EENT and Dental Objectives

1. 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 EMSC

2. EYE EMERGENCIES Illinois EMSC

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

4. FOCUSED ASSESSMENT • Visual acuity • External Inspection • Lids, lashes, conjunctiva, and cornea • Symmetry of eyes • Eye movement • Palpate orbital rim • Pupils Illinois EMSC

5. Eye Anatomy Illinois EMSC

6. EYE ASSESSMENT Current History • Mechanism of injury • New or recurrent problem • Loss/change of vision • How does the eye feel? Illinois EMSC

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

8. Eyelid Laceration Illinois EMSC

9. Corneal Laceration Illinois EMSC

10. Corneoscleral Laceration Illinois EMSC

11. 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 EMSC

12. 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 EMSC

13. Subconjunctival Hemorrhage Illinois EMSC

14. Orbital Floor Fracture Illinois EMSC

15. 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 EMSC

16. HYPHEMA Illinois EMSC

17. Hyphema Illinois EMSC

18. 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 EMSC

19. Alkali Burn of the Cornea Illinois EMSC

20. Corneal Ulcer Illinois EMSC

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

22. Corneal Foreign Body Illinois EMSC

23. 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 EMSC

24. ENT Emergencies Illinois EMSC

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

26. 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 Selected ENT Emergencies Illinois EMSC

27. 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 Interventions In Ear Emergencies Illinois EMSC

28. Interventions In Nose Emergencies • Nasal fracture • Check for related injuries (e.g. head injury) • Ice • Refer to ED/MD • Epistaxis • Firm pressure for 10-15 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 EMSC

29. 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 EMSC

30. 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 EMSC

31. Dental Emergencies Illinois EMSC

32. Assessment Of Dental/Oral Trauma • Use body substance isolation precautions • ABC’s • Types include: • Soft tissue • Impaled objects • Injury to tooth • Injury to bonystructures Illinois EMSC

33. 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 EMSC

34. 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 EMSC

35. Bony Fractures • Alveolar Fracture • LeForte Fracture • Mandible fracture • Fracture of the zygomatic arch Illinois EMSC

36. 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 EMSC

37. Dental Pain • Caries • Exfoliation • Eruption • Orthodontic appliances Illinois EMSC

38. 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 EMSC

39. 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 EMSC

40. 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 EMSC

41. 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 EMSC

42. Any Questions?? Illinois EMSC