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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

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eent and dental objectives
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

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eye emergencies
EYE EMERGENCIES

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

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focused assessment
FOCUSED ASSESSMENT
  • Visual acuity
  • External Inspection
    • Lids, lashes, conjunctiva, and cornea
    • Symmetry of eyes
    • Eye movement
  • Palpate orbital rim
  • Pupils

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eye anatomy
Eye Anatomy

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eye assessment
EYE ASSESSMENT

Current History

  • Mechanism of injury
  • New or recurrent problem
  • Loss/change of vision
  • How does the eye feel?

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selected eye injuries
Selected Eye Injuries
  • Lacerations
  • Suspected Perforation or Rupture of the Globe
  • Hyphema
  • Blunt Trauma
  • Chemical/Thermal/Radiation Burn
  • Corneal Abrasion
  • Foreign Body

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eyelid laceration
Eyelid Laceration

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corneal laceration
Corneal Laceration

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blunt trauma
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

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perforation rupture of the globe
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!

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hyphema
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

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hyphema16
HYPHEMA

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hyphema17
Hyphema

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burns
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

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corneal ulcer
Corneal Ulcer

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

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eye injury prevention
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

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ent emergencies

ENT Emergencies

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special considerations25
Special Considerations
  • Common in school age population
  • Can be life-threatening
  • May cause great anxiety
  • Usually non-urgent

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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

Selected ENT Emergencies

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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

Interventions In Ear Emergencies

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interventions in nose emergencies
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

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interventions in throat emergencies
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

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prevention
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

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dental emergencies
Dental Emergencies

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assessment of dental oral trauma
Assessment Of Dental/Oral Trauma
  • Use body substance isolation precautions
  • ABC’s
  • Types include:
    • Soft tissue
    • Impaled objects
    • Injury to tooth
    • Injury to bonystructures

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soft tissue trauma
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

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dental trauma
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

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bony fractures
Bony Fractures
  • Alveolar Fracture
  • LeForte Fracture
  • Mandible fracture
  • Fracture of the zygomatic arch

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bony fracture interventions
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

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dental pain
Dental Pain
  • Caries
  • Exfoliation
  • Eruption
  • Orthodontic appliances

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soft tissue pain
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

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psychosocial pain
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

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prevention40
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

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summary
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.

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any questions
Any Questions??

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