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Head and Spinal Trauma | Eye Ear & Dental

Head and Spinal Trauma

Eye, Ear and Dental Trauma: address life-threatening injuries first
Ear: barotitis is caused by changes in barometric pressure. Treatments specific to injury:

  • Direct pressure to lacerations
  • Ice to swelling
  • Cover, protect avulsions
  • Irrigate chemical injuries 2-3 minutes 3 or 4 times
  • Cover traumatic perforations to prevent further contamination
  • Yawn, swallow to clear eustachian tube

Eye: blunt or penetrating trauma from MVA, sports, fights, chemicals, animal bites.
Assessment:

  • History: mechanism of injury, previous medical history, medications
  • Pupil reaction: Unequal, delay in response
  • Extra-ocular movements: tracking movement, blurred vision
  • Contusions: pain, photophobia, tear-shaped pupil
  • Corneal Abrasion: foreign body sensation >>> gentle irrigation
  • Foreign body: foreign body sensation while open/closing eye >>> copious irrigation
  • Traumatic hyphema: blood in anterior chamber >>> immobilize spine, elevate head Globe or scleral rupture: decreased vision, soft eye, pupil irregular, hyphema >>> immobilize spine, elevate head, protect globe from dehydration

Never remove an impaled object, secure it, cover BOTH eyes to limit eye movement
Irrigate a chemical injury for at least 20 minutes

Control bleeding with gentle direct pressure (except on the globe)

Dental Trauma: Most common trauma are fractures and avulsions of the anterios teeth, tongue and surrounding mucous membranes. Teeth can be reimplanted, within an hour is best.
Management:

  • Remove teeth or fragments, suction airway
  • Do not rinse the tooth, try to save in milk or sterile saline
  • Advise the ED

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