1. Diagnostic and emergency assistance if damaged eye and LOR- organs Prepared by: Candidate of Medical Science, assistant professor of outpatient therapy and emergency medical emergency KSMU A.R. Alpyssova

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

3. The plan of the lecture injuries age Wounds of the eyeball Wounds of the eyeball contusion century Contusion of the eyeball orbital contusion eye burns Foreign bodies of the conjunctiva and cornea Foreign body ear canal Outer ear trauma The trauma of middle and inner ear injuries age Wounds of the eyeball Wounds of the eyeball contusion century Contusion of the eyeball orbital contusion eye burns Foreign bodies of the conjunctiva and cornea Foreign body ear canal Outer ear trauma The trauma of middle and inner ear

4. INJURY ORGAN OF VIEW Injury of age Diagnosis of injuries century presents no special difficulties, but they can be the beginning of wound channels that penetrate into the cavity of the orbit, skull, paranasal sinuses, the damage not only the eye but also pose a threat to life. Diagnosis of injuries century presents no special difficulties, but they can be the beginning of wound channels that penetrate into the cavity of the orbit, skull, paranasal sinuses, the damage not only the eye but also pose a threat to life.Treatment ■ First medical help ■ First medical help administration of analgesics, broad-spectrum antibiotics; administration of analgesics, broad-spectrum antibiotics; Removal of superficial foreign bodies; Removal of superficial foreign bodies; treatment of the surrounding tissues by antiseptics (lizanin); treatment of the surrounding tissues by antiseptics (lizanin); imposition of monocular aseptic dressing. imposition of monocular aseptic dressing.

5. If the eyelid is almost completely cut off or, you want to save (record aseptic bandage or wrap in a sterile cloth, moistened with saline and delivered with the victims in a specialized hospital). If the eyelid is almost completely cut off or, you want to save (record aseptic bandage or wrap in a sterile cloth, moistened with saline and delivered with the victims in a specialized hospital). ■ Most wounds need to be age of primary surgical treatment of an ophthalmologist. ■ Most wounds need to be age of primary surgical treatment of an ophthalmologist. ■ Injuries are often accompanied by injuries century eyeballs. ■ Injuries are often accompanied by injuries century eyeballs.

6. Wounds of the eyeball Perforated not injured (closed injury) - a wound does not pass through all layers of the fibrous capsule eye (cornea or sclera). Perforated not injured (closed injury) - a wound does not pass through all layers of the fibrous capsule eye (cornea or sclera). CLINICAL PICTURE Complaints: Complaints: stinging stinging photophobia photophobia 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, physical examination revealed: Symptoms, physical examination revealed: good lighting can identify an area where there is no mirror of the cornea (erosion - deepitelizatsiya), wound or conjunctival foreign body. good lighting can identify an area where there is no mirror of the cornea (erosion - deepitelizatsiya), wound or conjunctival foreign body.

7. Treatment ■ First medical help: ■ First medical help: with anesthetic drops [procaine (Novocain) 2% solution or lidocaine 2% solution]; with anesthetic drops [procaine (Novocain) 2% solution or lidocaine 2% solution]; Gentamicin 0.3% solution. Gentamicin 0.3% solution. ■ Outpatient treatment under the supervision of an ophthalmologist. ■ Outpatient treatment under the supervision of an ophthalmologist. ■ Often accompanied by the introduction of unpreforated injured foreign bodies in the outer membrane of the eye (cornea, sclera) or mucous century. ■ Often accompanied by the introduction of unpreforated injured foreign bodies in the outer membrane of the eye (cornea, sclera) or mucous century. Perforated wound of the eyeball In an open wound injury of the eyeball (wound channel) passes through all layers of the fibrous capsule eye (cornea or sclera). In most cases, damaged the inner membrane (vascular, retina) and eye protection (lens, vitreous body). In an open wound injury of the eyeball (wound channel) passes through all layers of the fibrous capsule eye (cornea or sclera). In most cases, damaged the inner membrane (vascular, retina) and eye protection (lens, vitreous body).

