Diagnostic and Diagnostic and emergency assistanceemergency assistance if if

damaged eyedamaged eye andand LOR- organsLOR- organs

Prepared by:Prepared by:Candidate of Medical Science, Candidate of Medical Science,

assistant professor assistant professor of outpatient therapy andof outpatient therapy and

emergency medical emergency medical emergency KSMUemergency KSMU

AA..RR.. Alpyssova Alpyssova

The purpose of the lectureThe purpose of the lecture

After completing the lecture, students After completing the lecture, students should focus on issues of diagnosis and should focus on issues of diagnosis and emergency care in eye injuries and upper emergency care in eye injuries and upper respiratory tract in the amount of the first respiratory tract in the amount of the first medical care (doctor's line crews), and medical care (doctor's line crews), and depending on the patient - in the amount of depending on the patient - in the amount of specialized care (intensive care team, intensive specialized care (intensive care team, intensive care team .)care team .)

The plan of the lectureThe plan of the lecture

injuries ageinjuries ageWounds of the eyeballWounds of the eyeballWounds of the eyeballWounds of the eyeballcontusion centurycontusion centuryContusion of the eyeballContusion of the eyeballorbital contusionorbital contusioneye burnseye burnsForeign bodies of the conjunctiva and corneaForeign bodies of the conjunctiva and corneaForeign body ear canalForeign body ear canalOuter ear traumaOuter ear traumaThe trauma of middle and inner earThe trauma of middle and inner ear

INJURY ORGAN OF VIEWINJURY ORGAN OF VIEW

Injury of ageInjury of age Diagnosis of injuries century presents no Diagnosis of injuries century presents no

special difficulties, but they can be the special difficulties, but they can be the beginning of wound channels that penetrate into beginning of wound channels that penetrate into the cavity of the orbit, skull, paranasal sinuses, the cavity of the orbit, skull, paranasal sinuses, the damage not only the eye but also pose a the damage not only the eye but also pose a threat to life.threat to life.

TreatmentTreatment ■ ■ First medical helpFirst medical help administration of analgesics, broad-spectrum administration of analgesics, broad-spectrum

antibiotics;antibiotics; Removal of superficial foreign bodies;Removal of superficial foreign bodies; treatment of the surrounding tissues by treatment of the surrounding tissues by

antiseptics (lizanin);antiseptics (lizanin); imposition of monocular aseptic dressing.imposition of monocular aseptic dressing.

If the eyelid is almost completely cut off or, you want If the eyelid is almost completely cut off or, you want to save (record aseptic bandage or wrap in a to save (record aseptic bandage or wrap in a sterile cloth, moistened with saline sterile cloth, moistened with saline and delivered with the victims in a specialized and delivered with the victims in a specialized hospital).hospital).

■ ■ Most wounds need to be age of primary Most wounds need to be age of primary surgical treatment of an ophthalmologist.surgical treatment of an ophthalmologist.

■■ Injuries are often accompanied Injuries are often accompanied by injuries century eyeballs.by injuries century eyeballs.

Wounds of the eyeballWounds of the eyeball Perforated not injured (closed injury) - a Perforated not injured (closed injury) - a

wound does not pass through all layers of the wound does not pass through all layers of the fibrous capsule eye (cornea or sclera).fibrous capsule eye (cornea or sclera).

CLINICAL PICTURECLINICAL PICTURE Complaints:Complaints: stingingstinging photophobiaphotophobia Local or diffuse hyperemia of the conjunctiva; Local or diffuse hyperemia of the conjunctiva;

Local or diffuse hyperemia of the conjunctiva;Local or diffuse hyperemia of the conjunctiva; some reduction in vision.some reduction in vision. Symptoms,Symptoms, physical examination revealed: physical examination revealed: good lighting can identify an area where there is good lighting can identify an area where there is

no mirror of the cornea (erosion -no mirror of the cornea (erosion -deepitelizatsiya), wound or conjunctival foreign deepitelizatsiya), wound or conjunctival foreign body.body.

TreatmentTreatment ■ ■ First medical helpFirst medical help:: with anesthetic drops [procaine (Novocain) 2% with anesthetic drops [procaine (Novocain) 2%

solution or lidocaine 2% solution];solution or lidocaine 2% solution]; Gentamicin 0.3% solution.Gentamicin 0.3% solution. ■■ Outpatient treatment under the supervision Outpatient treatment under the supervision

of an ophthalmologist.of an ophthalmologist. ■■ Often accompanied by the introduction Often accompanied by the introduction

of unpreforated injured foreign bodies in of unpreforated injured foreign bodies in the outer membrane of the the outer membrane of the eye (cornea, sclera) or mucous century.eye (cornea, sclera) or mucous century.

Perforated wound of the eyeballPerforated wound of the eyeball In an open wound injury of the eyeball (wound In an open wound injury of the eyeball (wound

channel) passes through all layers of the fibrous channel) passes through all layers of the fibrous capsule eye (cornea or sclera). In most capsule eye (cornea or sclera). In most cases, damaged the inner cases, damaged the inner membrane (vascular, retina) and eye protection (lmembrane (vascular, retina) and eye protection (lens, vitreous body).ens, vitreous body).

