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Traumatic emergency injury :runner::skin-tone-4: (Urgency traumatic eye ds…

- - - - Acid burns (less severe than alkali)
        
        Coagulative necrosis
      - Alkaline chemicals (more Severe!)
        
        Eg. Cleaners น้ำยาเป็ด, detergents, industrial solvent, concrete
        
        Liquefactive necrosis, Rapid penetration
    - - Depends on: type, volume, concentration, duration of exposure
      - :rabbit:Hughes classification
        
        Extent of surface injury & ischemia guides to prognosis of Alkaline burn based on — epithelial defect, cornea clarity, limbal ischemia
        
        Grading :grapes: ➭ Affect Mx
    - - Test pH with litmus paper or (no litmus) urine dipstick ➭ Copious irrigation with normal saline at least 2000 cc before refer to specialist ➭ after irrigation 5-10 mins test pH at Inferior fornix (optimum pH 7.3-7.7)
      - Topical anesthesia + eye speculum or manual lid retraction
      - Cotton bud to remove particular matter fr fornix while irrigation
      - Oral analgesics for pain relieving
- - - - S&S
      - Grading :grapes:
      - Management: ALL admit
        
        General therapy
    - - Risks of rebleeding
        
        VA 20/200
        
        Initial hyphema stage II (>1/3)
        
        Delayed medical attention > 1 day after injury
        
        :arrow_up: IOP at initial examination
      - Specific therapy
        
        Surgical: paracentesis OR fibirnolysin irrigation if IOP :arrow_up:
        keep sustained > 35 mmHg in 7 days or > 50 mmHg in 5 day
        
        Prevention of secondary glaucoma, optic atrophy, anterior synechiae, Blood-stained cornea
- - - - Cause
      - Mechanism
      - Contamination
      - Duration
  - - - Snellen chart
        
        Standard 6m for distance vision
        
        Glasses or pinhole to correct refractive errors
      - Near chart
        
        30 cm fr the eye (for immobilized patients)
      - Newspaper headline: VA 20/000
        
        Standard txbook printed: VA 20/70
    - - Direct light reflex
      - Consensual light reflex
      - Relative afferent pupillary defect (RAPD)
    - - Digital palpation
      - Schiotz tonometer
    - - Body orbit
        
        Fracture
        
        Rim
        
        Floor (blow out)
        
        Ethmoidal
        
        Near and at apex (optic canal)
        
        :shamrock:Wall
        
        Enopthalmos
        
        :shamrock:Retrobulbar hemorrhage:warning:
      - Eyelids
        
        Laceration vs avulsion
        
        :shamrock:Contusion
        
        Edema
        
        Ptosis
        
        Lagopthalmos
      - Extraocular muscles movement (EOM)
        
        Range of eye movements
        
        Ocular alignment (strabismus)
      - Lacrimal apparatus
        
        Lacrimal gland trauma
        
        Tear of punctum & canaliculi (upper & lower)
        
        Nasolacrimal sac & duct injury
        
        Epiphora
      - Conjunctiva
        
        Abrasion
        
        :shamrock:Laceration
        
        Penetration
        
        Chemosis
      - Cornea
        
        :shamrock:Abrasion: lots of tear
        
        Laceration
        
        Penetration
        
        Scar: won’t have tear
        
        :shamrock:Foreign bodies
      - Anterior chamber
        
        :star:Hyphema
        
        Leaking of aqueous
        
        Flattening of AC
      - Iris & Ciliary body
        
        Iris prolapsed to penetration wound
        
        Iridodialysis
        
        Usu cased from Hyphema
        
        Irregular pupil
      - Lens
        
        Traumatic cataract
        
        :shamrock:Dislocation & subluxation of lens
      - Vitreous
        
        :shamrock:Vitreous hemorrhage
      - Retina
        
        :shamrock:Retinal detachment, Dialysis
        
        Retinal hemorrhage
      - Optic disc injuries
        
        Disc edema
        
        Disc atrophy
        
        Avulsion
        
        :shamrock:Optic nerve injury
      - Macular
        
        Macula edema
        
        Macular hemorrhage
      - Intraocular foreign body (IOFB)
        
        Occult FB should be suspected in:
        mechanical, grinding, sanding, drilling and hammering
        
        Common site
        
        Posterior segment 70%
        
        Anterior chamber 15%
        
        Lens 8%
        
        Orbit 7%
        
        Material
        
        Plastic, glass
        are relatively inert
        
        Organic FB
        ➭Infection
        
        Iron-containing intraocular FB: Siderosis (late complication) ➭ Macular ischemia
        
        Copper-containing compounds: Chalcosis ➭ Retinal toxicity
        
        Mx
        
        Investigation
        
        U/S, CT, MRI (if non magnetic)
        
        Orbital soft tissue X-ray ➭ find radioopaque FB
        
        Admit for Surgical remove plan
        
        NPO
        
        Protective shield
        
        IV ATBs
        
        Cycloplegic
- - - - Rigid eye shield during transport to prevent fr pressure or inadvertent contact
      - :!: eye patches are C/I :red_cross:
    - - Continue prehospital care
      - Prophylactic broad spectrum ATBs
        
        Ideally within 6 hrs of injury
        
        Prevent endophthalmitis
        (5% in penetrated, 10% in FB)
      - Tetanus immune status & update as I/C ➭ may given TAT, TT gives asap within 24 hr
      - NPO, admit, bed rest
      - Antiemetic — Promethazine (Phenergen) to prevent Valsalva
      - Analgesics as I/C
      - Surgical repair ควรรีบทำ
      - If repair is impossible ➭ Enucleation (ยกออก) may needed to prevent Sympathetic opthalmia (ทำตอนเริ่ม or within 1st 7-14 days)
      - :!: notice:
        
        Ocular Steroids - no role
        
        :red_cross: C/I in using Succinylcholine for GA ➭ :arrow_up: IOP & spasm of rectus muscles