8. CLINICAL PICTURE Complains: Complains: stinging stinging photophobia ; photophobia ; reduced vision reduced vision Symptoms, physical examination revealed: Symptoms, physical examination revealed: gaping wounds of the cornea or sclera, which may impair intraocular membranes and the environment: the iris (in the form of a dark bubble), fragments of the lens; gaping wounds of the cornea or sclera, which may impair intraocular membranes and the environment: the iris (in the form of a 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 lens is damaged - the pupil black; deformation and displacement of the pupil, the lens is damaged - the pupil black; tone lowered eyes tone lowered eyes

9. Complications Post-traumatic uveitis. Post-traumatic uveitis. Endophthalmitis. Endophthalmitis. Sympathetic ophthalmia. Sympathetic ophthalmia. Treatment Treatment Even in cases of suspected perforated wound should stop any manipulation. Even in cases of suspected perforated wound should stop any manipulation. ■ The first medical care: ■ The first medical care: Mixing of solutions of antibiotics (gentamicin 0.3% solution or 20% solution of sodium Sulfatsil *); Mixing of solutions of antibiotics (gentamicin 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.

10. Orbit injuries Orbit injuries classified as serious injury. Is often combined with damage to the sinuses, brain, maxillofacial area (depending on the damage factor, the direction and length of the wound channel). CLINICAL PICTURE Complains: Complains: decreased vision; decreased vision; motion abnormalities of the eyeball. motion abnormalities of the eyeball. Emergency Conditions in ophthalmology Emergency Conditions in ophthalmology ■ Symptoms detected on physical examination: ■ Symptoms detected on physical examination: exophthalmos or enophthalmos (with extensive fractures of the bone walls); exophthalmos or enophthalmos (with extensive fractures of the bone walls); subcutaneous emphysema and age of the periorbital region (crepitus on palpation) in the event of damage to the inner wall of the orbit; subcutaneous emphysema and age of the periorbital region (crepitus on palpation) in the event of damage to the inner wall of the orbit; liquorrhea (penetrating wound of the brain). liquorrhea (penetrating wound of the brain).

11. Treatment The imposition of aseptic dressings. The imposition of aseptic dressings. The introduction of analgesics, broad-spectrum antibiotics. The introduction of analgesics, broad-spectrum antibiotics. Admission to general hospital, where, along with eye care, may have neurosurgical, LOR, have a department of maxillofacial surgery. Admission to general hospital, where, along with eye care, may have neurosurgical, LOR, have a department of maxillofacial surgery. Contusion of the vision (eyes closed injury) Closed eye injury are caused by blunt injury. Distinguished by the severity of light, moderate and severe. Closed eye injury are caused by blunt injury. Distinguished by the severity of light, moderate and severe.

12. Contusion eyelids Clinical picture The clinical picture depends on the severity of the injury. The clinical picture depends on the severity of the injury. ■ Easy to injury: ■ Easy to injury: subcutaneous hemorrhage and podkonyunktivalno;may be tears brim eyelids. subcutaneous hemorrhage and podkonyunktivalno; 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 eyelids. free edge of tears or small (3-5 mm) wound eyelids. ■ Heavy: ■ Heavy: significant tear-contused wounds; significant tear-contused wounds; partial detachments eyelids at the medial (damage to tear ducts) or at the lateral angles; partial detachments eyelids at the medial (damage to tear ducts) or at the lateral angles; completely severed eyelids (very rare) completely severed eyelids (very rare)

13. Treatment ■ The introduction of antibiotics, analgesics, application of dressings monocular with contusions of moderate and severe cases in the presence of tear-contused wounds. ■ The introduction of antibiotics, analgesics, application of dressings monocular with contusions of moderate and severe cases in the presence of tear-contused wounds. ■ The victim is sent to an ophthalmologist. ■ The victim is sent to an ophthalmologist. ■ In some cases, concussion injuries are accompanied by eyelids of the eyeball or eye socket. ■ In some cases, concussion injuries are accompanied by eyelids of the eyeball or eye socket.

