Pemicu V

Pemicu 5Niko Hizkia Simatupang405090117Trauma pada MataKelopak mata : hematom periokular, laserasiApparatus lakrimal : laserasiKonjungtiva : perdarahan subkonjungtiva, benda asingKornea : edema kornea, benda asing, luka bakarLensa : dislokasi lensaCOA : hifemaBenda asing intraokular, trauma kimiaTrauma to the eyelidPeriocular HematomaSOAP- A black eye consisting of a haematoma (focal collection of blood) and/or periocular ecchymosis (diffuse bruising) - Edema : the most common blunt injury to the eyelid or forehead.

Periocular hematoma4Periocular Hematoma

Periocular hematoma and edemaPeriocular hematoma and subconjunctival hemorrhage Panda eyes (basis cranial fracture)5Abrasion and laceration of the lidAbrasi PalberaSOAPbenda berbentuk partikel yg harus dikeluarkan untuk mengurangi risiko tattoing pada kulit Abrasi palpebra- Benda btk partikel harus dikeluarkan dgn cara : irigasi luka dgn saline + ditutup dgn salep AB & kasa steril jar. yg terlepas dibersihkan & dilekatkan kembali.- Laserasi partial-thickness di palpebra yg tdk mengenai tepi palpebra dpt diperbaiki secara bedah.- Laserasi full-thickness palpebra yg mengenai batas palpebra harus diperbaiki secara hati-hati cegah penonjolan tepi palpebra dan trikiasis- Bila perbaikan primer tidak dilakukan dalam 24 jam edema tunda penutupan - Luka harus dibersihkan secara cermat dan diberikan antibiotik.Management

Laserasi KanalikulusLaserasi di dekat kantus internus seringkali mengenai kanalikulus.Penggunaan stent atau intubasi dapat memperberat derajat kerusakan kanalikulus risiko stenosisPerbaikan dengan Veirs rod atau stent lainIntubasi nasokanalikular silikon dengan Quickert probes.Perdarahan subkonjungtivaHematoma SubkonjungtivaSOAPFunduskopi : bila tekanan bola mata rendah dgn pupil lonjong disertai tajam penglihatan menurun dan hematom subkonjungtiva eksplorasi bola mata u/ cari kemungkinan adanya ruptur bulbus okuliKadang bisa menutup keadaan mata yg lbh buruk sperti : perforasi bola mataPembuluh darah rentan dan mudah pecah : usia lanjut, HT, arteriosklerosis, konjungtivitis, anemia.Hematoma subkonjungtivaPengobatan dini : kompres hangatAkan hilang atau diabsorpsi dalam 1-2 minggu tanpa diobati

Superficial foreign bodySubtarsal Foreign BodySOAPSmall foreign bodies : particles of steel, coal or sand often impact on the corneal or conjunctival surface. Subtarsal Foreign BodyMay be washed along the tear film lacrimal drainage system or adhere to the superior tarsal conjunctiva in the subtarsal sulcus abrade the cornea with every blink (pathognomonic pattern of linear corneal abrasions)13Corneal Foreign BodySOAPLeukocytic infiltration may also develop around any foreign body of some durationAny discharge, infiltrate, or significant uveitis suspicion of secondary bacterial infectionCorneal Foreign Body- Careful slit-lamp examination to locate the exact position and depth of the foreign body.- The foreign body removed under slit lamp visualization using a sterile 26-gauge needle.- Magnetic removal deeply embedded metallic foreign body.- A residual rust ring remove with a sterile burr, if available.- Antibiotic ointment + cycloplegic and/or typical NSAIDs to promote comfort.

