Sideline Evaluation of the Eye, Face, and Related Structures

1
Sideline Evaluation of the Eye, Face, and Related
Structures

• Orthopedic Assessment III Head, Spine, and
  Trunk with Lab
• PET 5609C

2
Orbital Fractures

• Asymptomatic Fractures
• Ice to injured area (loosely applied)
• Avoid direct pressure on the globe
• Symptomatic Fractures
• Pain with eye movement
• Shield the Eye
• Instruct athlete to gaze straight ahead with
  uninvolved eye (limits voluntary eye movement ?
  eyes move in unison)

3
Contact Lens Removal

• Hard Lenses Removal
• Open eyes wide
• Laterally pull outer margin of eyelids
• Patient blinks, forcing lens out
• Soft Lenses Removal
• Patient looks up
• Clean finger placed on inferior edge of lens
• Lens manipulated inferiorly and laterally
• Pinch between fingers

4
Penetrating Eye Injury

• Penetrating Eye Injuries
• Do NOT attempt to remove the object
• Do NOT apply direct pressure on the eye
• Shield the eye
• If object is protruding far from the eye, use a
  paper/plastic cup to cover
• Immediate transportation to hospital

5
Chemical Burns

• Chemical Eye Burns
• Injury caused by an acid, alkali substance or an
  irritant
• Causes
• Chemical is splashed in eye
• Exposure to concentrated fumes and aerosols
• Severity depends on substance causing it and
  exposure time
• Usually, damage is limited to the front of the eye

6
Chemical Burns

• Chemical Eye Burns
• Symptoms
• Eye pain and redness
• Sensitivity to light
• Eye irritation and tearing
• Inability to keep the eye open
• Sensation of something in the eye
• Swelling of the eyelids

• Chemical Burns Types
• Alkali Burns
• Alkalis - chemicals that have a high pH
• Most dangerous type of chemical burn
• Alkalis penetrate the surface of the eye
• Common alkali substances contain the hydroxides
  of ammonia, potassium, sodium, calcium, and
  magnesium
• Lye, drain cleaner, metal polishes, oven
  cleaners, cement, lime, and ammonia

7
Chemical Burns

• Chemical Burns Types
• Acid Burns
• Caused by chemicals with a low pH
• Less severe than alkali burns
• Acids usually damage the very front of the eye
• Sulfuric acid, sulfurous acid, hydrochloric acid,
  nitric acid, acetic acid, chromic acid, muriatic
  acid, and hydrofluoric acid
• automobile battery explosion

• Chemical Burns Types
• Irritants
• Neutral pH.
• Effect - Significant pain but does not cause
  damage to the eye
• Pepper spray

8
Chemical Burns

• Treatment
• Medical emergency
• Wash your eye with water and/or saline
  immediately
• Longer exposure increased damage
• Wash the eye for at least 10 minutes
• Patch the eye
• Transport immediately

9
Lacerations

• Initial Care
• Control bleeding
• After controlled, palpate area for tenderness
  (possible underlying fracture)
• Imbedded object ? leave in place
• Facial laceration ? refer to physician
  (prevention of scars)
• Within 24 hours
• Throat laceration ? assess ABCs
• Avulsed tissue (ear, nose, tongue)
• Clean tissue (sterile water), wrap in gauze, put
  on ice, transport with athlete to hospital

10
Lacerations

• March 22, 1989 Clint Malarchuk (Buffalo Saber)
  caught a skate to the throat ? severed jugular
  vein
• Jim Pizzutelli (ATC) reached into Malarchuk's
  neck and pinched off the bleeding until doctors
  arrived to begin suturing the wound
• Within minutes of death
• 300 stitches
• Back to practice 4 days later

11
Lacerations

• Feb. 12, 2008 Richard Zednik ? lacerated right
  neck (another players was upended, skate swung up
  hitting Zednik in the right side of the neck,
  nearly severing his carotid artery)
• Underwent emergency surgery
• Five units of blood
• Dr. Noor The slashed artery was hanging by a
  thread. She stressed if the artery had been
  completely severed it would have recessed into
  the neck, requiring even more extensive surgery

12
Lacerations
13
Lacerations

• Laryngeal Injuries
• Can be life-threatening
• Signs
• Progressive swelling
• Crepitation (presence of subcutaneous air)
• Stridor harsh, high-pitched sound during
  respiration (resembles blowing wind)
• Bleeding from oral cavity
• Treatment
• Stabilize and transport

14
Facial Fractures

• MOI ? Significant blunt trauma
• May also cause head injury (concussion)
• Unconscious
• Head injury takes precedence
• Stable facial fracture (airway intact)
• Move athlete to sideline
• Obvious fracture present

15
Facial Fractures

• Sept. 28, 2008 Anquan Boldin injury
• Knocked unconscious
• Fractured paranasal sinuses and other facial
  injuries
• Surgery Eight plates in his face and wiring in
  his jaw
• Only missed three weeks

• http//www.youtube.com/watch?vj9RfJwSkMU8

16
TMJ Injuries

• MOI Blow to the jaw
• Mandible injury
• Signs/Symptoms
• Malocclusion remove athlete from participation
• Immediate referral
• Dislocation can immobilize athlete with
  Philadelphia collar

17
Nasal Fractures/Epistaxis

• Nasal Fractures
• With Epistaxis ? control the bleeding
• Traditional Method should it be used?
• With Fracture
• Pack nose with gauze
• Ice
• Rolled cotton gauze placed between anterior upper
  lip and gum
• Pressure placed on nasal mucosa arteries

18
Nasal Fractures/Epistaxis

• Nasal Fractures
• Treatment
• Control bleeding
• Nose, Cartilage, maxillary, zygomatic, and
  frontal bones can be palpated for tenderness
• Deformity present
• Athlete discourage to look
• Shock

19
Dental Injuries

• Tooth Injury (other than class I fracture) ?
  remove from competition
• Immediate referral to dentist
• Avulsed tooth Find It!
• Death of tooth primary reason due to death of
  periodontal ligament attached to avulsed tooth

20
Dental Injuries

• Avulsed Tooth
• Tooth separated from bony socket ? tearing of the
  periodontal ligament
• First aid Survival depends on rapid replacement
  into socket
• Replantation Preferably done at the site of
  injury (minimize extra-alveolar time - tooth out
  of socket)
• Attempt to replant tooth within first 15-20 min
  (stabilize by biting down gently on towel or
  gauze
• If the thin gum tissue (periodontal ligament)
  that is attached to the roots of the tooth dries
  before the tooth is replaced (extra-alveolar
  period gt1 hour) chance of tooth loss ?
• Minimal consequences if periodontal ligament is
  left attached to the root surface and does not
  dry out (extra-alveolar period lt1 hour)

21
Dental Injuries

• Do not handle tooth on Root Surface
• Never brush/scrub tooth
• Do NOT sterilize with disinfecting solutions
• If debris present, gently rinse with saline or
  water (10 seconds) and than replant
• Other alternatives (Transporting mediums)
• Best Save-A-Tooth container
• Should be in ATCs kit
• 2nd best Milk
• 3rd best Under athlete's tongue ONLY if athlete
  is conscious and alert or in a container into
  which the athlete spits
• 4th best Wrap in saline-soaked gauze
• 5th best Water
• Least desirable storage medium  
• Transport immediately