14. Contusion of the eyeball CLINICAL PICTURE The clinical picture depends on the severity of the injury. ■ Easy: 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. ■ M oderate : ■ M oderate : some deformity or pupil mydriasis due to pupillary edge of the iris tears; some deformity or pupil mydriasis due to pupillary edge of the iris tears; may be a small hyphema (meniscus with a horizontal level of 1-2 mm in height). may be a small hyphema (meniscus with a horizontal level of 1-2 mm in height). Visual acuity maintained or reduced to a small extent. Visual acuity maintained or reduced to a small extent.

15. ■ Heavy: ■ Heavy: significant (more than two times) reduction in visual acuity; significant (more than two times) 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 blood (hyphema); partial or complete filling of the anterior chamber of the blood (hyphema); deformation of the pupil due to iris root separation (iridodialysis), if visible; deformation of the pupil due to iris root separation (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 break in the case podkonyunktivalno scleral wound when the capsule eyes to see, but have severe damage to internal structures. hypotension eyes ('eyes as soft cloth "), there is a break in the case podkonyunktivalno scleral wound when the capsule eyes to see, but have severe damage to internal structures.Treatment A significant reduction in visual function should be considered as a serious injury. The victim should be lying down with a binocular bandage sent to a specialized hospital. A significant reduction in visual function should be considered as a serious injury. The victim should be lying down with a binocular bandage sent to a specialized hospital.

16. Orbital contusion CLINICAL PICTURE The clinical picture depends on the severity of the injury. The clinical picture depends on the severity of the injury. ■Easy: ■Easy: 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 mobility; small change in the position of the eyeball and limited mobility; mild diplopia. mild diplopia. ■ Heavy: ■ Heavy: exophthalmos or enophthalmos; exophthalmos or enophthalmos; limitation of eye movement until immobility (ophthalmoplegia) limitation of eye movement until immobility (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 place of the fracture zone in severe local pain; bone defect margin of orbit (a symptom of a "step") in place of the fracture zone in severe local pain;

17. crepitus (emphysema at the turn of the inner wall of the orbit); crepitus (emphysema at the turn of the inner wall of the orbit); significant decrease in visual acuity up to no light perception, which may be due to compression of the central artery of the retina, optic nerve retrobulbar hematoma or reactive tissue edema orbit, its damage in the orbit or in the channel of the optic nerve (traumatic optikopatiya); significant decrease in visual acuity up to no light perception, which may be due to compression of the central artery of the retina, optic nerve retrobulbar hematoma or reactive tissue edema orbit, its damage in the orbit or in the channel of the optic nerve (traumatic optikopatiya); syndrome of upper orbital fissure: ptosis, ophthalmoplegia (limited or no eye movement), impaired sensation in the area of the projection of the first branch of trigeminal nerve. syndrome of upper orbital fissure: ptosis, ophthalmoplegia (limited or no eye movement), impaired sensation in the area of the projection of the first branch of trigeminal nerve.Treatment When contusions of moderate severity or heavy administered analgesics, impose a binocular bandage evacuated lying on a stretcher in an ophthalmic hospital. When contusions of moderate severity or heavy administered analgesics, impose a binocular bandage evacuated lying on a stretcher in an ophthalmic hospital. Mild concussion treated as outpatients under the supervision of an ophthalmologist. Mild concussion treated as outpatients under the supervision of an ophthalmologist.

18. EYE BURNSCLASSIFICATION: On the etiology of eye burns is divided into: On the etiology of eye burns is divided into: chemical; chemical; thermical; thermical; radiant energy (with powerful flares, explosions, the voltaic arc, the impact of intense visible light, with a significant UVR). radiant energy (with powerful flares, explosions, the voltaic arc, the impact of intense visible light, with a 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).

19. CLINICAL PICTURE The clinical picture depends on the severity of the burn. ■ Easy: small sharp pain, photophobia, small sharp pain, photophobia, singed eyelashes; singed eyelashes; mild hyperemia and edema of the eyelid skin and conjunctiva; mild hyperemia and edema of the eyelid skin and 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").