14Subtarsal, Abrasion, and Corneal

Subtarsal foreign bodyLinear abrasion stained with fluoresceinCorneal foreign body with surrounding cellular infiltration.15Benda asing di permukaan mata dan abrasi korneaAbrasi Kornea dan Benda AsingSOAP- Nyeri & mata merah krn iritasi saat mata & kelopak mata digerakkan- Pola tanda goresan vertikal di kornea benda asing terbenam di permukaan konjungtiva tarsalis palpebra superior- Pemakaian lensa kontak yg berlebihan edema kornea

Abrasi Kornea dan Benda Asing- Pengeluaran benda asing anestetik topikal + spud (alat pengorek) / jarum berukuran kecil mata diberikan salep AB dan ditutup- Luka diperiksa setiap hari cari tanda-tanda infeksi sampai luka sembuh sempurna- Terapi defek epitel kornea : salep AB & balut tekan imobilisasi palpebra- Jangan pernah beri larutan anestetik topikal pada pasien u/ dipakai ulang setelah cedera kornea memperlambat penyembuhan, menutupi kerusakan lebih lanjut, pembentukan jaringan parut kornea yang permanen.- Defek epitel hindari KS- Abrasi kornea : komplikasi anestesi umum hindari dgn menutup mata (dengan plester) / memberi salep pelumas mata di forniks konjungtiva sewaktu induksi.- Kdg tjd erosi epitel rekuren terapi : penutupan, bandage contact lens, mikropungsi kornea, excimer laser phototherapeutic keratectomy (PTK)Benda Asing

Luka bakar pada mataLuka Bakar KimiaSOAP- Basa (alkali) cepat menembus jaringan mata dan akan terus menimbulkan kerusakan lama setelah cedera terhenti - Luka bakar alkali TIO - Pelepasan PG tekanan sekunder (2-4 jam kemudian) berpotensi uveitis berat Luka bakar kimia- Harus diterapi sebagai kedaruratan mata.- Segera lakukan : pembilasan dengan air yang mengalir (air keran) di lokasi dikirim/dirujuk- IGD/UGD anamnesis dan pemeriksaan singkat permukaan mata dan forniks konjungtiva diirigasi dengan cairan yang sangat banyak- Saline isotonik steril diberikan melalui selang IV standar- Blefarospasme spekulum palpebra mata dan inflitrasi anestetik lokalLuka Bakar KimiaSOAP- Basa (alkali) cepat menembus jaringan mata dan akan terus menimbulkan kerusakan lama setelah cedera terhenti - Luka bakar alkali TIO - Pelepasan PG tekanan sekunder (2-4 jam kemudian) berpotensi uveitis berat Luka bakar kimia- Analgesik, anestetik topikal dan sikloplegik hampir selalu diberikan.- Aplikator kapas yang dibasahi dan pinset mengeluarkan benda-benda berbentuk partikel dari forniks (contoh : cedera yang berhubungan dengan plaster bangunan atau semen)- Periksa pH permukaan mata jika pH 7,3-7,7 ulangi irigasi salep antibiotik dan balutan tekan

Luka Bakar KimiaSOAP- Basa (alkali) cepat menembus jaringan mata dan akan terus menimbulkan kerusakan lama setelah cedera terhenti - Luka bakar alkali TIO - Pelepasan PG tekanan sekunder (2-4 jam kemudian) berpotensi uveitis berat Luka bakar kimia- Basa (alkali) bilasan jangka panjang dan pemeriksaan pH secara berkala.- Pelepasan PG potensi uveitis berat th/ : Steroid topikal, obat antiglaukoma, dan sikloplegik selama 2 minggu pertama- Setelah 2 minggu, pemakaian steroid harus hati-hati dapat menghambat reepitelisasi.- Luka bakar alkalis derajat sedang tetes mata askorbat (vitamin C) dan sitrat

Luka Bakar KimiaSOAP- Basa (alkali) cepat menembus jaringan mata dan akan terus menimbulkan kerusakan lama setelah cedera terhenti - Luka bakar alkali TIO - Pelepasan PG tekanan sekunder (2-4 jam kemudian) berpotensi uveitis berat Luka bakar kimia- Terpajannya kornea dan adanya defek epitel yang menetap air mata buatan, tarsorafi, atau bandage contact lens.- Kasus-kasus berat transplantasi epitel limbus serta graft membran amnion, corneal grafting membantu epitelisasi kornea.

