Lecture 14 (HEENT)-Exam 14 Flashcards
Chemical Burns
* Hx of what?
* Immediate what?
* What should you use?
* Eye pH measurements?
* What is a tip?
- History of eye exposure, decreased vision, pain, blepharospasm, redness
- Immediate Irrigation- Morgan Lens
- Proparacaine less irritating than tetracaine
- Eye pH measurements- should be 7.4
- Tip- may add 10mL 1% lidocaine to irrigating fluid
What is the chemical burns?
* Post irrigation treatment
- Topical ABX-erythromycin 0.5% q4-6 hrs
- Cycloplegic (atropine, tropicamide)
- Pain management
- Intraocular pressure measurements
Chemical Burns
* What is the difference between Acid vs Alkali?
* What has items are alkali
- Acid burns tend to be less devastating- cause coagulation necrosis, and vision loss but usually self limited
- Alkali burns most serious- causes liquefactive necrosis that penetrates and dissolves tissues until agent is removed
- Magnesium sparklers- mag hydroxide – alkali
- Hair straighteners, detergents, air bags- alkali
What is this?
Corneal Abrasion-
* What is it?
* What are the sx?
* How do you dx?
- Defect in the corneal epithelium, often traumatic
- Very painful, reluctant to open eye, photophobia
- Dx: corneal defect on fluorescein exam ->Perform eyelid eversion to r/o foreign body
Corneal Abrasion- (Brief Review)
* What is the txt?
Txt: Topical antibiotics, Tdap, close follow up
* 1st line- erythromycin ointment
* Contact lens use–> Abx needs to cover pseudomonas (cipro, ofloxacin)
* Delayed treatment of abrasion post trauma may result in ulceration (counsel patient)
What is this?
Corneal Foreign Body
* Try what?
* Evert what?
* What needle?
* What are the txt?
Lid Laceration
* when can it be closed with steristrips?
* What should partial thickness be repaired with?
* What type of complex lacerations need a referraL
The presence of orbital fat in an eyelid laceration indicates damage to the orbital septum and possibly to the underlying muscle. Ophthalmology consultation should be obtained.
Hyphema
* What is it?
* When does it become problematic?
* Can be what?
* usually what?
* Watch for what?
Hyphema
* What type fo consult?
* Most can be what?
* What are the goals?
* Avoid what?
- Ophthalmology consult (eval within 24 hours)
- Most can be conservatively managed
- Goals: Prevent increased pressure, rebleeding, vision loss
- Avoid straining, elevate HOB 30 degrees, bedrest, analgesics, topical betablocker +/- alpha-agonist. PO acetazolamide sometimes used. IV mannitol sometimes used.
Hyphema
* What are the indications for admission?
- > 50% involvement
- Decreased vision
- Increased IOP
- Sickle cell disease
Subconjunctival Hemorrhage
* Often what?
* Can be what?
* how do you dx?
* Txt with what?
* Screen for what?
* Resolves when?
Vitreous Hemorrhage
* What is it?
* Seen in who?
* What are the sx?
- Bleeding in the vitreous from variety of causes
- Seen in diabetic retinopathy, vitreous detachment, retinal vein occlusion, and trauma (especially shaken baby syndrome)
- Symptoms include hazy vision, black spots, “floaters”
Vitreous Hemorrhage
* What does the exam show?
* What referral?
* Elevated what?
* Avoid what?
* If trauma hx, then what?
What is this?
Vitreous Hemorrhage
Globe Rupture
* Hx of what?
* What does the exam show?
What is this?
Globe rupture
What is the seidel sign?
What is the tx for globe rupture?
Orbital Wall Fracture
* What are the exam signs?
* How do you dx it?
Orbital Wall Fracture
* Most are what?
* Evaluate for what?
* If fracture involves infected sinus- treat with what?
* Patients are instructed to avoid what?
* Who do you need to consult?
Blowout Fracture
* What is it?
* Often associated with what?
* Caused by what?
What is this?
Orbital Floor Fracture or “Blowout Fracture”
Orbital Compartment Syndrome- Pathophysiology
* The oribit is what?
* What can cuase rapidly elevated pressure?
* Decreased what?
* Treat with what?
What is a lateral canthotomy?
What is this?
Hyphema
What is this?
Subconjunctival Hemorrhage
Corneal Foreign Body
Blowout Fracture-> Entrapment of inferior rectus muscle
Conjuctival Foreign Body