CLINICAL PICTURECLINICAL PICTURE ComplainsComplains:: stingingstinging photophobiaphotophobia;; reduced visionreduced vision Symptoms,Symptoms, physical examination revealed: physical examination revealed: gaping wounds of the cornea or sclera, gaping wounds of the cornea or sclera,

which may impair intraocular membranes and the which may impair intraocular membranes and the environment: the iris (in the form of a environment: the iris (in the form of a dark bubble), fragments of the lens;dark bubble), fragments of the lens;

blood in the anterior chamber (hyphema);blood in the anterior chamber (hyphema); deformation and displacement of the pupil, the deformation and displacement of the pupil, the

lens is damaged - the pupil black;lens is damaged - the pupil black; tone lowered eyestone lowered eyes

ComplicationsComplications Post-traumatic uveitis.Post-traumatic uveitis.

Endophthalmitis.Endophthalmitis. Sympathetic ophthalmia.Sympathetic ophthalmia. TreatmentTreatment Even in cases of suspected perforated wound Even in cases of suspected perforated wound

should stop any manipulation.should stop any manipulation. ■ ■ The first medical care:The first medical care: Mixing of solutions of antibiotics (gentamicin Mixing of solutions of antibiotics (gentamicin

0.3% solution or 20% solution of sodium Sulfatsil 0.3% solution or 20% solution of sodium Sulfatsil *);*);

administration of analgesics;administration of analgesics; imposition of a binocular bandage.imposition of a binocular bandage. Evacuation in an eye hospital lying on stretchers.Evacuation in an eye hospital lying on stretchers.

Orbit injuriesOrbit injuries Orbit injuries classified as serious injury. Is often Orbit injuries classified as serious injury. Is often

combined with damage to the sinuses, brain, combined with damage to the sinuses, brain, maxillofacial area (depending on the damage factor, maxillofacial area (depending on the damage factor,

the direction and length of the wound channel).the direction and length of the wound channel). CLINICAL PICTURECLINICAL PICTURE

Complains:Complains: decreased vision;decreased vision; motion abnormalities of the eyeball.motion abnormalities of the eyeball. Emergency Conditions in ophthalmologyEmergency Conditions in ophthalmology ■ ■ SymptomsSymptoms detected on physical examination: detected on physical examination: exophthalmos or enophthalmos (with extensive exophthalmos or enophthalmos (with extensive

fractures of the bone walls);fractures of the bone walls); subcutaneous emphysema and age of the periorbital subcutaneous emphysema and age of the periorbital

region (crepitus on palpation) in the event of damage region (crepitus on palpation) in the event of damage to the inner wall of the orbit;to the inner wall of the orbit;

liquorrhea (penetrating wound of the brain).liquorrhea (penetrating wound of the brain).

TreatmentTreatment The imposition of aseptic dressings.The imposition of aseptic dressings. The introduction of analgesics, broad-spectrum The introduction of analgesics, broad-spectrum

antibiotics.antibiotics. Admission to general hospital, where, along Admission to general hospital, where, along

with eye care, may have neurosurgical, LOR, with eye care, may have neurosurgical, LOR, have a department of maxillofacial surgery.have a department of maxillofacial surgery.

Contusion of the vision (eyes closed injury)Contusion of the vision (eyes closed injury) Closed eye injury are caused by blunt injury. Closed eye injury are caused by blunt injury.

Distinguished by the severity of light, moderate Distinguished by the severity of light, moderate and severe.and severe.

Contusion eyelidsContusion eyelids Clinical pictureClinical picture

The clinical picture depends on the severity of the The clinical picture depends on the severity of the injury.injury.

■ ■ Easy to injury:Easy to injury: subcutaneous hemorrhage and subcutaneous hemorrhage and

podkonyunktivalno;podkonyunktivalno; may be tears brim eyelids.may be tears brim eyelids. ■ ■ Central of gravity:Central of gravity: marked subcutaneous hemorrhage;marked subcutaneous hemorrhage; free edge of tears or small (3-5 mm) wound free edge of tears or small (3-5 mm) wound

eyelids.eyelids. ■ ■ Heavy:Heavy: significant tear-contused wounds;significant tear-contused wounds; partial detachments eyelids at the medial partial detachments eyelids at the medial

(damage to tear ducts) or at the lateral angles;(damage to tear ducts) or at the lateral angles; completely severed eyelids (very rare)completely severed eyelids (very rare)

TreatmentTreatment ■ ■ The introduction of antibiotics, analgesics, The introduction of antibiotics, analgesics,

application of dressings monocular with contusions application of dressings monocular with contusions of moderate and severe cases in the presence of of moderate and severe cases in the presence of tear-contused wounds.tear-contused wounds.

■ ■ The victim is sent to an ophthalmologist.The victim is sent to an ophthalmologist. ■ ■ In some cases, concussion injuries are In some cases, concussion injuries are

accompanied by eyelids of the eyeball or eye socket.accompanied by eyelids of the eyeball or eye socket.