Luka Bakar KimiaKomplikasi jangka panjang :Glaukoma, pembentukan jaringan parut korneam simblefaron, entropion, dan keratitis sikaPrognosis :Semakin banyak jaringan epitel perilimbus dan pembuluh darah sklera dan konjungtiva yang rusak prognosisi semakin burukLuka Bakar TermalSOAP- Iradiasi UV keratitis superfisialis yang nyeriTerpajan bunga api las tanpa perlindungan suatu filter, korsleting pada kabel tegangan tinggi, atau terpajan pantulan cahaya dari salju tanpa kacamata pelindung 6-12 jam nyeri keratitis superfisialis.- Energi radiasi dari menatap matahari atau gerhana matahari tanpa filter yang sesuai luka bakar serius pada makula gangguan penglihatan yang permanenPajanan sinar X yang berlebihan katarakKerusakan kornea yang berkepanjangan edema palpebra yang ekstensif (tindakan balut tekan tidak berguna) 2-3 hari mulai terjadi ektropion dan retraksi palpebra.Luka bakar termal- Kasus-kasus flash burn yang parah pemeriksaan : penetesan anestetik topikal steril terapi : balut tekan + salep antibiotik.- Pada palpebra terapi : antibiotik topikal dan balutan steril.- Tarsorafi dan moisture chamber yang dibuat dari plastik melindungi kornea- Full-thickness skin graft ditunda sampai kontraksi kulit tidak lagi berlanjut.

Dislokasi lensaEctopia LentisSOAP- Displacement of the lens from its normal position. Completely dislocated, rendering the pupil aphakic (luxated), or partially displaced, still remaining in the pupillary area (subluxated). - Hereditary or acquired. - Acquired causes : trauma, a large eye (e.g. high myopia, buphthalmos), anterior uveal tumours and hypermature cataract. Ectopia Lentis27Without Systemic AssociationSOAPAD condition characterized by bilateral symmetrical superotemporal displacement may manifest congenitally or later in life.Familial Ectopia LentisRare, congenital, bilateral, AR disorder characterized by displacement of the pupil and the lens in opposite directions. - The pupils are small, slit-like and dilate poorly.- Other findings : iris transillumination, large corneal diameter, glaucoma, cataract and microspherophakia.Ectopia Lentis et PupillaeAniridia is occasionally associated with ectopia lentis28Without Systemic Association

Ectopia Lentis et pupillaeInferior subluxation in aniridia29With Systemic AssociationSOAP- Ectopia lentis :bilateral and symmetrical is present in 80% of cases. - Subluxation is most frequently supero-temporal, but may be in any meridian. - Because the zonule is frequently intact accommodation is retained, although rarely the lens may dislocate into COA or vitreous. The lens may also be microspherophakic.Marfan Syndrome30Marfan Syndrome

Superotemporal subluxation with intact zonuleDislocation into the vitreous (rare)31With Systemic AssociationSOAP- Ectopia lentis : inferior occurs in 50% of cases during late childhood or early adult life. - Microspherophakia is common so that subluxation occurs anteriorly to cause pupil block or occasionally into COAWeill-Marchesani syndrome

32With Systemic AssociationSOAP- Ectopia lentis : inferonasal, almost universal by the age of 25 years in untreated cases. - The zonule which normally contains high levels of cysteine (deficient in homocystinuria) disintegrates accommodation is often lost. - Secondary angle-closure may occur as a result of pupil block caused by lens incarceration in the pupil, or a total dislocation into the anterior chamber.