20. Treatment When expressed pain syndrome and blepharospasm injected analgesics, buried procaine, trimekaina, lidocaine 2% solution. When expressed pain syndrome and blepharospasm injected analgesics, buried procaine, trimekaina, lidocaine 2% solution. ■ Chemical burns. ■ Chemical burns. In case of eye powdered chemical to remove it dry swab. In case of eye powdered chemical to remove it dry swab. Rinse the eye with running Rinse the eye with running catalyst (2% solution of sodium hydrogen burns acids, 2% solution of boric acid - alkali), in the absence of converters - with running water for 20-30 minutes. catalyst (2% solution of sodium hydrogen burns acids, 2% solution of boric acid - alkali), in the absence of converters - with running water for 20-30 minutes. In the case of particles of the chemical in the conjunctival cavity to remove them with a moist swab (if it is necessary to unscrew the top and bottom eyelids). In the case of particles of the chemical in the conjunctival cavity to remove them with a moist swab (if it is necessary to unscrew the top and bottom eyelids). Lay with the antibiotic eye ointment (tetracycline 1% or eritromitsinovaya 1%). Lay with the antibiotic eye ointment (tetracycline 1% or eritromitsinovaya 1%).

21. ■ Thermal burns. ■ Thermal burns. Should remove superficial foreign bodies, lay ophthalmic antibiotic ointment. Should remove superficial foreign bodies, lay 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 supervision of an ophthalmologist, burns of moderate and severe - in hospitals (isolated - in ophthalmology, together, with the spread to other parts of the body - in burn centers or offices with an ophthalmologist). Minor burns treated as outpatients under the supervision of an ophthalmologist, burns of moderate and severe - in hospitals (isolated - in ophthalmology, together, with the spread to other parts of the body - in burn centers or offices with an ophthalmologist).

22. Foreign bodies conjunctiva and cornea Eye injuries are often accompanied by the introduction of foreign bodies in the morphological structures of the eye. By the nature of the substance of a foreign body is isolated magnetic (iron-containing) non-magnetic pieces (not containing iron). By the nature of the substance of a foreign body is isolated magnetic (iron-containing) non-magnetic pieces (not containing iron). Localization of the fragment distinguish foreign bodies: conjunctiva, the cornea, intraocular foreign bodies foreign body orbit. When wound the conjunctiva and cornea, and the surface location of the fragment in the power of any doctor who knows first aid and remove it. In the last two cases (intraocular foreign bodies and foreign body orbit) to provide expert assistance should only ophthalmologist and first aid for this condition is general practitioners, as in the cross- cutting (penetrating) wounds of the eye Localization of the fragment distinguish foreign bodies: conjunctiva, the cornea, intraocular foreign bodies foreign body orbit. When wound the conjunctiva and cornea, and the surface location of the fragment in the power of any doctor who knows first aid and remove it. In the last two cases (intraocular foreign bodies and foreign body orbit) to provide expert assistance should only ophthalmologist and first aid for this condition is general practitioners, as in the cross- cutting (penetrating) wounds of the eye

23. Foreign body of conjunctiva Clinic After contact with a foreign body in the conjunctiva in a patient comes tearing, blinking, foreign body sensation. Sometimes associated photophobia and eye pain Corneal foreign bodies Clinic The presence of a foreign body in the cornea accompanied by pain, lacrimation, blepharospasm, photophobia, foreign body sensation. Visually determined by a foreign body and conjunctival injection and eyelids of the eyeball.

24. Emergency aid for foreign bodies of the conjunctiva and cornea Local anesthesia 0.25% solution dikaina, 2-4% lidocaine or 0.4% sodium inokaina. Removal of foreign body surface is wet swab. After removal of foreign body requires installation of 30% solution of sodium Sulfatsil, 0.25% solution of chloramphenicol, or 0.3% solution normaksa. After removal of foreign body requires installation of 30% solution of sodium Sulfatsil, 0.25% solution of chloramphenicol, or 0.3% solution normaksa. For ever and lay 1% tetracycline eye ointment or levomitsetinovuyu. For ever and lay 1% tetracycline eye ointment or levomitsetinovuyu. In the future - consultation ophthalmologist in an outpatient procedure. In the future - consultation ophthalmologist in an outpatient procedure. If the foreign body penetrated the cornea and can not remove the above methods, you need immediate specialized care. If the foreign body penetrated the cornea and can not remove the above methods, you need immediate specialized care.