Contusion of the eyeballContusion of the eyeball CLINICAL PICTURECLINICAL PICTURE

The clinical picture depends on the The clinical picture depends on the severity of the injury.severity of the injury.

■ ■ EasyEasy: : slight decrease in visual acuity;slight decrease in visual acuity; hemorrhage under the conjunctiva;hemorrhage under the conjunctiva; slight swelling of the cornea;slight swelling of the cornea; Visual acuity maintained or decreased slightly.Visual acuity maintained or decreased slightly. ■ ■ MModerateoderate :: some deformity or pupil mydriasis due to pupillary some deformity or pupil mydriasis due to pupillary

edge of the iris tears;edge of the iris tears; may be a small hyphema (meniscus with a may be a small hyphema (meniscus with a

horizontal level of 1-2 mm in height).horizontal level of 1-2 mm in height). Visual acuity maintained or reduced to a small Visual acuity maintained or reduced to a small

extent.extent.

■ ■ HeavyHeavy:: significant (more than two times) significant (more than two times)

reduction in visual acuity;reduction in visual acuity; extensive hemorrhage under the conjunctiva (giposfagmy);extensive hemorrhage under the conjunctiva (giposfagmy); partial or complete filling of the anterior chamber of the partial or complete filling of the anterior chamber of the

blood (hyphema);blood (hyphema); deformation of the pupil due to iris root separation deformation of the pupil due to iris root separation

(iridodialysis), if visible;(iridodialysis), if visible; often can not see the pupil (the "eye filled with blood");often can not see the pupil (the "eye filled with blood"); hypotension eyes ('eyes as soft cloth "), there is a hypotension eyes ('eyes as soft cloth "), there is a

break in the case podkonyunktivalno scleral wound break in the case podkonyunktivalno scleral wound when the capsule eyes to see, but have severe when the capsule eyes to see, but have severe damage to internal structures.damage to internal structures.

TreatmentTreatment A significant reduction in visual function should be A significant reduction in visual function should be

considered as a serious injury. The victim should be lying considered as a serious injury. The victim should be lying down with a binocular bandage sent to a specialized down with a binocular bandage sent to a specialized hospital.hospital.

Orbital contusionOrbital contusion CLINICAL PICTURECLINICAL PICTURE

The clinical picture depends on the severity of the The clinical picture depends on the severity of the injury.injury.

■■EasyEasy:: slight diplopia;slight diplopia; restriction of movement of the eyeball.restriction of movement of the eyeball. ■ ■ Moderate severity:Moderate severity: pain;pain; small change in the position of the eyeball and limited small change in the position of the eyeball and limited

mobility;mobility; mild diplopia.mild diplopia. ■ ■ HeavyHeavy:: exophthalmos or enophthalmos;exophthalmos or enophthalmos; limitation of eye movement until immobility limitation of eye movement until immobility

(ophthalmoplegia)(ophthalmoplegia) ptosis (may be obscured by swelling of the century);ptosis (may be obscured by swelling of the century); bone defect margin of orbit (a symptom of a "step") in bone defect margin of orbit (a symptom of a "step") in

place of the fracture zone in severe local pain;place of the fracture zone in severe local pain;

crepitus (emphysema at the turn of the inner wall of crepitus (emphysema at the turn of the inner wall of the orbit);the orbit);

significant decrease in visual acuity up to no light significant decrease in visual acuity up to no light perception, which may be due to compression of the perception, which may be due to compression of the central artery of the retina, optic nerve retrobulbar central artery of the retina, optic nerve retrobulbar hematoma or reactive tissue edema orbit, its damage hematoma or reactive tissue edema orbit, its damage in the orbit or in the channel of the optic nerve in the orbit or in the channel of the optic nerve (traumatic optikopatiya);(traumatic optikopatiya);

syndrome of upper orbital fissure: ptosis, syndrome of upper orbital fissure: ptosis, ophthalmoplegia (limited or no eye movement), ophthalmoplegia (limited or no eye movement), impaired sensation in the area of the projection impaired sensation in the area of the projection of the first branch of trigeminal nerve.of the first branch of trigeminal nerve.

TreatmentTreatment When contusions of moderate severity or heavy When contusions of moderate severity or heavy

administered analgesics, impose a binocular bandage administered analgesics, impose a binocular bandage evacuated lying on a stretcher in an ophthalmic evacuated lying on a stretcher in an ophthalmic hospital.hospital.

Mild concussion treated as outpatients under the Mild concussion treated as outpatients under the supervision of an ophthalmologist.supervision of an ophthalmologist.

EYE BURNSEYE BURNS

CLASSIFICATION:CLASSIFICATION: On the etiology of eye burns is divided into:On the etiology of eye burns is divided into: chemicalchemical;; thermicalthermical;; radiant energy (with powerful flares, explosions, the radiant energy (with powerful flares, explosions, the

voltaic arc, the impact of intense visible light, with a voltaic arc, the impact of intense visible light, with a significant UVR).significant UVR).

By severity are distinguished:By severity are distinguished: Mild (I degree).Mild (I degree). Moderate severity (II degree).Moderate severity (II degree). Severe burns (III degree).Severe burns (III degree).