Homocystinuria

Inferior subluxation with zonule disintegration33ComplicationRefractive error (lenticular myopia)Optical distortion due to astigmatism and/or lens edge effectGlaucoma Lens-induced uveitis.34TreatmentSpectacle correction correct astigmatism induced by lens tilt or edge effect in eyes with mild subluxation. Aphakic correction afford good visual results if a significant portion of the visual axis is aphakic in the undilated state.Surgical removal of the lens, using closed intraocular microsurgical techniques intractable ametropia, meridional amblyopia, cataract, lens-induced glaucoma, uveitis or endothelial touch.

35HyphemaSOAP- Contusive forces tear the iris vessels and damage the anterior chamber angle. Blood in the aqueous may settle out in a visible layer (hyphema). - Hemorrhage in COA- Source of bleeding : iris or ciliary body.- Traumatic hyphaema associated with IOP elevation due to trabecular blockage by red blood cellsHyphema- Treatment prevention of secondary haemorrhage and control of any elevation of IOP that may result in corneal blood staining .- -blocker to lower the increased IOP.- Topical steroids reduce inflammation and possibly the risk of secondary hemorrhage.- Surgical evacuation of the blood risk of permanent corneal staining (rare) or persistently intolerable IOP. - If a total hyphaema persists for > 5 days consider evacuation to prevent the occult development of peripheral anterior synechiae and chronic secondary glaucoma.

HyphemaSOAP- Contusive forces tear the iris vessels and damage the anterior chamber angle. Blood in the aqueous may settle out in a visible layer (hyphema). - Hemorrhage in COA- Source of bleeding : iris or ciliary body.- Traumatic hyphaema associated with IOP elevation due to trabecular blockage by red blood cellsHyphema- Visible hyphema filling > 5% of the COA should rest. - Steroid drops. - Pupillary dilation risk of re-bleeding deferred until the hyphema has resolved by spontaneous absorption. - Initial assessment for posterior segment damage : require ultrasound examination. - The eye should be examined frequently for secondary bleeding, glaucoma, or corneal blood staining from iron pigment.

Hyphema

Bleeding from the ciliary bodySmall hyphemaTotal hyphema Corneal blood staining38Intraocular Foreign BodyIOFBSOAP- Infection or exert other toxic effects on the intraocular structures. - Notable mechanical effects : cataract formation secondary to capsular injury, vitreous liquefaction, and retinal haemorrhages and tears. Stone and organic foreign bodies are associated with a higher rate of infectionIntraocular Foreign Body

DIAGNOSIS :- Accurate history - Examination possible sites of entry or exit. - Gonioscopy and fundoscopy must be performed. - Associated signs (lid laceration and damage to anterior segment structures) must be noted.- CT with axial and coronal cuts to detect and localize a metallic IOFB.-MRI contraindicated in the context of a metallic (specifically ferrous) IOFB.- Magnetic removal of ferrous foreign bodies sclerotomy with application of a magnet followed by cryotherapy to the retinal break. - Scleral buckling reduce the risk of retinal detachment.- Forceps removal non-magnetic foreign bodies and magnetic foreign bodies that cannot be safely removed with a magnet. - Prophylaxis against infection.* Ciprofloxacin 750mg b.d. or moxifloxacin 400mg daily open globe injuries, together with topical antibiotic, steroid and cycloplegia.* Intravitreal antibiotics for high-risk cases (e.g. agricultural injuries). 40IOFB

In the lensIn the angleIn the anterior vitreous On the retina, associated with pre-retinal hemorrhage41Eye Chemical injuryChemical InjurySOAP- 2/3 of accidental burns occur at work and the remainder at home. - Alkali burns are twice as common as acid burns since alkalis are more widely used both at home and in industry. - Alkalis tend to penetrate more deeply than acids, as the latter coagulate surface proteins, forming a protective barrier. - Ammonia and sodium hydroxide may produce severe damage because of rapid penetration. - Hydrofluoric acid tends to rapidly penetrate the eye- Sulphuric acid complicated by thermal effects and high velocity impact after car battery explosions.

