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Pearls and pifalls from the fast track room
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Pearls and pifalls from the fast track room

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Transcript

  • 1. Pearls & Pitfalls from the Fast Track Room
    By Kane Guthrie
  • 2. Case Study
    18 male plaster
    Mixing cement 20mins ago
    Splashed up into L eye
    Developed burning sensation to eye
    Irrigated for 5mins before presenting to ED
    ATS ? to FastTrack
  • 3. A True Ocular Emergency
    ATS 2
  • 4. Eye Anatomy
  • 5. Chemical Burns to the Eye
  • 6. Severity of Chemical Burns
    Minor
    • Minor irritation, typified by redness, lacrimation and mild oedema
    Moderate
    • Moderate irritation, such as irritation to cornea
    Severe
    • Severe irritation, such as corneal ulceration or perforation, can lead to blindness
  • Chemicals
    Alkaline chemicals are particularly harmful to eyes and can lead to necrosis
  • 7. Why are Alkalis so Bad!!
    Cause disruption of eye’s protective permeability barrier (cornea)
    Once alkali rapidly penetrate the cornea they release collagenase that then enters the anterior chamber
    Acid’s don’t seem to penetrate the cornea as much as alkalis, and tend to coagulate on the surface of the eye, limiting there damage.
    “Hydrofluoric acid is the exemption, tends to work the same as an alkali”
  • 8. History
    When did it occur?
    What is the chemical? (acid/alkali)
    Any first aid administered and how soon after the incident.
    Symptoms? E.g. loss of vision, redness, tearing, pain, photophobia,
    Associated injuries? E.g. skin exposure
  • 9. Assessment
    Look for Red eye
    (severe alkali burns alkali burns can present as eye completely white due to total loss of conjunctival blood vessels)
    Signs of severe burn
    Decreased visual acuity
    Cloudy cornea
    Epithelial defect with fluroscein
  • 10. Acute Burn
  • 11. Acute Severe Burn
  • 12. Pre-Hospital Care
    Copious irrigation for at least 30mins
    Neutral fluid (CSL or N/saline)
    Try and remove foreign bodies first
    Main need topical anaesthetic
  • 13. Emergency Department Management
    Irrigation ? CSL is better
    Morgan's Vs Nasal Oxygen
    Analgesia
    Same day Opthal r/v
  • 14. Emergency Department Management
    Pain relief
    Topical is better
    Helps relieve blepharospasm
    Assist with irrigation
    “Tetracaine Hydrochloride 1%”
    Avoid repeated application
  • 15. Emergency Department Management
    Irrigation > ASAP>Time is EYE sight
    Objectives of Irrigation
    Immediate dilution of offending agent
    Removal of agent
    Removal of foreign bodies
    Normalisation of anterior chamber pH
  • 16. Irrigation
    Which fluid is best?
    • Pre-Hosp any fluid better than nothing
    • 17. N/saline can cause more stinging compared to CSL, generally recommend in most texts
    • 18. New literature heading towards CSL as has closer pH to the eye.
    • 19. Some studies showed warmed fluids were better tolerated
    Bottom line, not enough evidence yet!!
  • 20. How long for? When do I stop?
    Literature recommends at least 20-30mins
    Stop when:
    When normalisation of pH,( ?7.3)
    Use litmus paper
    If pH deranged continue for another 20-30mins
    Symptoms improved
    Keep patient warm
  • 21. Morgan’s Lens “Friend or Foe”?
  • 22. Is the a better way to Irrigate
  • 23.
  • 24. Emergency Department Management
    Ophthalmology review
    Urgent once irrigation has been completed
    Can be sent to clinic
    May require ongoing management in OT, debridement, transplant
    Keep NPO
  • 25. The End
    Questions

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