Seattle/King County EMT-B Class

Topics

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Eye Injuries: Chapter 25

Face & Throat Injuries: Chapter 26

Chest Injuries: Chapter 27

1 Eye Injuries

Eye Injuries

• Can produce severe complications• Examine pupil for shape and

reaction.

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Appearance of Eye

• In a normal, uninjured eye, the entire circle of the iris should be visible.

• Pupils should be round, equal in size, react equally when exposed to light.

• Both eyes should move in same direction when following a finger.

• Always note patient’s signs and symptoms including severity and duration.

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• Observe for hazards.• Request additional help

early

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1. Scene Size-up

Scene Size-up

• Decide SICK/NOT SICK.• Eye injuries can cause

permanent disability.• Can create great

anxiety• Approach patient

calmly.

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1. Scene Size-up

Initial Assessment

2. Initial Assessment

Rapid physical exam• In bleeding cases, do

not focus just on bleeding.

• Quickly assess entire patient from head to toe.

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1. Scene Size-up

Focused History/Physical Exam

2. Initial Assessment

3. Focused History/ Physical Exam

Focused physical exam• Begin with eyes and

face.• Assess eyes for equal

gaze.• Check pupil shape and

response to light.• Assess globe for

bleeding.• If eye is swollen shut, do

not attempt to open.

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1. Scene Size-up

Focused History/Physical Exam

2. Initial Assessment

3. Focused History/ Physical Exam

• Perform if patient is stable and time allows.

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1. Scene Size-up

Detailed Physical Exam

2. Initial Assessment

3. Focused History/ Physical Exam4. Detailed Physical Exam

• With serious injuries, make sure bandage covers both eyes and is not putting pressure on eyeball.

• Communication and documentation

• Inform hospital in case eye specialists are available.

• Document the patient’s vision or changes in vision.

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1. Scene Size-up

Ongoing Assessment

2. Initial Assessment

3. Focused History/ Physical Exam4. Detailed Physical Exam

5. Ongoing Assessment

Foreign Objects in the Eye

• For small foreign objects lying on the surface of the eye, irrigate with saline.

• Flush from the nose outward.

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Removing a Foreign Object• Never attempt to

remove an object on the cornea.

• Have the patient look down.

• Place a cotton-tipped applicator on the outer surface of the upper lid.

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Removing a Foreign Object• Pull the lid

upward and forward.

• Gently remove the foreign object from the eyelid with a moistened, sterile applicator.

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Foreign Objects Impaled in the Eye• If there is an object

impaled in the eye, do not remove it.

• Immobilize the object in place.

• Prepare a doughnut ring by wrapping a 2” piece of gauze around your fingers and thumb.

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• Remove the gauze from your hand and wrap remainder of gauze around ring.

• Carefully place the ring over the eye and impaled object, without bumping the object.

1Foreign Objects Impaled in the Eye

• Stabilize the object with roller gauze.

• Cover the injured and uninjured eye.

1Foreign Objects Impaled in the Eye

Chemical Burns• Chemicals, heat, and light rays can

burn the eye.• For chemicals, flush eye with saline

solution or clean water.• You may have to force eye open to

get enough irrigation to eye.• With an alkali or strong acid burn,

irrigate eye for about 20 minutes.• Bandage eye with dry dressing.

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Irrigating the Eye1

Thermal Burns• For thermal burns, cover both eyes with

a moist, sterile dressing.

• Transport patient to a burn center.

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Light Burns• Infrared rays, eclipse light, direct

sunlight, and laser burns can damage the eye.

• Cover each eye with a sterile pad and eye shield.

• Transport the patient in a supine position.

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Common Eye Injuries

Lacerations

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• Lacerations to the eyes require very careful repair.

• Never exert pressure on or manipulate the eye.

• If part of the eyeball is exposed, apply a moist, sterile dressing.

• Cover the injured eye with a protective metal eye shield.

Common Eye Injuries, continuedLaceration

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• Blunt trauma can cause a number of serious injuries.̶E A fracture of the orbit

(blowout fracture)̶E Retinal detachment

• May range from a black eye to a severely damaged globe

Blunt trauma

Common Eye Injuries, continuedLaceration

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• Bleeding in the anterior chamber of the eye

• May seriously impair vision

Blunt trauma

Hyphema

Common Eye Injuries, continuedLaceration

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• May occur from blunt trauma caused by a fracture of the orbit

• Bone fragments may entrap muscles that control eye movement, causing double vision.

Blunt trauma

Hyphema

Blowout fracture

Common Eye Injuries, continuedLaceration

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• Often seen in sports injuries

• Produces flashing lights, specks, or floaters in field of vision

• Needs prompt medical attention

Blunt trauma

Hyphema

Blowout fracture

Retina detachment

Contact Lenses and Artificial Eyes• Contact lenses should be kept in the

eyes unless there is a chemical burn.