Eye chemical injuryEMERGENCY TH/Copious irrigation crucial to minimize duration of contact with the chemical and normalize the pH in the conjunctival sac as soon as possibleDouble-eversion of the upper eyelid Debridement of necrotic areas of corneal epithelium Admission to hospital severe injuries (grade 4 3) to ensure adequate eye drop instillation in the early stages.43SOAPEye chemical injuryTH/- Most mild (grade 1 and 2) injuries topical antibiotic ointment for about a week, with topical steroids and cycloplegics if necessary. - Steroids reduce inflammation and neutrophil infiltration, and address anterior uveitis. - Cycloplegia improve comfort.- Topical antibiotic drops prophylaxis of bacterial infection (e.g. chloramphenicol q.i.d.)- Ascorbic acid improves wound healing, promoting the synthesis of mature collagen by corneal fibroblasts. - Citric acid : powerful inhibitor of neutrophil activity reduces the intensity of the inflammatory response. - Tetracyclines effective collagenase inhibitors and inhibit neutrophil activity and reduce ulceration. - Symblepharon formation lysis of developing adhesions with a sterile glass rod or damp cotton bud.Monitor IOP and treat if necessary; oral acetazolamide is recommended.Surgery44Etiology

Roper Hall Grading

Limbal ischemia grade 2 corneal haze but visible iris detailsgrade 3 corneal haze obscuring iris detailsgrade 4 total corneal opacification46Complication

Conjunctival bandsSymblepharonCicatricial entropion of the upper eyelidKeratoprosthesis 47Diagnosis : Physical ExaminationCheck pH of both eyes not normal irrigationAsses the extent and depth of injuryThe degre of corneal, conjunctival, and limbal involvement to predict visual outcomePalpebral fissures and the fornicesIOP increased in acute and chronic alkali injuries

SymptomSevere pain Epiphora Blepharospasm Reduced visual acuity

Recommended TreatmentGrade I Topical antibiotic ointment (erythromycin or similar) 4x/dayPrednisolone acetate 1% 4x/dayPreservative free artificial tears as neededPain consider short acting cycloplegic (cyclopentolate) 3x/day

Recommended TreatmentGrade II Topical antibiotic drop (fluoroquinolone) 4x/dayPrednisolone acetate 1% hourly while awake for the 1st 7-10 days epithelium has not healed by day 10-14 consider taperingLong acting cycloplegic (atropine)Oral vitamin C 2 g 4x/dayDoxycycline, 100 mg 2x/day (avoid in children)Sodium ascorbate drops (10%) hourly while awakePreservative free artificial tears as needed Debridement of necrotic epithelium and application of tissue adhesive as needed

Recommended TreatmentGrade IIIAs for Grade IIConsider AMT/Prokera placement ideally performed in the 1st week of injuryGrade IVAs for Grade IIIEarly surgery Significant necrosis Tennoplasty reestablish limbal vascularitySeverity of the ocular surface damage AMTOcular and orbital traumaTrauma to the GlobeSOAP- Closed injury due to blunt trauma, the corneoscleral wall is still intact.- Open injury full-thickness wound of the corneoscleral envelope.- Contusion : closed injury resulting from blunt trauma damage may occur at or distant to the site of impact.- Rupture : full-thickness wound caused by blunt trauma weakest point may not be at the site of impact.Laceration : full-thickness defect in the eye wall produced by tearing injury result of direct impact.- Lamellar laceration : partial-thickness .- Incised injury : by a sharp object such as glass or a knife.- Penetrating injury : single full-thickness wound caused by sharp object without an exit wound.- Perforation : 2 full-thickness wounds (one entry and one exit) caused by a missile.Trauma to the globe

SPECIAL INVESTIGATIONS :- Plain radiographs foreign body is suspected- CT superior to plain radiography in the detection and localization of intraocular foreign bodies. MRI : more accurate than CT in the detection and assessment of injuries of the globeElectrodiagnostic tests useful in assessing the integrity of the optic nerve and retinaDetermination of the nature and extent of any life-threatening problems.History of the injury : the circumstances, timing and likely object.Thorough examination of the eyes and the orbits.