CLINICAL PICTURECLINICAL PICTURE

The clinical picture depends on the severity of the burn.The clinical picture depends on the severity of the burn. ■ ■ EasyEasy:: small sharp pain, photophobia,small sharp pain, photophobia, singed eyelashes;singed eyelashes; mild hyperemia and edema of the eyelid skin and mild hyperemia and edema of the eyelid skin and

conjunctiva;conjunctiva; cornea clear.cornea clear. ■ ■ Moderate severity:Moderate severity: expressed sharp pain, photophobia;expressed sharp pain, photophobia; moderate hyperemia, edema of the eyelids;moderate hyperemia, edema of the eyelids; blistering;blistering; conjunctival edema (chemosis);conjunctival edema (chemosis); slight clouding of the cornea.slight clouding of the cornea. ■ ■ Heavy:Heavy: blepharospasm (the victim can not open your eyes);blepharospasm (the victim can not open your eyes); escharosis (skin necrosis century);escharosis (skin necrosis century); gray film on the conjunctiva;gray film on the conjunctiva; cloudy cornea (the form of "ground-glass or porcelain plate").cloudy cornea (the form of "ground-glass or porcelain plate").

TreatmentTreatment

When expressed pain syndrome and When expressed pain syndrome and blepharospasm injected analgesics, blepharospasm injected analgesics, buried procaine, trimekaina, lidocaine 2% buried procaine, trimekaina, lidocaine 2% solution.solution.

■ ■ Chemical burns.Chemical burns. In case of eye powdered chemical to remove it dry In case of eye powdered chemical to remove it dry

swab.swab. Rinse the eye with runningRinse the eye with running catalyst (2% solution of sodium hydrogen burns acids, catalyst (2% solution of sodium hydrogen burns acids,

2% solution of boric acid - alkali), in the absence of 2% solution of boric acid - alkali), in the absence of converters - with running water for 20-30 minutes.converters - with running water for 20-30 minutes.

In the case of particles of the chemical in the In the case of particles of the chemical in the conjunctival cavity to remove them with a moist swab (if conjunctival cavity to remove them with a moist swab (if it is necessary to unscrew the top and bottom eyelids).it is necessary to unscrew the top and bottom eyelids).

Lay with the antibiotic eye ointment (tetracycline 1% or Lay with the antibiotic eye ointment (tetracycline 1% or eritromitsinovaya 1%).eritromitsinovaya 1%).

■ ■ Thermal burns.Thermal burns. Should remove superficial foreign bodies, lay Should remove superficial foreign bodies, lay

ophthalmic antibiotic ointment.ophthalmic antibiotic ointment. Bandages on the eyelids and face do not impose.Bandages on the eyelids and face do not impose. Minor burns treated as outpatients under the Minor burns treated as outpatients under the

supervision of an ophthalmologist, burns of supervision of an ophthalmologist, burns of moderate and severe - in hospitals (isolated - in moderate and severe - in hospitals (isolated - in ophthalmology, together, with the spread to other ophthalmology, together, with the spread to other parts of the body - in burn centers or offices with parts of the body - in burn centers or offices with an ophthalmologist).an ophthalmologist).

Foreign bodies conjunctiva and corneaForeign bodies conjunctiva and cornea            Eye injuries are often accompanied by the Eye injuries are often accompanied by the

introduction of foreign bodies in the morphological introduction of foreign bodies in the morphological structures of the eye.structures of the eye.

By the nature of the substanceBy the nature of the substance of a foreign body is of a foreign body is isolatedisolatedmagnetic (iron-containing)magnetic (iron-containing)non-magnetic pieces (not containing iron).non-magnetic pieces (not containing iron).

Localization Localization of the fragment distinguish foreign bodies:of the fragment distinguish foreign bodies:conjunctiva,conjunctiva,the cornea,the cornea,intraocular foreign bodiesintraocular foreign bodiesforeign body orbit.foreign body orbit.     When wound the conjunctiva and cornea, and the      When wound the conjunctiva and cornea, and the surface location of the fragment in the power of any surface location of the fragment in the power of any doctor who knows first aid and remove it. In the last two doctor who knows first aid and remove it. In the last two cases (intraocular foreign bodies and foreign body orbit) cases (intraocular foreign bodies and foreign body orbit) to provide expert assistance should only ophthalmologist to provide expert assistance should only ophthalmologist and first aid for this condition is general practitioners, and first aid for this condition is general practitioners, as as in the cross-cutting (penetrating) wounds of the in the cross-cutting (penetrating) wounds of the eyeeye

Foreign body of conjunctivaForeign body of conjunctivaClinicClinic

          After contact with a foreign body in the After contact with a foreign body in the conjunctiva in a patient comes tearing, blinking, conjunctiva in a patient comes tearing, blinking, foreign body sensation. Sometimes associated foreign body sensation. Sometimes associated

photophobia and eye painphotophobia and eye painCorneal foreign bodiesCorneal foreign bodies

  Clinic  Clinic     The presence of a foreign body in the cornea      The presence of a foreign body in the cornea

accompanied by pain, lacrimation, blepharospasm, accompanied by pain, lacrimation, blepharospasm, photophobia, foreign body sensation. Visually photophobia, foreign body sensation. Visually determined by a foreign body and conjunctival determined by a foreign body and conjunctival

injection and eyelids of the eyeball.injection and eyelids of the eyeball.

