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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• 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

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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

• Visual acuity

• External Inspection

– Lids, lashes, conjunctiva, and cornea

– Symmetry of eyes

– Eye movement

• Palpate orbital rim

• Pupils

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Eye Anatomy

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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

• 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

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Corneal Laceration

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Corneoscleral Laceration

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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

• 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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Subconjunctival Hemorrhage

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Orbital Floor Fracture

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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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HYPHEMA

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Hyphema

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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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Alkali Burn of the Cornea

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Corneal Ulcer

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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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Corneal Foreign Body

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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

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Special Considerations

• Common in school age population

• Can be life-threatening

• May cause great anxiety

• Usually non-urgent

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Selected ENT EmergenciesEar• Laceration

• Hematoma

• Abrasions

• Foreign Body

• Burns

• Frostbite

Nose• Nasal fracture

• Epistaxis

• Foreign Body

• Acute Sinusitis

Throat• Tonsillitis

• Streptococus infection

• Peritonsillar abscess

• Epiglottis

• Retropharyngeal abscess

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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

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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

• 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

• 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

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Assessment Of Dental/Oral Trauma

• Use body substance isolation precautions

• ABC’s

• Types include:

– Soft tissue

– Impaled objects

– Injury to tooth

– Injury to bony structures

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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• 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• Alveolar Fracture

• LeForte Fracture

• Mandible fracture

• Fracture of the zygomatic arch

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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

• Caries

• Exfoliation

• Eruption

• Orthodontic appliances

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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• 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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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

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??