55Ocular TraumaSOAP- Common cause of unilateral blindness in children and young adults sustain the majority of severe ocular injuries. - Young adults (esp : men) most likely victims of penetrating ocular injuries. - Severe ocular trauma multiple injuries to the lids, globe, and orbital soft tissues Ocular trauma

INITIAL EXAMINATION :The direct and indirect ophthalmoscopes to view the lens, vitreous, optic disk, and retina. Photographic documentation for medicolegal purposes in all cases of external trauma. In all cases of ocular trauma, the apparently uninjured eye should also be carefully examined.

- Analgesics, antiemetics, and tetanus antitoxin are given as needed. - Small children may also be better examined initially with the aid of a short-acting general anesthetic.- Caution:Topical anesthetics, dyes, and other medications placed in an injured eye must be sterile. Both tetracaine and fluorescein are available in sterile, individual dose units.

Ocular Trauma

Eyelid laceration with concurrent ocular open globe injury. A. Rather innocuous-appearing V-shaped eyelid laceration involving the upper and lower lid and medial canthal skinOcular TraumaEyelid laceration with concurrent ocular open globe injury. B. Total dark red hyphema and hemorrhagic chemosis are evident when the lids are separated. Note also that laceration extends through both lacrimal canaliculi.

Trauma tumpul bola mataBlunt TraumaSOAP- Etiology : squash balls, elastic luggage straps and champagne corks. Severe orbital blunt trauma anteroposterior compression with simultaneous expansion in the equatorial plane associated with a transient but severe in IOP. - The impact is primarily absorbed by the lens-iris diaphragm and the vitreous base damage can also occur at a distant site : posterior pole. - The extent of ocular damage depends on the severity of trauma. - Commonly results in long-term effects; the prognosis is therefore necessarily guarded. Trauma tumpul pada mataGlaucoma : topical therapy with -blockers (timolol 0.25% 2x/day), prostaglandin analogs (latanoprost 0.005% in the evening), dorzolamide 2% 2-3x/day, or apraclonidine 0.5% 3x/day. Oral therapy with acetazolamide (250 mg orally 4x/day) and hyperosmotic agents (mannitol, glycerol, and sorbitol) if topical therapy is ineffective. Glaucoma drainage surgery extreme cases.

60Blunt Trauma

61Blunt Trauma

62Trauma tembus bola mataPenetrating TraumaSOAP- The extent of the injury is determined by the size of the object, its speed at the time of impact and its composition. Sharp objects (knives) well-defined lacerations of the globe.

Trauma tembus bola mata64Penetrating TraumaMale : female ration = 3 : 1 , typically occur in a younger age group (50% aged 1534). The most frequent causes : assault, domestic and occupational accidents, and sport. Extent of damage caused by flying foreign bodies determined by their kinetic energy. Risk of infection with any penetrating injury : endophthalmitis or panophthalmitis loss of the eye. Risk factors : delay in primary repair, ruptured lens capsule and a dirty wound. Any eye with an open injury should be covered by a protective eye shield upon diagnosis.

65Corneal Penetrating WoundSOAP- Small shelving wounds with formed anterior chamber often heal spontaneously or with the aid of a soft bandage contact lens.- Medium-sized wounds require suturing, especially if COA is shallow or flat postoperative bandage contact lens may be applied subsequently for a few days to ensure that the anterior chamber remains deep.Trauma tembus kornea- With iris involvement wounds require iris abscission.- With lens damage wounds suturing the laceration and removing the lens by phacoemulsification or with a vitreous cutter.