Emergency aid for foreign bodies of the conjunctiva Emergency aid for foreign bodies of the conjunctiva and corneaand cornea

Local anesthesia 0.25% solution dikaina, 2-4% lidocaine or Local anesthesia 0.25% solution dikaina, 2-4% lidocaine or 0.4% sodium inokaina.0.4% sodium inokaina.

Removal of foreign body surface is wet Removal of foreign body surface is wet swab.swab.

After removal of foreign body requires After removal of foreign body requires installation of 30% solution of sodium installation of 30% solution of sodium Sulfatsil, 0.25% solution of Sulfatsil, 0.25% solution of chloramphenicol, or 0.3% solution chloramphenicol, or 0.3% solution normaksa.normaksa.

For ever and lay 1% tetracycline eye ointment or For ever and lay 1% tetracycline eye ointment or levomitsetinovuyu.levomitsetinovuyu.

In the future - consultation ophthalmologist in an outpatient In the future - consultation ophthalmologist in an outpatient procedure.procedure.

If the foreign body penetrated the cornea and can not If the foreign body penetrated the cornea and can not remove the above methods, you need immediate remove the above methods, you need immediate specialized care.specialized care.

EEye injuriesye injuries The injuries may be accompanied by damage to the The injuries may be accompanied by damage to the

eyes of the cornea or sclera, or a combination eyes of the cornea or sclera, or a combination

thereof. If the wound goes through all of the cornea thereof. If the wound goes through all of the cornea

or sclera shells, wounding is pervasive. Penetrating or sclera shells, wounding is pervasive. Penetrating

injuries, regardless of their location are always injuries, regardless of their location are always

severe injuries. They are more dangerous than severe injuries. They are more dangerous than

penetrating.penetrating. The definitive diagnosis can only set an The definitive diagnosis can only set an

ophthalmologist.ophthalmologist.

Neprobodnye (non-penetrative) injury to the Neprobodnye (non-penetrative) injury to the cornea and scleracornea and sclera

occur when the surface effects of occur when the surface effects of the traumatic agent, when wounded the traumatic agent, when wounded by small foreign bodies.by small foreign bodies.

The clinic. The clinic. The patient complained of pain in the eye, The patient complained of pain in the eye, photophobia, lacrimation, blepharospasm, decreased photophobia, lacrimation, blepharospasm, decreased vision. In wounds of the conjunctiva or sclera soreness vision. In wounds of the conjunctiva or sclera soreness is usually small, damaged corneas as having very is usually small, damaged corneas as having very severe pain and foreign body sensation in the eye.severe pain and foreign body sensation in the eye.

Emergency care.Emergency care. For pain treatment - instillation of For pain treatment - instillation of 0.5% solution dikaina. Prevention of infectious 0.5% solution dikaina. Prevention of infectious complications: a 30% solution of sodium sulfatsil, complications: a 30% solution of sodium sulfatsil, 0.25% solution of chloramphenicol or 0.25% solution of chloramphenicol or levomitsetinovaya or 1% tetracycline ointment After levomitsetinovaya or 1% tetracycline ointment After applying aseptic dressings binocular patient should be applying aseptic dressings binocular patient should be transported to a specialized hospital.transported to a specialized hospital.

Perforated Perforated (penetrating) injuries of the eyeball are (penetrating) injuries of the eyeball are in the form of through damages the cornea and in the form of through damages the cornea and sclera of the eyeball.sclera of the eyeball.     Allocate 3 reliable sign of perforated injured eye:     Allocate 3 reliable sign of perforated injured eye: 1. The presence of the gaping wound of the cornea 1. The presence of the gaping wound of the cornea or sclera, where it is clear that the integrity of the or sclera, where it is clear that the integrity of the outer membrane of the eye broken across its outer membrane of the eye broken across its thickness;thickness;2. The presence of prejudice between the edges of 2. The presence of prejudice between the edges of the wound of the cornea or sclera of the inner shells the wound of the cornea or sclera of the inner shells the eye (iris, ciliary body, choroid proper, retina), or the eye (iris, ciliary body, choroid proper, retina), or vitreous humor;vitreous humor;3. The presence of a foreign body inside the eye.3. The presence of a foreign body inside the eye. The The clinicclinic is similar to perforated wound injury is similar to perforated wound injury neprobodnym eyes.neprobodnym eyes.