• Do not attempt to remove a lens from an injured eye.

• Notify the hospital if the patient has contact lenses.

• If there is no function in an eye, ask if the patient has an artificial eye.

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Contact Lens Removal

• If absolutely necessary, remove a hard contact lens with a small suction cup, moistening the end with saline.

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Contact Lens Removal, cont'dTo remove a soft contact lens:

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1. Place two drops of normal saline in eye.

2. Gently pinch it between your gloved thumb and index finger.

3. Lift it off surface of eye.

2Face & Throat Injuries

Anatomy of the Head2

Landmarks of the Neck2

Injuries to the Face• Injuries about the face can lead to

upper airway obstructions.

• Bleeding from the face can be profuse.

• Loosened teeth may lodge in the throat.

• If the great vessels are injured, significant bleeding and pressure may occur.

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Soft-Tissue Injuries• Soft-tissue injuries to

the face and scalp are common.

• Wounds to the face and scalp bleed profusely.

• A blunt injury may lead to a hematoma.

• Sometimes a flap of skin is peeled back from the underlying muscle.

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Hematoma

• Blunt injury that does not break the skin may cause a break in a blood vessel wall.

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Care of Soft-Tissue Injuries

• Assess the ABCs and care for life-threatening injuries.

• Follow proper BSI precautions.• Blood draining into the throat can lead

to vomiting. Monitor airway constantly.• Take appropriate precautions if you

suspect a neck injury.

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Care of Soft-Tissue Injuries• Control bleeding

by applying direct pressure.

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Care of Soft-Tissue Injuries

• Injuries around the mouth may obstruct the airway.

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Injuries of the Nose

• Blunt trauma to the nose can result in fractures and soft-tissue injuries.

• Cerebrospinal fluid coming from the nose is indicative of a basal skull fracture.

• Bleeding from soft-tissue injuries of the nose can be controlled with a dressing.

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Injuries of the Ear• Place a dressing

between the ear and scalp when bandaging the ear.

• For an avulsed ear, wrap the part in a moist sterile dressing.

• If a foreign body is lodged in the ear, do not try to manipulate it.

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Facial Fractures

• A direct blow to the mouth or nose can result in a facial fracture.

• Severe bleeding in the mouth, loose teeth, or movable bone fragments indicate a break.

• Fractures around the face and mouth can produce deformities.

• Severe swelling may obstruct the airway.

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Dislodged Teeth

• Dislodged teeth should be transported with the patient in a container with some of the patient’s saliva or with some milk to preserve them.

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Blunt Injuries of the Neck• A crushing injury of the

neck may involve the larynx or trachea.

• A fracture to these structures can lead to subcutaneous emphysema.

• Be aware of complete airway obstruction and the need for rapid transport to the hospital.

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Penetrating Injuries of the Neck• They can cause severe

bleeding.• The airway,

esophagus, and spinal cord can be damaged from penetrating injuries.

• Apply direct pressure to control bleeding.

• Place an occlusive dressing on a neck wound.

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Penetrating Injuries of the Neck• Secure the

dressing in place with roller gauze, adding more dressing if needed.

• Wrap gauze around and under patient’s shoulder.

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Eye Injuries Following a Head Injury• One pupil larger than the other• Eyes not moving together or pointing in

different directions• Failure of the eyes to follow equally

E̶Bleeding under the conjunctivaE̶Protrusion or bulging of one eye

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Pupil Size and Head Injury

• Variation in pupil size may indicate a head injury.

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3 Chest Injuries

Organs of the Chest3

Structures of the Chest3

Mechanics of Ventilation

Inspiration (active process)• Intercostal muscles contract and

diaphragm flattens.Expiration (passive process)

• Intercostal muscles and diaphragm relax; tissues move back to normal position.

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Mechanics of Ventilation, cont'dSpinal cord injury below C5

• Loss of ability to move intercostal muscles

• Diaphragm can still contract; patient can still breathe.

Spinal cord injury at C3 or higher• No ability to breathe

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Spinal Cord Injury Below C53

Injuries to the ChestClosed chest injuries

• Caused by blunt trauma

Open chest injuries• Caused by

penetrating trauma

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Signs and Symptoms• Pain at site of injury

• Pain aggravated by increased breathing

• Bruising to chest wall

• Crepitus with palpation of chest

• Penetrating injury to chest

• Dyspnea

• Hemoptysis

• Failure of chest to expand normally

• Rapid, weak pulse and low blood pressure

• Cyanosis around lips or fingernails

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Inspection

• Decreased breath sounds usually indicate significant damage to a lung.

