Illinois EMSC1 EENT and Dental Objectives Upon completion of this lecture, you will be better able to: List the steps in assessing an eye injury Describe interventions for specific eye injuries Identify school activities that place students at risk for eye injuries Evaluate the severity of an emergency involving the ears, nose or throat Describe signs that indicate pathology of the oral cavity Identify dental, oral and maxillofacial trauma and describe appropriate interventions

Illinois EMSC2 EYE EMERGENCIES

Illinois EMSC3 SPECIAL CONSIDERATIONS Eye injury - suspect head injury Loss of vision is traumatic Great anxiety Contact lenses Transient signs and symptoms

Illinois EMSC4 FOCUSED ASSESSMENT Visual acuity External Inspection –Lids, lashes, conjunctiva, and cornea –Symmetry of eyes –Eye movement Palpate orbital rim Pupils

Illinois EMSC5 Eye Anatomy

Illinois EMSC6 EYE ASSESSMENT Current History –Mechanism of injury –New or recurrent problem –Loss/change of vision –How does the eye feel?

Illinois EMSC7 Selected Eye Injuries Lacerations Suspected Perforation or Rupture of the Globe Hyphema Blunt Trauma Chemical/Thermal/Radiation Burn Corneal Abrasion Foreign Body

Illinois EMSC8 Eyelid Laceration

Illinois EMSC9 Corneal Laceration

Illinois EMSC10 Corneoscleral Laceration

Illinois EMSC11 BLUNT TRAUMA Symptoms –Pain –High risk for orbital fracture and intraorbital bleeding –Decrease or loss in vision Cover eye loosely Transport to ED or MD

Illinois EMSC12 Perforation/Rupture of the Globe Call EMS Avoid increasing intraocular pressure (have student sit upright, restrict activity, avoid blowing nose) Patch affected eye Cover both eyes Do not leave alone If impaled object –Stabilize object-do not remove!

Illinois EMSC13 Subconjunctival Hemorrhage

Illinois EMSC14 Orbital Floor Fracture

Illinois EMSC15 HYPHEMA Caused by trauma to the eye Injury to iris blood vessel Bleeding into anterior chamber Decreased vision Treatment –Restrict activity –Cover eye with shield –Refer for ophthalmologic exam or transport to ED

Illinois EMSC16 HYPHEMA

Illinois EMSC17 Hyphema

Illinois EMSC18 Burns Chemical Burns –Call EMS –Irrigate continuously, gently Heat Burns –Apply a loose, moist dressing Light Burns –Symptoms delayed - bilateral –Cover both eyes with dark patches

Illinois EMSC19 Alkali Burn of the Cornea

Illinois EMSC20 Corneal Ulcer

Illinois EMSC21 Corneal Abrasions Common Caused by scratches, small foreign bodies, or contacts Present with pain and light sensitivity Refer to ophthalmologist/MD

Illinois EMSC22 Corneal Foreign Body

Illinois EMSC23 Eye Injury Prevention Education Require use of protective eyewear Investigate causes of eye injuries and remove hazards Collaborate with school staff to reduce incidence of injury

Illinois EMSC24 ENT Emergencies

Illinois EMSC25 Special Considerations Common in school age population Can be life-threatening May cause great anxiety Usually non-urgent

Illinois EMSC26 Selected ENT Emergencies Ear Laceration Hematoma Abrasions Foreign Body Burns Frostbite Nose Nasal fracture Epistaxis Foreign Body Acute Sinusitis Throat Tonsillitis Streptococus infection Peritonsillar abscess Epiglottis Retropharyngeal abscess

Illinois EMSC27 Interventions In Ear Emergencies Lacerations/avulsions –Pad between scalp and ear –Assess for tetanus status Hematomas –Refer for possible aspiration Abrasions –Clean the area –Assess for tetanus status Foreign bodies –Attempt to remove if near external meatus –Avoid excessive manipulation Burns –Wrap lightly in gauze –Pad between scalp and ear Frostbite –Rewarm in warm water –Avoid excessive heat

Illinois EMSC28 Interventions In Nose Emergencies Nasal fracture –Check for related injuries (e.g. head injury) –Ice –Refer to ED/MD Epistaxis –Firm pressure for minutes –Refer if bleeding continues or frequent epistaxis Foreign body –Have student blow nose vigorously –Remove only if easily retrievable Acute Sinusitis –Refer to primary care provider

Illinois EMSC29 Interventions in Throat Emergencies Tonsillitis/Streptococcus infection –Refer to primary care provider Peritonsillar abcess/cellulitis –Severe pain, dysphagia –Urgent - refer to MD for treatment Epiglottitis - emergent!! –Monitor ABC’s and call EMS Retropharyngeal abscess - emergent!! –Monitor ABC’s and call EMS

Illinois EMSC30 Prevention Ear protection from loud noises Isolation of infected students Protective padding and helmets for sports –Correct size and fit –Educate students in proper use

Illinois EMSC31 Dental Emergencies

Illinois EMSC32 Assessment Of Dental/Oral Trauma Use body substance isolation precautions ABC’s Types include: –Soft tissue –Impaled objects –Injury to tooth –Injury to bony structures

Illinois EMSC33 Soft Tissue Trauma Laceration/Bleeding –Apply direct pressure and ice –If major bleed (over 5 minutes) - call EMS Edema –If swelling related to trauma - apply ice –Airway compromise, difficulty talking – call EMS Impaled Object –Emergent-call EMS –Apply cold packs –Pack gauze sponges around object to secure it

Illinois EMSC34 Dental Trauma Fracture of a tooth –Small, cover with dental wax –Large, emergent-refer to dentist Displacement of tooth –Refer to dentist Avulsion of tooth –Replace if possible –Store appropriately for transport with student to dentist –Send to dentist within the hour

Illinois EMSC35 Bony Fractures Alveolar Fracture LeForte Fracture Mandible fracture Fracture of the zygomatic arch

Illinois EMSC36 Bony Fracture Interventions Assess ABC's Check for abnormal movement –Teeth –Upper or lower jaw Ice and direct pressure for bleeding Emergent - call EMS! For mandible fracture, stabilize jaw by wrapping a cravat around the protuberance of chin and top of head Transport to ED

Illinois EMSC37 Dental Pain Caries Exfoliation Eruption Orthodontic appliances

Illinois EMSC38 Soft Tissue Pain Types –Bleeding gums –Fistula and edema –Ulcers Most are non-urgent URGENT CONDITIONS –Fistula or swelling Non-draining Risk of airway compromise from cellulitis –Diffuse ulcers Fever and malaise Refer for diagnosis and cause

Illinois EMSC39 Psychosocial Pain Dysmorphism –Facial disfigurement –Craniofacial abnormalities Urgent May be subjected to peer teasing or harassment Refer to craniofacial team Oral Habits –Thumb/finger sucking Non-urgent May result in malocclusion as well as social ridicule Refer to dentist

Illinois EMSC40 PREVENTION Protective devices are recommended for sport and recreational activities to decrease/prevent the risk of injuries Total head and larynx protection – football, hockey, lacrosse, baseball catchers, batters Full face protection – fencing, hockey goalies Eye protectors – all racquet sports, soccer, basketball, softball

Illinois EMSC41 SUMMARY Pain or injury involving the eyes, ears, nose, throat or oral structures often evokes tremendous anxiety in students. Always maintain a reassuring demeanor as you perform your assessment and management. Develop and conduct injury prevention programs and implement safety measures to prevent EENT emergencies.

Illinois EMSC42 Any Questions??