Emergency care.Emergency care. In penetrating wounds of all In penetrating wounds of all operations related to the examination and treatment operations related to the examination and treatment should be carried out very carefully, as this may should be carried out very carefully, as this may cause a reflex spasm of the eyelids and squeezing cause a reflex spasm of the eyelids and squeezing the inner contents of the eyeball through a wound. the inner contents of the eyeball through a wound. Treatment of eyelid skin is a 1% solution of brilliant Treatment of eyelid skin is a 1% solution of brilliant green, for pain treatment - Installation of 0.5% green, for pain treatment - Installation of 0.5% solution dikaina. Prevention of infectious solution dikaina. Prevention of infectious complications: a 30% solution of sodium sulfatsil, complications: a 30% solution of sodium sulfatsil, 0.25% solution of chloramphenicol (ointment not 0.25% solution of chloramphenicol (ointment not use !!!). Provided that the phase transport a patient use !!!). Provided that the phase transport a patient to a specialized medical institution may take more to a specialized medical institution may take more than 2-3 hours, should intramuscularly than 2-3 hours, should intramuscularly administration of antibiotics, and to prevent the administration of antibiotics, and to prevent the possible development of tetanus - the introduction of possible development of tetanus - the introduction of tetanus toxoid and tetanus toxoid. After applying tetanus toxoid and tetanus toxoid. After applying aseptic dressings binocular patient should be aseptic dressings binocular patient should be transported to a specialized hospital in ambulances, transported to a specialized hospital in ambulances, lying on its side on the side of a wounded eye. In this lying on its side on the side of a wounded eye. In this situation, if there is a foreign body inside the eye, it situation, if there is a foreign body inside the eye, it usually falls to the bottom of the eye in the place usually falls to the bottom of the eye in the place most suitable for disposal.most suitable for disposal.

Eye contusionEye contusion

Distinguish direct contusion, ie, the Distinguish direct contusion, ie, the direct effect on the eye, and indirect, direct effect on the eye, and indirect, by shaking the torso and the skull by shaking the torso and the skull (the fall, the shock wave in the (the fall, the shock wave in the explosions).explosions).

The clinic. The clinic. If the main symptom of concussion is a dull If the main symptom of concussion is a dull ache, dizziness, injection of the conjunctiva and ache, dizziness, injection of the conjunctiva and hemorrhage in the subcutaneous tissue and eyelids hemorrhage in the subcutaneous tissue and eyelids structure of the eyeball.structure of the eyeball.

Emergency care.Emergency care. Inside diakarb 2 tab. 0.25 g once. Inside diakarb 2 tab. 0.25 g once. General anesthesia - intramuscularly Tramal, Analgin. General anesthesia - intramuscularly Tramal, Analgin. Urgent consultation of a neurosurgeon, an Urgent consultation of a neurosurgeon, an ophthalmologist specialized care.ophthalmologist specialized care.

An acute attack of glaucomaAn acute attack of glaucoma Glaucoma Glaucoma - a large group of eye diseases - a large group of eye diseases

characterized by continuous or periodic increase in characterized by continuous or periodic increase in

intraocular pressure with the subsequent intraocular pressure with the subsequent

development of typical visual field defects, development of typical visual field defects,

decreased central vision and optic atrophy.decreased central vision and optic atrophy. Attack of glaucoma is caused by a rapid rise in Attack of glaucoma is caused by a rapid rise in

intraocular pressure, which is accompanied by intraocular pressure, which is accompanied by

clinical symptoms. Meets the bowl in the elderly, on clinical symptoms. Meets the bowl in the elderly, on

one side. Provoking factors are usually nervous one side. Provoking factors are usually nervous

overload and stress.overload and stress.

The clinic. Harbinger of an acute attack The clinic. Harbinger of an acute attack of glaucoma can be blurred vision and of glaucoma can be blurred vision and the appearance of bright circles around the appearance of bright circles around lights.lights.

The emergence of an The emergence of an attackattack is characterized by sudden onset is characterized by sudden onset of severe pain in the eye, radiating to the corresponding half of of severe pain in the eye, radiating to the corresponding half of the head. Sharply reduced visual acuity up to save only the head. Sharply reduced visual acuity up to save only svetooschusheniya. The pain may be accompanied by nausea, svetooschusheniya. The pain may be accompanied by nausea, vomiting, dizziness, severe chills, malaise.vomiting, dizziness, severe chills, malaise.

Instead of black, acute attack of glaucoma, the pupil appears Instead of black, acute attack of glaucoma, the pupil appears greenish, butgreenish, but the most important sign of glaucoma is a the most important sign of glaucoma is a sharp eye seal.sharp eye seal.

Emergency care. The main objective - to reduce intraocular Emergency care. The main objective - to reduce intraocular pressure and to normalize the blood circulation in the eye to pressure and to normalize the blood circulation in the eye to restore the power of the retina and optic nerve. To do this, restore the power of the retina and optic nerve. To do this, designate 1% solution of pilocarpine every 15, then 30 min to 2 designate 1% solution of pilocarpine every 15, then 30 min to 2 drops, 0.5% timolol solution once. Inside are 40-60 mg of drops, 0.5% timolol solution once. Inside are 40-60 mg of furosemide. Recommends the introduction of sedatives. It is furosemide. Recommends the introduction of sedatives. It is shown that giving saline laxative, hot foot bath. Hospitalization shown that giving saline laxative, hot foot bath. Hospitalization in a specialized hospital.in a specialized hospital.

Foreign bodies in otolaryngologyForeign bodies in otolaryngologyForeign bodies external auditory canalForeign bodies external auditory canal

Etiology. Etiology. Sulphur, epidermal cork plugging the lumen Sulphur, epidermal cork plugging the lumen of the ear canal; foreign bodies of different natureof the ear canal; foreign bodies of different nature..