66Corneal Penetrating Wound

A. Small shelving with formed COA.B. With flat COA.C. With iris involvement.D. With lens damaged.67Scleral Penetrating WoundSOAP- Anterior scleral lacerations have a better prognosis than those posterior to the ora serrata. - Anterior scleral wound serious complications : iridociliary prolapse and vitreous incarceration. Vitreous incarceration not appropriately managed subsequent fibrous proliferation along the plane of incarcerated vitreous and tractional retinal detachment. Trauma tembus sklerascleral suturing reposit viable uveal tissue and cut prolapsed vitreous flush with the wound.

68Scleral Penetrating Wound

A. Anterior circumferential scleral laceration with iridociliary prolapse.B. Radial anterior scleral laceration with ciliary and vitreous prolapse.C. Fibrous proliferation.69TreatmentAnterior segment wounds microsurgical techniques. Corneal lacerations 10-0 nylon sutures to form a watertight closure. Incarcerated iris or ciliary body exposed for < 24 hours reposition in the globe with viscoelastics or by introducing a cyclodialysis spatula through a limbal stab incision and sweeping the tissue out of the wound. If this cannot be achieved, if the tissue has been exposed for > 24 hours, or if it is ischemic and severely damaged prolapsing tissue should be excised at the level of the wound lipLens remnants and blood removed with mechanical irrigation and aspiration or vitrectomy equipment. Anterior chamber reformation during repair viscoelastics, air, or physiologic intraocular fluids.Scleral wounds closed with interrupted 8-0 or 9-0 nonabsorbable sutures. Trauma pada TelingaTrauma aurikulerTrauma tulang temporalBarotraumaTrauma di membran tympani (perforasi membran tympani)Trauma aurikulaAuricular HematomaSOAP- Blunt injury to the auricle auricular hematoma.- Common injury in sport, particularly in wrestlers and boxers.- Injury to perichondrial BF blood accumulation in the subperichondrial space perichondrium off of the cartilage not drained cartilage necrosis.- The trapped blood and injured perichondrium fibrocartilagenous mass cauliflower ear

Auricular hematoma- Auricular hematoma must be evaluated and addressed as soon as possible following the injury (preferably within 62 hours).- Long-recommended treatment : evacuation of the hematoma and application of pressure dressing prevent re-accumulation of the blood.- Wide incision with a scalpel drainage and removal of clot and fibroneocartilage bolster dressing for 7-10 days.Auricular Hematoma

Burns TraumaSOAP- 1st degree burns scald injuries and results in little necrosis, inflammation and considerable pain.Usually heals with no scar- 2nd degree burns partial thickness burns epidermolysis and blistering.- 3rd degree burns full thickness and generally anesthetic significant tissue loss

Burns trauma- 1st degree burns Th/ : NSAID for pain and emollient creams- 2nd degree burns Th/ : NSAID, gentle cleansing and application of antibiotic ointment- 3rd degree burns Th/ : 2nd degree burn and require reconstructive intervention- Pressure on the auricle should be avoided the patient may need to wear protective cup or bolster.- Adequate analgesics to all patients with burns.- Complication : perichondritis (25% of all 2nd and 3rd degree burns) prevention : topical antibiotic ointment FrostbiteSOAP- Prolonged exposure to T < 0oC anesthesia, pallor, ice crystal formation within tissue.- With thawing, endothelial damage severe edema and sludging of blood risk of necrosis.- Acute area be gently thawed by application of moist cotton pledgets slightly warmer than body T.

frostbite- Compressive dressing should be avoided.- Apply antibiotic creams

Trauma tulang temporalTemporal Bone TraumaPhysical insult of the temporal bone induced by impact with a blunt surface of penetrating missile.Young men (20-30 y.o) the most commonly affected group.Road traffic accident 40-50% traumatic temporal bone fractures.Causes : falls, assaults, industrial and sporting accidents.