25. Eye injuries The injuries may be accompanied by damage to the eyes of the cornea or sclera, or a combination thereof. If the wound goes through all of the cornea or sclera shells, wounding is pervasive. Penetrating injuries, regardless of their location are always severe injuries. They are more dangerous than penetrating. The injuries may be accompanied by damage to the eyes of the cornea or sclera, or a combination thereof. If the wound goes through all of the cornea or sclera shells, wounding is pervasive. Penetrating injuries, regardless of their location are always severe injuries. They are more dangerous than penetrating. The definitive diagnosis can only set an ophthalmologist. The definitive diagnosis can only set an ophthalmologist.

26. Neprobodnye (non-penetrative) injury to the cornea and sclera occur when the surface effects of the traumatic agent, when wounded by small foreign bodies. occur when the surface effects of the traumatic agent, when wounded by small foreign bodies. The clinic. The patient complained of pain in the eye, photophobia, lacrimation, blepharospasm, decreased vision. In wounds of the conjunctiva or sclera soreness is usually small, damaged corneas as having very severe pain and foreign body sensation in the eye. The clinic. The patient complained of pain in the eye, photophobia, lacrimation, blepharospasm, decreased vision. In wounds of the conjunctiva or sclera soreness is usually small, damaged corneas as having very severe pain and foreign body sensation in the eye. Emergency care. For pain treatment - instillation of 0.5% solution dikaina. Prevention of infectious complications: a 30% solution of sodium sulfatsil, 0.25% solution of chloramphenicol or levomitsetinovaya or 1% tetracycline ointment After applying aseptic dressings binocular patient should be transported to a specialized hospital. Emergency care. For pain treatment - instillation of 0.5% solution dikaina. Prevention of infectious complications: a 30% solution of sodium sulfatsil, 0.25% solution of chloramphenicol or levomitsetinovaya or 1% tetracycline ointment After applying aseptic dressings binocular patient should be transported to a specialized hospital.

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

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

29. Eye contusion Distinguish direct contusion, ie, the direct effect on the eye, and indirect, by shaking the torso and the skull (the fall, the shock wave in the explosions). Distinguish direct contusion, ie, the direct effect on the eye, and indirect, by shaking the torso and the skull (the fall, the shock wave in the explosions). The clinic. If the main symptom of concussion is a dull ache, dizziness, injection of the conjunctiva and hemorrhage in the subcutaneous tissue and eyelids structure of the eyeball. The clinic. If the main symptom of concussion is a dull ache, dizziness, injection of the conjunctiva and hemorrhage in the subcutaneous tissue and eyelids structure of the eyeball. Emergency care. Inside diakarb 2 tab. 0.25 g once. General anesthesia - intramuscularly Tramal, Analgin. Urgent consultation of a neurosurgeon, an ophthalmologist specialized care. Emergency care. Inside diakarb 2 tab. 0.25 g once. General anesthesia - intramuscularly Tramal, Analgin. Urgent consultation of a neurosurgeon, an ophthalmologist specialized care.

30. An acute attack of glaucoma Glaucoma - a large group of eye diseases characterized by continuous or periodic increase in intraocular pressure with the subsequent development of typical visual field defects, decreased central vision and optic atrophy. Glaucoma - a large group of eye diseases characterized by continuous or periodic increase in intraocular pressure with the subsequent development of typical visual field defects, decreased central vision and optic atrophy. Attack of glaucoma is caused by a rapid rise in intraocular pressure, which is accompanied by clinical symptoms. Meets the bowl in the elderly, on one side. Provoking factors are usually nervous overload and stress. Attack of glaucoma is caused by a rapid rise in intraocular pressure, which is accompanied by clinical symptoms. Meets the bowl in the elderly, on one side. Provoking factors are usually nervous overload and stress.

