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OBJECTIVES
At the end of this presentation students will be able to:

1) To define eye injury.

2) To explain the types of eye, ear & sinus and its sign & symptoms
and treatment.

3) To define post traumatic epilepsy.

4) To explain management of epilepsy.

INTRODUCTION
The eye injuries are very last irritating and painful for casualty, some
potentially be serious. The ear is the organ of hearing. The nerve supply this
special is the eight cranial or auditory nerve and sinus of the nose can
potentially serious disease that can be difficult to diagnoses in early stages.

Post traumatic epilepsy is divided in to early and late (seizure accruing with
in 7 days of injury) intracranial hematoma and early epilepsy.

DEFINITION EYE INJURIES

The eye injuries are at the very last irritating and painful for casualty, some
potentially be serious even a superficial graze to the cornea can cause
searing resulting in permanent damage and deterioration in casualty &
vision. Prompt and appropriate fist aid can be very beneficial.

The aim of this chapter is to understand the first aid treatment of eye
injuries.
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TYPES OF EYE INJURIES
1. Foreign body in eye.

2. Chemical injury to the eye.

3. Es gas injury.

4. Penetrating eye injury.

FOREIGN BODY IN THE EYE

A foreign body in the eye e.g. aspeek of dust girl eyelash can be very
irritating for the casualty the treatment depends on whether the foreign body
is loose or adherent.

TREATMENT
1. Ask the casualty to sit down facing the light.

2. Stand behind the casualty and using the finger and thumb gently
separate the eyelids and examine the eye.

3. Ask the casualty to look left right up and down.

4. Loose foreign body irrigate the eye with clean water or sterile eye
wash.

5. Adherent foreign body remove using a cotton wool bud or the edge of
a piece of cardboard.

CHEMICAL INJURY OF THE EYE

1. All chemical injuries to eye can potentially cause blindness.
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2. Alkali injuries to the eye can be particularly devastating and are much
more serious than acid injuries. The seed at which the initial ittigation
of the eye begins has greatest influence on the prognosis and outcome
of eye burns.

SIGN & SYMPTOMS

1. Painful eye.

2. Redness and swelling around the eye.

3. Inability to open the eye.

4. Copious watering of the eye.

5. History suggestive of chemical injury.

TREATMENT
The priority is to the eye so that chemical is diluted and dispersed. The eye
should be washed out immediately with copious amount of water. Irrigate,
irrigate & irrigate.

1. Ensure it is safe to approach. Put on gloves if available, ventilate the

area to disperse fumes and if possible seal the chemical.

2. Irrigate the casualty affected eye with running cold water for at least
10 minutes an eye irrigate or a glass may also be used to pour water
over the eye. It may necessary to prise the eyelids open if there are
closed tight in a spasm of pain.

3. Ensure that the eyelid is thoroughly irrigated both inside and out.
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4. Take care not to allow contaminated water to splash in to unaffected
eye.

5. Apply a sterile eye pad or a clean non-fluffy pad over the injured eye.

6. Arrange urgent transfer to an A & E Department.

7. Identify the chemical if possible.

8. Ask the casualty to keep the un-injured eye still because movement of
this will also result in movement of the injured eye which aggravate
the injury.

C S GAS INJURY
C S gas or tear gas is a solvent spray used by the police for riot control and
self protection. It is sometimes used by unauthorized personnel as an assault
weapon.

EFFECTS ON THE CASUALTY

Effects of CS Spray on the casualty include:

1. Lachrymation

2. Uncontrolled sneezing and coughing.

3. Burning sensation on the skin and in the throat.

4. Chest tightness.

5. Vomiting.

The effects usually wear off within 10 – 15 minutes sometimes longer if the
spray was in a confined space.
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TREATMENT
1. If possible ensure your own protection from the CS spray.

2. Escort the casualty to a well ventilated area.

3. Reassure the casualty that the symptoms will soon resolve.

4. If the casualty eye are painful, fan them to speed up the vaporization
of the CS chemical, this is preferable to eyes irrigation.

5. Discourage the casualty from rubbing the eye.

PENETRATING EYE INJURY

A penetrating eye injury is not always obvious and can easily be missed.
Any history of high velocity injury e.g. use of hammer and chisel should
increase suspicion of a penetrating eye injury.

TREATMENT
If there is a suspected penetrating eye injury or if is clearly evident.

1. Apply a sterile eye pad or a clean non-fluffy pad over the injured eye
to protect it from any pressure.

2. Ask the casualty to keep the un-injured eye still because movement of
this will also result in movement of the injured eye which could
aggravate the injury.

3. Arrange transfer to an audient & emergency department or a specialist

eye unit.

4. Never manipulate and attempt to remove embedded object e.g. dart.

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5. All penetrating eye injuries receive immediate specialist ophthalmic
management without delay.

CONCLUSION
Eye injuries can be very irritating and painful for the casualty. Some can
potentially the serious. This chapter has provided and overview to the first
aid treatment of eye injuries.

POST TRAUMATIC EPILEPSY

ASSOCIATED FACTORS

Factor Incidence

No depressed fracture 3%

Depressed fracture 17%

No carly epilepsy 3%

Early epilepsy present 25%

No intracranial hematoma 3%

Intracranial hematoma present 35%

STATUS EPILEPSY
This is an acute medical emergency and refers to occurrence of repeated
tonic/cloric seizures with oral recovery between attack or one seizure lasting
longer than 30 minutes. If uncontrolled irreversible structureal brain damage
may occur, due to hyper pyrexia, hypotension and the efferts of continuting
unchecked clutreoid activity.
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MANAGEMENT
1. Protect air way remove dentures if present.

