Eyes, ears, teeth and everything in between

Transcription

1 Eyes, ears, teeth and everything in between E M E R G E N C Y D E P A R T M E N T J U N I O R T E A C H created 14/11/10 by S.R. Bruijns, version 1.0

2 Objectives Eyes Ears Teeth Maxilla- facial

3 EYES

4 Approaching the eye

5 Approaching the eye: History Occupation Previous eye or other medical problems Use of glasses or contact lenses If due to injury, what happened? Sharp or blunt injury Chemical splashes Exposure to bright light Change in vision/ pain/ itch/ discharge Sensation of something in the eye Photophobia

6 Approaching the eye: Examination Visual acuity Look at Lids & external eye Redness, discharge, foreign body Cloudiness Examine Iris and pupil Anterior chamber Under the upper and lower eyelids You may need to numb the eye To colour the eye

7 Eyes: acute loss of vision Vitreous haemorrhage Complains of new multiple floaters, visual haze, smoke, shadows, or cobwebs Variable loss of fundus detail with floating debris

8 Eyes: acute loss of vision Retinal detachment Sensation of a flashing light accompanied by a shower of floaters. Evidence of vitreous haemorrhage and large detachment of the posterior pole

9 Eyes: loss of vision Optic neuritis Rapidly developing impairment of vision in one eye Pupillary light reaction is decreased (Marcus Gunn pupil)

10 Eyes: loss of vision Retinal artery occlusion Painless loss of monocular vision Pale retina with a cherry red macula

11 Eyes: Acute Angle Closure Glaucoma Typical complaint Ocular pain, nausea/vomiting, and intermittent blurring of vision with halos ED finding Conjunctival injection, mid-dilated nonreactive pupil In a large percentage of patients, extraocular symptoms are the chief complaint Headache, abdominal pain from vomiting

12 Eyes: Trauma slideshow

13 Eyes: Trauma slideshow

14 Eyes: Trauma slideshow Typical teardrop sign Represents the herniated orbital contents, periorbital fat and inferior rectus muscle

15 Eyes: Trauma slideshow With inferior rectus trapped the patient is unable to look down

16 EARS

17 Ears: Otitis Media Exceedingly common in paediatric population Diagnostic criteria is Acute onset Middle ear effusion Middle ear inflammation Severe illness Severe otalgia Temperature > 39 o Treatment < 6 months: always treat if suspected 6 months to 2 years: treat if all criteria present/ severe illness > 2 years: can be observed if no signs of severe illness

18 Ears: Otitis Externa 1-2 days of progressive ear pain Symptoms may include Pruritus within the ear canal Purulent discharge Conductive hearing loss/ feeling of fullness or pressure Examination The main finding is pain on gentle traction of the external ear Erythema, oedema, and narrowing of the external auditory canal Treatment Topical antibiotic/steroid mix (Sofradex) Foam or gauze wick aids delivery of drops to affected area

19 Ears: tympanic perforation Most will heal without intervention Consider antibiotics with pain or discharge Advise not to get water in their ear Arrange follow-up

20 DENTAL

21 Dental: Basics There are up to 20 primary teeth replaced by Up to 32 permanent teeth from 6 yrs of age That s 32 teeth in 4 quadrants UR 1-8 UL 1-8 LR 1-8 LL 1-8 Numbered from front to back

22 Dental: Basics

23 Dental: Post Extraction Bleeding Bite on a dry gauze pack placed in socket Attempt the same but using a medicated pack Adrenaline Tranexamic acid With failure will need referral for suturing of socket

24 Dental: Fractures

25 Dental: Avulsion Best replaced in the first hour Transport medium Re-implanting procedure Handle tooth minimally (touch only the crown) Clean in saline Orientate and re-implant with firm pressure Needs antibiotics and referral for stabilisation

26 MAXILLO- FACIAL

27 MaxFax: Nasal fractures Obvious deformity Palpate for deformities/tenderness Cerebrospinal fluid rhinorrhoea Look for Septal deviation, Mucosal tears, Septal haematoma Treatment delayed Epistaxis advise sheet Follow up with Maxfax

28 MaxFax: Mandible anatomy BODY

29 MaxFax: Mandible fractures

30 MaxFax: TMJ dislocation May be traumatic or with minimal movement with a lax joint capsule (laughing/ yawning) No need for x-ray with good history and no trauma Treatment is to reduce the dislocation Use gloves and gauze for protection Sit patient up in a chair with head back against a wall Down and backward force whilst rotating jaw anteriorly Patient comfort and relaxation is the key (may need some form of sedation)

31 MaxFax: Mid-face fractures High-energy blunt force Often part of an injury complex Priority is to establish that the airway is patent With airway adjuncts (intubation) Without airway adjuncts (patient able to maintain own airway with no concern for impending obstruction) Clinical picture Soft tissue swelling, ecchymosis, blood and haematoma Less often seen is flattened appearance (dish/ pan-face)

32 MaxFax: Mid-face fractures

33 QUESTIONS

34 Summary Eyes Vitreous haemorrhage Retinal detachment Optic neuritis Retinal artery occlusion Glaucoma Hyphema Lens dislocation Orbital blow out Ears Otitis Media & Externa TM perforation Dental Post extraction bleed Dental fracture Tooth avulsion MaxFax Nasal fracture Mandible fracture TMJ dislocation Midface fractures Key is (ALS priorities) recognition and referral