31. The clinic. Harbinger of an acute attack of glaucoma can be blurred vision and the appearance of bright circles around lights. The clinic. Harbinger of an acute attack of glaucoma can be blurred vision and the appearance of bright circles around lights. The emergence of an attack is characterized by sudden onset of severe pain in the eye, radiating to the corresponding half of the head. Sharply reduced visual acuity up to save only svetooschusheniya. The pain may be accompanied by nausea, vomiting, dizziness, severe chills, malaise. The emergence of an attack is characterized by sudden onset of severe pain in the eye, radiating to the corresponding half of the head. Sharply reduced visual acuity up to save only svetooschusheniya. The pain may be accompanied by nausea, vomiting, dizziness, severe chills, malaise. Instead of black, acute attack of glaucoma, the pupil appears greenish, but the most important sign of glaucoma is a sharp eye seal. Instead of black, acute attack of glaucoma, the pupil appears greenish, but the most important sign of glaucoma is a sharp eye seal. Emergency care. The main objective - to reduce intraocular pressure and to normalize the blood circulation in the eye to restore the power of the retina and optic nerve. To do this, designate 1% solution of pilocarpine every 15, then 30 min to 2 drops, 0.5% timolol solution once. Inside are 40-60 mg of furosemide. Recommends the introduction of sedatives. It is shown that giving saline laxative, hot foot bath. Hospitalization in a specialized hospital. Emergency care. The main objective - to reduce intraocular pressure and to normalize the blood circulation in the eye to restore the power of the retina and optic nerve. To do this, designate 1% solution of pilocarpine every 15, then 30 min to 2 drops, 0.5% timolol solution once. Inside are 40-60 mg of furosemide. Recommends the introduction of sedatives. It is shown that giving saline laxative, hot foot bath. Hospitalization in a specialized hospital.

32. Foreign bodies in otolaryngology Foreign bodies external auditory canal Foreign bodies in otolaryngology Foreign bodies external auditory canal Etiology. Sulphur, epidermal cork plugging the lumen of the ear canal; foreign bodies of different nature. Etiology. Sulphur, epidermal cork plugging the lumen of the ear canal; foreign bodies of different nature. The clinic depends on the size, shape, chemical composition of the foreign body. Children are becoming restless, refuse food, deprived of sleep. The clinic depends on the size, shape, chemical composition of the foreign body. Children are becoming restless, refuse food, deprived of sleep. Emergency care. Foreign body ear canal to be removed. Most of the foreign body is removed by washing with warm, low concentration of potassium permanganate, in which case the liquid jet is directed along the posterolateral wall of the upper canal. Emergency care. Foreign body ear canal to be removed. Most of the foreign body is removed by washing with warm, low concentration of potassium permanganate, in which case the liquid jet is directed along the posterolateral wall of the upper canal. The use of forceps to remove the foreign body rounded endoauralno totally unacceptable because of the danger of herniation of a foreign body in the bone department, injured eardrum, the introduction of a foreign body in the tympanic cavity and the subsequent development of acute otitis media, mastoiditis, and even meningitis. The use of forceps to remove the foreign body rounded endoauralno totally unacceptable because of the danger of herniation of a foreign body in the bone department, injured eardrum, the introduction of a foreign body in the tympanic cavity and the subsequent development of acute otitis media, mastoiditis, and even meningitis. To remove a living foreign bodies in the ear canal pour alcohol solution or sterile vaseline warmed or sunflower oil, after 4-5 min. produce flushing the ear. To remove a living foreign bodies in the ear canal pour alcohol solution or sterile vaseline warmed or sunflower oil, after 4-5 min. produce flushing the ear.

33. Foreign bodies of the nose and paranasal sinuses Foreign bodies of nasal observed predominantly in children who have pushed themselves and their peers in various subjects nose. The diagnosis of nasal foreign body is put on the basis of history, and radiological data rinoskopicheskih. The diagnosis of nasal foreign body is put on the basis 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.