2. Give oxygen.

3. Insert in intravenous cannula, estimate blood glucose and correct any

hypoglycacmia if present.

4. Give an intravenous diazepam 0.15mg KG over 2 minutes observe for

respiratory depression and monitor the electrocardiogram (ECG).

5. Repeat if seizures have not stopped within 5 minutes.

6. At the same time assigning the diazepam observe the ECG for
dayrhythmias and monitor the blood pressure carefully hypotension.

7. If seizures continues consider a continuous infection of a benzo

diazepam 100mg diazepam in 500ml of 5% dextrose admission tered
at a rate of 14ml/hour. Initial infusion rate of 40 – 100ml, over 5 – 10
minutes. It should subsequently be given at 10-15 minutes, drops
Perminite.

8. It seizures continue for more than 60 minutes paralyze incubate and

ventilate.

INJURY OF EAR

INTRODUCTION TO EAR
The ear is the organ of hearting. The nerve supplies this special sense is the
eighth cranial or auditory nerve. The ear is divided in to three parts, external
middle and internal. Although problems affecting the ear. It is important to
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be aware that some times serious complication can occur e.g. repeated ear
infection can cause deafness.

TYPES OF INJURIES
1. Earache.

2. Foreign body in the ear.

EARACHE
Earache is usually caused by infection, young children in particular are
prone to middle ear infection because their Eustachian tubes can easily
become blocked. Sometimes earache is the main presenting symptom of
pathology from structure other that the ear.

TREATMENT
1. The casualty may wish to take two Paracetamol tablets (1 gm dose in
adults).

2. Offer the casualty a source of heat to had against the ear e.g. hot wter
bottle wrapped up in a towel.

3. Ensure the casualty is well supported with propped up pillow lying,

flat may exacerbate the pain.

4. Advise the casualty to see his Gf if the pain doesn’t resolve.

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FOREIGN BODY IN THE EAR

PERIPHERAL LINES
A foreign body in the ear is usually encountered in children (intentional
insertion) but sometimes is also seen in adults e.g. end of cotton bud the
casualty may require ENT referral.

SIGN & SYMPTOMS

Sign and symptoms may include:

 Pain and deafness in the one ear.

 Discharge from the affected ear.

TREATMENT
1. Ask the casualty to turn the head so that the ear with the foreign body
is facing the floor. The influence of gravity may dislodge the foreign
body.

2. Don’t try physically to remove the foreign body as this may result in it
being pushed further into the ear.

3. Arrange for transport to and A & E Department.

INSECT IN THE EAR

An insect such as a fly trapped in the ear is quite common. The casualty may
complain of an imitating buzzing in one ear to remove the insect suggested
technique is to:

1. Ask the casualty to sit down.

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2. Ask the casualty to position the head on the side with the affected ear
facing upwards.

3. Gently pour tepid water into the ear to down the insect and flood it
out.

4. If this fails arrange for transport to and A & E department.

THE INJURY OF SINUS

INTRODUCTION
The nose and sinus can harbor potentially serious disease that can be
difficult to diagnose in early stages. Prompt diagnosis can be achieved by
the correct interpretation of symptoms and sign. Careful examination and
appropriate investigation, trauma to the nose requires accurate assessment of
the structural deformity caused in order to effect successful surgical
correction.

ANATOMY OF NOSE AND PARANASAL SINUSES

The supporting structure of the nose are shown in the paired nasal bones join
in the middne with astur and are supported by the anterior quadrilateral
cartilage the perpendicular plates of the ethmoid and vomer.

TRAUMA TO THE NOSE AND PARANASAL SINUSES

Trauma to the nose is commonly sustained in sporting injuries fights and
road traffic accidents. Moderate trauma may fracture or deform the nasal
septal cartilage.
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NASAL TRAUMA
1. Don’t over look aseptal hematoma.

2. Displaced nasal bone fracture should be reduced with in 10-20 days of

injury.

3. Severe persistent epitasis suggested laerimal bone fracture and injury

to anterior ethnoid artery.

4. Cerebrospinal fluid rhinorrhoea indicate a fracture involving the

forntal or ethmoid sinuses with a dural tear.

MANAGEMENT OF FRACTURED NASAL BONES

Fractured nasal bones are often accompanied by extensine over lying soft
tissues swelling and burning which may hinder the assessment of the under
lying bony deformity reviewing the patient in 4 to 5 days when th soft
tissues swelling has oiminished heel allow a better assessment of any
deformity. If there is a significant degree of nasal deformity then this can be
corrected by manipulating of nasal bones.

SUMMARY
In this assignment to introduced injuries of eye, ear and sinuses explain the
types and sign & symptoms and treatment post traumatic epilepsy is
describe in detail and its management.

REFERENCES
1. E B N Lauy, P V Marks, (1992), Head Injury W B Saunders
Company, P. # 79 – 81.
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2. Barbara Averran, Pamela Eaishitte, P. # 80

3. Barbara Averran, Pamela Eaishitte, P. No. 79

4. Malcolm R Colmer, Surgery for Nurses.

5. Baily & Loues, 24th Edition, Short Practice of Surgery.