Temporal Bone TraumaSOAPHilang pendengaran- 17% of patients will lose all hearing in the affected ear as result of temporal bone fracture.- Evidence of a penetrating injury to the temporal region of the skull- Otorrhea - Bruising over the mastoid process (Battles sign)- LMN N.VII palsy.- Otoscopy : presence of fresh blood in EAC, injury to TM with perforation, hemotympanum, step deformity in the bony wall of EAC.Trauma tulang temporal

DIAGNOSIS- CT Scans diagnostic gold standard test.- MRI evidence of N.VII injury and hematoma within cochlear.- Hearing assessment : pure-tone audiometry, tympanometry.- Vestibular assessment : Dix-Hallpike manoevres, Romberg test- Facial nerve function - CSF, otorrhea, rhinorrhea : Beta-2 transferrin analysis.- TM perforation which persist for 3 months after initial injury surgical closure (tympanoplasty).- Bilateral profound SNHL secondary to labyrinthine trauma cochlear implant.

Fraktur tulang temporalTemporal Bone FracturesSOAPedema, hematoma, bleeding, conductive or SNHL, dizziness, CSF leak, facial paralysis.Fraktur tulang temporal

DIAGNOSISHRCT (High Resolution Computed Tomography)Surgery- Run parallel to the long axis of the petrous ridge- Comprised 70-90% of all temporal bone fractures and were seen with N.VII injury 10-25% of time.- Laceration of EAC extending into tears of TM TM perforation and ossicular discontinuity HL- Anterior fractures low incident of middle meningeal artery laceration epidural hematoma.Fraktur Longitudinal- Hemotympanum, SNHL, vertigo, nystagmus, and N.VII paresis (38-50% patients)- Medial fractures transversed the fundus of IAC complete and permanent SNHL.- Lateral fractured the cochlea or vestibule incomplete SNHL fluctuant related to PLFFraktur TransversalBarotrauma (aerotitis)Otitic BarotraumaPathological conditions of the ear induced by pressure changes.Commonly occurs in airline passengers, divers, water skiing etc.Failure of middle ear pressure equalization inner ear compression barotrauma.Decompression and recompression middle ear barotrauma.

Otitic BarotraumaSOAPPain increasing with depth, ear canal skin and TM become injected and petechial hemorrhage and even bleeding.External ear barotrauma

Causes : cerumen, earplugs, foreign bodies or exostoses.clear EAC of blood/wax debris, antibiotic drops for secondary infection, surgical repair of any perforation if spontaneous healing fails, consider exosrectomy.- Sensation of a blocked ear with strong desire to equalize otalgiaMinimal conductive HLPerforation may occur sudden severe pain

Middle ear barotrauma

Very common during flight and scuba diving.

- Preventation : oral pseudoephedrine and Otovents.- Treatment : surgical repair of TM and nasal septal (vomero-ethmoidal) surgery (to improve the ability to equalize middle ear pressure)Dysequilibirum with manouevres which ICP, sensorineural HL, mild nausea, unaccustomed motion sickness, vertigo, tinnitus, BPPV.Inner ear barotrauma

3 types : inner ear hemorrhage, labyrinthine tears, and perilymphatic fistulae.Surgery severity of the HL and failure of the vestibular symptoms to resolve.

Middle Ear Barotrauma

Barotrauma

Trauma membran tympaniMiddle Ear TraumaSOAPPain, conductive / sensory HL, disequilibrium, tinnitus, and rarely dysgeusia or N.VII paralysis.

Trauma membran tympani

- Penetrating objects : misguided cotton tip applicator, hairpin, key, pencil, picks and knives.- Treatment : facilitating spontaneous closure debridement of the canal .- Perforations > 3-10 months tympanoplasty to reduce the risk of chronic infection or cholesteatoma.

Middle Ear TraumaInjury : localized and often has predictable path.Complication : delayed infection, otorrhea, subsequent cholesteatoma formation.88% traumatic perforation of TM heal spontaneously within 3-10 months related to size of the perforation.