The clinic The clinic depends on the size, shape, chemical depends on the size, shape, chemical composition of the foreign body. Children are becoming composition of the foreign body. Children are becoming restless, refuse food, deprived of sleep.restless, refuse food, deprived of sleep.

Emergency care. Emergency care. Foreign body ear canal to be Foreign body ear canal to be removed. Most of the foreign body is removed by removed. Most of the foreign body is removed by washing with warm, low concentration of potassium washing with warm, low concentration of potassium permanganate, in which case the liquid jet is directed permanganate, in which case the liquid jet is directed along the posterolateral wall of the upper canal.along the posterolateral wall of the upper canal.

The use of forceps to remove the foreign body rounded The use of forceps to remove the foreign body rounded endoauralno totally unacceptable because of the danger endoauralno totally unacceptable because of the danger of herniation of a foreign body in the bone department, of herniation of a foreign body in the bone department, injured eardrum, the introduction of a foreign body in injured eardrum, the introduction of a foreign body in the tympanic cavity and the subsequent development of the tympanic cavity and the subsequent development of acute otitis media, mastoiditis, and even meningitis.acute otitis media, mastoiditis, and even meningitis.

TTo remove a living foreign bodies in the ear canal pour o remove a living foreign bodies in the ear canal pour alcohol solution or sterile vaseline warmed or sunflower alcohol solution or sterile vaseline warmed or sunflower oil, after 4-5 min. produce flushing the ear.oil, after 4-5 min. produce flushing the ear.

Foreign bodies of the nose and paranasal sinusesForeign bodies of the nose and paranasal sinusesForeign bodies of nasal Foreign bodies of nasal observed predominantly in observed predominantly in children who have pushed themselves and their peers in children who have pushed themselves and their peers in

various subjects nose.various subjects nose. The diagnosis The diagnosis of nasal foreign body is put on the basis of nasal foreign body is put on the basis

of history, and radiological data rinoskopicheskih.of history, and radiological data rinoskopicheskih. Emergency care is to remove the foreign body.

Necessary to examine in detail the corresponding half of the nose, to determine the location and nature of its location. Pre-lubricate the nasal mucosa 3% solution of dikaina with 0.1% solution of epinephrine. In troubled children removal of foreign bodies of the nose should be done under general anesthesia. Pieces of cotton wool, gauze or other soft objects are removed with forceps or tweezers Hartmann. Rounded dense foreign bodies removed in this way is unacceptable. They should remove the special blunt hook Lange, who introduced a foreign body and careful traction "in itself" is removed from the nasal cavity.

Trauma of the external earTrauma of the external ear Damage to the ear there are bruises, wounds and Damage to the ear there are bruises, wounds and

bites. Observed varying degrees of tissue bites. Observed varying degrees of tissue damage up to the separation of the shell. In the damage up to the separation of the shell. In the perichondrium from the cartilage delamination perichondrium from the cartilage delamination may develop hemorrhage (otgematoma) in the may develop hemorrhage (otgematoma) in the form of the tumor purplish-blue or red. Often form of the tumor purplish-blue or red. Often there is inflammation of the perichondrium there is inflammation of the perichondrium (perihondrit). Damage to the external auditory (perihondrit). Damage to the external auditory canal are associated with shocks, bruises and a canal are associated with shocks, bruises and a foreign body. One of the most dangerous foreign body. One of the most dangerous manifestation of injury is a fracture of bone walls manifestation of injury is a fracture of bone walls of the external auditory canal, often accompanied of the external auditory canal, often accompanied by a concussion or fractured skull.by a concussion or fractured skull.

Typical signs of damage to the ear canal are a Typical signs of damage to the ear canal are a pain, its restriction due to infiltration and tissue pain, its restriction due to infiltration and tissue edema, hemorrhage, or bleeding, hearing loss. In edema, hemorrhage, or bleeding, hearing loss. In severe cases, there is significant bleeding, severe cases, there is significant bleeding, nausea, vomiting, sudden hearing loss, partial nausea, vomiting, sudden hearing loss, partial paresis of the facial nerve, liquorrhea, erysipelas.paresis of the facial nerve, liquorrhea, erysipelas.

Emergency aid Emergency aid for bruises shell is reduced to latch for bruises shell is reduced to latch the cold, and in the future - hot compress. In the the cold, and in the future - hot compress. In the presence of wounds - blurring the surrounding skin presence of wounds - blurring the surrounding skin with an alcoholic solution of iodine, the imposition of with an alcoholic solution of iodine, the imposition of aseptic dressings. In the crush of the skin and aseptic dressings. In the crush of the skin and cartilage - the introduction of tetanus toxoid and the cartilage - the introduction of tetanus toxoid and the primary debridement. If the ear shows perihondrite primary debridement. If the ear shows perihondrite dressing with ointment Vishnevsky, antibiotics. dressing with ointment Vishnevsky, antibiotics. Severe cases perihondritov, the presence of Severe cases perihondritov, the presence of otgematomy, the gap between the sink, turning the otgematomy, the gap between the sink, turning the ear canal, injury to weapons and firearms require ear canal, injury to weapons and firearms require hospitalization in a hospital. In these cases, the hospitalization in a hospital. In these cases, the affected area is necessary to impose an aseptic affected area is necessary to impose an aseptic dressing, but in no case should not be washed or dressing, but in no case should not be washed or instilled into the ear had any drops.instilled into the ear had any drops.