34. Trauma of the external ear Trauma of the external ear Damage to the ear there are bruises, wounds and bites. Observed varying degrees of tissue damage up to the separation of the shell. In the perichondrium from the cartilage delamination may develop hemorrhage (otgematoma) in the form of the tumor purplish-blue or red. Often there is inflammation of the perichondrium (perihondrit). Damage to the external auditory canal are associated with shocks, bruises and a foreign body. One of the most dangerous manifestation of injury is a fracture of bone walls of the external auditory canal, often accompanied by a concussion or fractured skull. Damage to the ear there are bruises, wounds and bites. Observed varying degrees of tissue damage up to the separation of the shell. In the perichondrium from the cartilage delamination may develop hemorrhage (otgematoma) in the form of the tumor purplish-blue or red. Often there is inflammation of the perichondrium (perihondrit). Damage to the external auditory canal are associated with shocks, bruises and a foreign body. One of the most dangerous manifestation of injury is a fracture of bone walls of the external auditory canal, often accompanied by a concussion or fractured skull. Typical signs of damage to the ear canal are a pain, its restriction due to infiltration and tissue edema, hemorrhage, or bleeding, hearing loss. In severe cases, there is significant bleeding, nausea, vomiting, sudden hearing loss, partial paresis of the facial nerve, liquorrhea, erysipelas. Typical signs of damage to the ear canal are a pain, its restriction due to infiltration and tissue edema, hemorrhage, or bleeding, hearing loss. In severe cases, there is significant bleeding, nausea, vomiting, sudden hearing loss, partial paresis of the facial nerve, liquorrhea, erysipelas.

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

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

37. Damage to the inner ear are uncommon. Usually they are the result of cranial trauma. The patient recorded the total lethargy, mental depression, deafness or deaf-mutism, dizziness, nausea, and vomiting. Skull trauma often leads to fracture(transverse or longitudinal) of the pyramid of the temporal bone, which may arise extensive hemorrhage into the inner ear, and sometimes in the tympanum. Damage to the inner ear are uncommon. Usually they are the result of cranial trauma. The patient recorded the total lethargy, mental depression, deafness or deaf-mutism, dizziness, nausea, and vomiting. Skull trauma often leads to fracture(transverse or longitudinal) of the pyramid of the temporal bone, which may arise extensive hemorrhage into the inner ear, and sometimes in the tympanum. Frequent symptom is the eardrum is bleeding from the ear canal. In the damage of the dura mater appears liquorrhea. The general condition of the patient, as a rule, heavy, sharp or there is a complete hearing loss, often paresis or paralysis of the facial nerve, dizziness, nausea, vomiting, loss of balance. In open fractures is a real danger of intracranial complications (meningitis, brain abscess). Frequent symptom is the eardrum is bleeding from the ear canal. In the damage of the dura mater appears liquorrhea. The general condition of the patient, as a rule, heavy, sharp or there is a complete hearing loss, often paresis or paralysis of the facial nerve, dizziness, nausea, vomiting, loss of balance. In open fractures is a real danger of intracranial complications (meningitis, brain abscess).

38. When emergency care for injuries of the eardrum must be careful not to make an infection in the tympanic cavity. Therefore, counter-washing or drying the ear. Allowed a careful removal of blood clots and small from the ear canal, and then injected into the ear of a sterile swab, intramuscularly - antibiotics and tetanus serum in the ear of aseptic bandage is applied. When emergency care for injuries of the eardrum must be careful not to make an infection in the tympanic cavity. Therefore, counter-washing or drying the ear. Allowed a careful removal of blood clots and small from the ear canal, and then injected into the ear of a sterile swab, intramuscularly - antibiotics and tetanus serum in the ear of aseptic bandage is applied. When damaged, the middle ear as a result of the impact of abrupt changes in pressure, as well as trauma of the inner ear is shown transporting a patient to the hospital in preparation for a used intravenously methenamine, subcutaneously Neostigmine with ascorbic acid tablets - Aeron and barbiturates. If there is bleeding, stop it all done by conventional methods - from medicinal agents to tamponade. When damaged, the middle ear as a result of the impact of abrupt changes in pressure, as well as trauma of the inner ear is shown transporting a patient to the hospital in preparation for a used intravenously methenamine, subcutaneously Neostigmine with ascorbic acid tablets - Aeron and barbiturates. If there is bleeding, stop it all done by conventional methods - from medicinal agents to tamponade.

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