• If both sides of chest do not have equal rise and fall, chest muscles have lost ability to work properly.

• If one section of chest moves in opposite direction from the rest of the chest (paradoxical motion), this is a life threat.

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Immediate Interventions• Decide SICK/NOT SICK.• Provide complete spinal immobilization.• Apply an occlusive dressing to any

penetrating chest injury.• Stabilize paradoxical motion with a large

bulky dressing and 2'' tape.• Apply oxygen via non-rebreathing mask.• Provide positive pressure ventilations if

breathing is inadequate.• Control bleeding/treat for shock.

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Circulation• Assess patient’s pulse.• Consider aggressive treatment for shock.• Internal bleeding can quickly cause death.• Pay attention to subtle clues such as:

– Skin signs– Level of consciousness– Sense of impending doom

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Complications of Chest Injuries

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A pneumothorax occurs when air leaks into the space between the pleural surfaces.

A pneumothorax occurs when air leaks into the space between the pleural surfaces.

Pneumothorax• Air enters through a

hole in the chest wall.– The lung may

collapse in a few seconds or a few minutes.

• An open or penetrating wound to the chest is called a sucking chest wound.

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Care for Open Pneumothorax• Clear and manage

the airway.• Provide oxygen.• Seal an open

wound with an occlusive dressing.

• Depending on local protocol, tape down all four sides or create a flutter valve.

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Spontaneous Pneumothorax• Some people are born with or develop

weak areas on the surface of the lungs.• Occasionally, the area will rupture

spontaneously, allowing air into the pleural space.

• Patient experiences sudden chest pain and trouble breathing.

• Consider a spontaneous pneumothorax for a patient with chest pain without cause.

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Tension PneumothoraxCan occur:

• from sealing all four sides of the dressing on a sucking chest wound.

• from a fractured rib (closed injury) puncturing the lung or bronchus.

• as a result from a spontaneous pneumothorax.

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Tension Pneumothorax, cont'd

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Signs and Symptoms include:• Respiratory distress• Distended neck veins• Tachycardia• Low blood pressure• Cyanosis• Decreased lung sounds• Tracheal deviation

3Tension Pneumothorax, cont'd

Care for Tension Pneumothorax• If a tension pneumothorax

develops from sealing an open chest wound, partly remove the dressing to let the air escape.

• If there is no open wound, follow local protocol.

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Hemothorax• Collection of blood in the pleural space• Suspect if the following are seen:

– Signs and symptoms of shock– Decreased breath sounds on affected

side

• If both air and blood are present in the pleural space, it is a hemopneumothorax.

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Hemothorax, continued3

Rib Fractures• They are very common in the older

people.• A fractured rib may lacerate the surface

of the lung.• Patients will avoid taking deep breaths

and breathing will be rapid and shallow.• The patient often holds the affected side

to minimize discomfort.• Administer oxygen.

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Flail Chest

• Segment of chest wall detached from rest of thoracic cage

• Occurs when:– Three or more ribs are fractured

in two or more places.– Sternum is fractured along with

several ribs.• Creates paradoxical motion

(asymmetrical and opposite movement of the chest during inspiration/expiration)

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Flail Chest, continued3

Care for Flail Chest• Maintain airway.• Provide respiratory

support with BVM if needed.

• Perform ongoing assessments for pneumothorax and other respiratory complications.

• Immobilize flail segment.

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Pulmonary Contusions

• Bruising of the lung.• Develops over hours.• Alveoli fill with blood, and edema

accumulates in the lung, causing hypoxia.

• Provide oxygen and ventilatory support.

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Traumatic Asphyxia• Sudden, severe compression of chest,

i.e.: (crushed by a car that fell of the jack)

• Produces rapid increase in pressure within chest

• Results in neck vein distention, cyanosis, and bleeding into the eyes

• Provide supplemental oxygen and monitor vital signs.

• Transport immediately.

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Blunt Myocardial Injury• Bruising of heart muscle.• Pulse is often irregular.• There is no prehospital treatment

for this condition.• Check patient’s pulse and note

irregularities.• Provide supplemental oxygen and

transport immediately.

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Pericardial Tamponade• Blood or other fluids collect in the pericardium.

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Pericardial Tamponade, cont'dSigns and symptoms include:

• Very soft and faint heart tones• Weak pulse• Low blood pressure• Decrease in difference between

systolic and diastolic blood pressure• Jugular vein distention (JVD)

Provide oxygen and transport quickly.

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Laceration of the Great Vessels• The superior vena cava, inferior vena

cava, pulmonary arteries and veins, and aorta are contained in the chest.

• Injury to these vessels can cause fatal hemorrhage.

• Treatment includes:• Ventilatory support• Supplemental oxygen• CPR• Transport immediately.

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• What questions do you have?

Questions

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