetrating injuries

lacrimal glands

produce fluid to keep the eye moist

retinal detachment

retina detaches from underlying choroid and sclera -> never endings are malnourished and can lead to blindness

factors that can lead to face and neck injury

• blood clots

• direct injuries

• dislodgement of teeth or dentures in throat

• partial or complete airway obstruction

• swelling

• CNS injuries

injured great vessels

sigificant bleeding and upper airway pressure

why are face and neck injuries vulnerable

• no protection

• swelling is more severe

• rich blood supply in areas so will bleed a lot more

• blunt injury can cause hematoma

why are mandible fractures common

prominence of mandible itself

dental injury problems

vehicle collisions and assaults

signs of mandible fractures

• misalignment of teeth

• numbness of chin

• inability to opne mouth

• swelling, bruising, and loosened teeth

signs of maxillary fractures

• facial swelling

• instability of facial bones

• misalignment, fractured, avulsed teeth

what to do if teeth fragments on scene

remove immediately to prevent obstruction and assess mouth

how to treat soft-tissue injuries to face and neck

treat same as soft-tissue injuries on body

• assess XABCs and life threats first

• follow standard precautions

• open and clear airway -> might need to suction or use jaw thrust maneuver

• avoid moving neck with spinal injuries

• once immobilized, tilt patient to side to drain blood and vomit

treating face and neck injuries

• direct pressure w dressing over exposed area

• use roller gauze to hold dressing in place

• apply ice to injuries under skin

• check for bleeding in mouth

what to do with portions of avulsed skin

• wrap in dressing and place in bag

• keep cool but no ice

• label and deliver to ED

why not to place avulsed skin on ice

freezing will cause further injury to tissue and make it unusable

what to do if avulsed skin is still attached in a loose flap

• place flap in position as close to normal as possible

• hold in place with dry, sterile dressing

when are eye injuries common

sports

how is eye affected in eye injuries

• blindness

• globe or eye tissues can be injured

• pupil reaction, shape, eye movement is affected

what happens if damage to cornea

loses smooth, wet appearnce

how is eye affected for blunt or penetrating trauma

swollen or lacerated eyelids
fracture of bones that circulate orbit

bright red conjunctive meaning

bleeding after irritation or injury

conjunctivitis

inflammation of the conjunctiva -> swelling, redness, tears -> produce tears to flush out object -> lots of pain -> difficulty keeping eyelids open because of light

foreign objects in eye

• orbit protects the eye from penetration of large objects

• even a small object may produce severe irritation

how to treat foreign objects in the eye

irrigation with a sterile saline solution will frequently flush away loose particles -> start at nose side of eye and go outside

what will foreign body leave on conjunctive

small abrasion -> still feel irritation

what part of eye should you not remove foreign material

coronea

what to do if foreign bodies may be impaled in the eye

• usually must be removed by a physician

• bandage the object in place to support it

• cover eye with dressing

• surround object with eye shield

• bandage both eyes w dressings to prevent further injury

what to suepect if someone has history of working with metal

embedded eye injuries

who usually removes embedded eye injuries

opthamologist

how tight to put dressing on eyes

loose enough to keep eye closed but tight enough to prevent eye movement

chemicals burns in eye

caused by acid or alkaline solutions

how to treat chemical burns in eye

• flush eye with greatest amount of water or saline as gently as possible

• force eyelids open

• inner to outside corner of eye

• if strong acid, irrigate continously for at least 20 minutes

• after irrigation, apply a clean, dry dressing to cover eye and transport

what to use for irrigation for eye

bulb or irrigation syringe, nasal cannula

treating thermal burns

• eyes will close to protect from heat, and eyelids will burn -> natural reflex to test the eye -> exposed and burned transport promptly

• cover both eyes with sterile dressing and apply eye shields

light burns

• infarerd rays, eclipse light, and laser beams all can cause significant damage when light focuses on retina

• retinal injuries caused by exposure to light are not painful but can be permanent damage

• severe

superficial burn to eye

UV rays from arc welding, light from prolonged exposure to sun lamp, reflected light from snow (bright) -> not painful until later

laceration guidlines

1. if laceration to globe itself, no pressure to eye

2. if part of eyeball is exposed, apply a moist sterile dressing to prevent drying

3. cover injured eye with eye shield, cup, or soft dressing and transport

lacerations to the eye

• require very careful repair to restore appearance and function

• bleeding may be heavy but it usually can be controlled with direct pressure

• compression to eye can interefere with blood supply damage to eye -> vision loss from damaged retina

what to do if eyeball is displaced from socket

do not reposition and treat like normal eye injury

hyphema

bleeding into anterior portion of eye obscures all or part of the iris

orbit fracture

fracture of bones that form eye floor and support the globe -> pain, decreased vision

orbit fracture aka

blow out fracture

how to treat orbit fracture

same as treating normal eye injury

retinal detachment

flashing lights, specks, floaters in vision and cloud/shade over vision often seen in sports

signs and symptoms of a possible head injury based on eyes

• unequal pupil size

• eyes not moving together or following finger

• bleeding under conjunctiva

• protrusion or bulging of one eye

• drying of ocular tissue

blast innjuries to eye

• severe pain and loss of vision in eye

• do not force eyelid open if swelling in eye

• do not remove foreign object in globe

• protect area of eye

• tell them everything that you are going to do

small hard contacts

tinted ,easy to see

large, soft contacts

clear and harder to see

what can manipulating contact lens do

aggravate eye

when to remove contact lenses

never unless chemical burn

how to remove hard contact lens

use small suction cup

how to remove soft contact lenses

place one or two drops of saline in eye, pinch lens between thumb and index finger, and lift

what to do with contact lens after removing

put in sterile saline solution and advise ED

how to recognize artificial eye

nonreactive to light, move in concert with opposite eye, same as opposite eye

anterior nosebleeds

originate from area of septum and bleed slowly

self limited and resolve quickly

posterior nosebleeds

more severe and often cause blood to drain into thorat

can become unstable from basilar skull fracture

types of nosebleeds

anterior and posterior

most common cause of nosebleeds

digital trauma

turbinates

moist lining that are in nasal chambers

three types of nasal chambers

superior, middle, and inferior

if severe nose bleeding what should you do

consider cervical spine that was caused by trauma

three parts of ear

outside, middle, inner

eustacian tube

permits equalization of pressure in middle ear when external atmospheric pressure occurs

what is in external ear

pinna, external auditory canal, eardrum

tympanic membrane aka

eardrum

ear drum

seals outer and middle ear vibrates as ear strikes it

ear canal

guides sound waves further into ear

hammer

malleus and attached to ear drum and moves when eardrum vibrates

anvil

passes vibrations from hammer to the stirrup

stirrup

transfers vibrations to the cochlea

inner ear

bony chambers filled with fluid

as head moves so does fluid

how is middle ear connected

nasopharynx by eustacian tube