eye injury and wound care

Question 1

treatment of eye injuries

Answer 1

Position the patient in a head up position, for example sitting at an approximately 45 degree angle.
* Irrigate chemical burns for at least 30 minutes.
* Apply pressure to external bleeding, but do not apply pressure to the globe if there is a possibility of a penetrating injury.
* Attempt to flush out a ‘simple floating’ foreign body (such an eyelash) using 0.9% sodium chloride.
* Examine and record the following:
a) The appearance of the eye and surrounding tissues. Consider taking a photograph using the ePRF tablet if there is an obvious abnormality.
b) Pupil size, shape and equality.
c) Pupil reactivity to light, including the consensual light reflex.
d) Eye movement, vertically and horizontally.
e) An approximate assessment of the vision in each eye.
* Administer ondansetron if the patient has an injury that appears to have penetrated the globe. See the ‘nausea and/or vomiting’ section for dosing.

Question 2

• When assessing the patient with an eye injury

Answer 2

ū Inspect the eyelids and surrounding skin for bruising, swelling and/or lacerations.
ū Inspect the cornea, which should appear clear and without signs of laceration or abrasion.
ū Inspect the anterior chamber, which should appear clear.
ū Inspect the conjunctiva. Blood vessels run between the conjunctiva and
the sclera and this is a common area for bleeding to occur.
ū Inspect the size, shape and equality of the pupils. Abnormality suggests
an internal injury to the eye, but always ask about previous eye surgery or the use of pharmacological eye drops which commonly cause a large, abnormally shaped and/or unreactive pupil.
ū Assess pupil reactivity to light, including the consensual light reflex (the constriction of the pupil of one eye when light is shone in the other).
ū Assess eye movement in the vertical and horizontal plane by asking the
patient to keep their head still and look at your finger while your finger moves.

Question 3

Provide a clear recommendation for the patient to be assessed in an ED if any of the following are present with a wound

Answer 3

ū Severe or uncontrolled bleeding.
ū Penetrating injuries of unknown depth.
ū Significant tissue loss, tissue damage or crush injury.
ū Signs of ischaemia.
ū Loss of sensory or motor function.
ū Significant wound contamination or foreign material that is unable to be
removed.
ū Signs of infection with systemic involvement.
ū Of cosmetic concern, for example involving the face.
ū Aged less than two years and requiring sutures or staples.

Question 4

Wounds that are less than 4 cm in length with edges that are easily brought together are usually suitable

Answer 4

to be closed using wound tape/strips or glue.

Question 5

Wounds caused by a dirty object or that are visibly contaminated, require thorough decontamination via irrigation: steps

Answer 5

ū Several minutes of irrigation is usually required.
ū The volume of irrigating fluid is more important than the nature of the
fluid, provided it is clean.
ū Clean running water or 0.9% sodium chloride may be used.
ū Have a low threshold for recommending the patient is seen in a medical
facility if it is not clear the wound has been adequately decontaminated.

Question 6

treatment princpals for skin tears

Answer 6

ū Ensure the dressing immediately over the involved skin is ‘non-stick’.
ū Apply an additional dressing that holds the non-stick dressing and underlying skin gently (but not tightly) in place. For example, use a
bandage over a non-stick dressing.
ū If a dressing is stuck around the skin tear, consider drawing on the dressing
(with an arrow) the direction in which it should be removed.
ū Provide advice to the patient and/or caregivers to keep the area dry.
ū Provide advice to be followed up in primary care, preferably by their own
GP.

Question 7

dressing wounds treatment principals

Answer 7

ū Covered wounds heal faster than non-covered wounds.
ū Wounds that are moist (but not wet) heal faster than wounds that are dry.
ū The wound should be clean before being dressed.
ū The skin edges should be dry and aligned before being dressed.
ū Whenever possible, the part of the dressing directly over the wound should
be ‘non-stick’. If a ‘non-stick’ dressing is not available and gauze is being used, this must be moistened prior to application.