The trauma of middle and inner earThe trauma of middle and inner ear The most common damage to the eardrum, resulting The most common damage to the eardrum, resulting

from cleaning the ear with matches, pins, pencils, and a from cleaning the ear with matches, pins, pencils, and a sudden change in air pressure in the rumors. pass sudden change in air pressure in the rumors. pass (kick failures. jump into the water, etc.).(kick failures. jump into the water, etc.).

At the time of injury the patient has severe and acute At the time of injury the patient has severe and acute pain, crackling sound in the ear, a sharp decrease pain, crackling sound in the ear, a sharp decrease in hearing, sometimes fainting occurs. Damage to the middle in hearing, sometimes fainting occurs. Damage to the middle ear can occur when sudden changes in atmospheric ear can occur when sudden changes in atmospheric pressure (for caissonpressure (for caisson work, when you fly on an airplane, for work, when you fly on an airplane, for diving, etc.). The patient begins to feel stuffydiving, etc.). The patient begins to feel stuffy in the ear noise, in the ear noise, ringing, hearing loss, less nausea, vomiting, bleeding. In severeringing, hearing loss, less nausea, vomiting, bleeding. In severe trauma does not exclude the possibility of purulent otitis media, trauma does not exclude the possibility of purulent otitis media, reaction on the part of the inner ear (spontaneous reaction on the part of the inner ear (spontaneous nystagmus, loss of balance, dizziness), as well asparesis nystagmus, loss of balance, dizziness), as well asparesis or paralysis of the facial nerve (facial nerve canal fracture). If or paralysis of the facial nerve (facial nerve canal fracture). If the woundarea captures the middle or posterior cranial the woundarea captures the middle or posterior cranial fossa with rupture of the dura mater, itfossa with rupture of the dura mater, it may may appear liquorrhea with the overall poor state of the patient.appear liquorrhea with the overall poor state of the patient.

Damage to the inner ear Damage to the inner ear are are uncommon. Usually they are the result of cranial uncommon. Usually they are the result of cranial trauma. The patient recorded the trauma. The patient recorded the total lethargy, mental depression, deafness or deaf-total lethargy, mental depression, deafness or deaf-mutism, dizziness, nausea, and mutism, dizziness, nausea, and vomiting. Skull trauma often leads to vomiting. Skull trauma often leads to fracture(transverse or longitudinal) of the pyramid of fracture(transverse or longitudinal) of the pyramid of the temporal bone, which may arise the temporal bone, which may arise extensive hemorrhage into the inner ear, and extensive hemorrhage into the inner ear, and sometimes in the tympanum.sometimes in the tympanum.

Frequent symptom is the eardrum is bleeding from the Frequent symptom is the eardrum is bleeding from the ear canal. In the damage of the dura ear canal. In the damage of the dura mater appears liquorrhea. The general condition of the mater appears liquorrhea. The general condition of the patient, as a rule, heavy, sharp or there is a patient, as a rule, heavy, sharp or there is a complete hearing loss, often paresis or paralysis of the complete hearing loss, often paresis or paralysis of the facial nerve, dizziness, nausea, vomiting, loss of facial nerve, dizziness, nausea, vomiting, loss of balance. In open fractures is a real danger of balance. In open fractures is a real danger of intracranial complications (meningitis, brain abscess).intracranial complications (meningitis, brain abscess).

When emergency care When emergency care for injuries of the for injuries of the eardrum must be careful not to make an infection eardrum must be careful not to make an infection in the tympanic cavity. Therefore, counter-in the tympanic cavity. Therefore, counter-washing or drying the ear. Allowed a careful removal washing or drying the ear. Allowed a careful removal of blood clots and small from the ear canal, and then of blood clots and small from the ear canal, and then injected into the ear of a sterile swab, injected into the ear of a sterile swab, intramuscularly - antibiotics and tetanus serum in the intramuscularly - antibiotics and tetanus serum in the ear of aseptic bandage is applied.ear of aseptic bandage is applied.

When damaged, the middle ear as a result of the When damaged, the middle ear as a result of the impact of abrupt changes in pressure, as well impact of abrupt changes in pressure, as well as trauma of the inner ear is shown transporting a as trauma of the inner ear is shown transporting a patient to the hospital in preparation patient to the hospital in preparation for a used intravenously methenamine, for a used intravenously methenamine, subcutaneously Neostigmine with ascorbic subcutaneously Neostigmine with ascorbic acid tablets - Aeron and barbiturates. If there is acid tablets - Aeron and barbiturates. If there is bleeding, stop it all done by conventional methods - bleeding, stop it all done by conventional methods - from medicinal agents to tamponade.from medicinal agents to tamponade.

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