Dr Pierre Viviers

Complain of pain above shoulder > injury

Associated injuries Airway/ C-spine Needs medical

attention Anatomy

Blow-out #: Blunt trauma (elbow) Compression (globe & orbital

contents) Fracture – orbital floor Peri-orbital bleeding Sunken eye Double vision on upward gaze

(entrapment of inferior rectus muscle)

Numbness of cheek Refer doctor Immediate anti-

biotic Specialized management

All eye injuries-thorough medical examination

Serious injuries-immediate referral (ophthalmologist)

Difficult dilemma-distinguish

Immediate referral: Severe eye pain Persistent photophobia Penetrating injury: pear

shaped pupil Hyphema Embedded FB Markedly impaired

visual acuity Loss visual field

Corneal Abrasion: Common, red & painful Rinse & refer AntibioticSub-conjunctiva Bleeding: No treatmentHyphema: Bleeding (cornea/ iris) Severe pain/ blurred

vision Refer (rest & pressure)Retinal Detachment: Light flashes “Curtain” – field of vision Urgent referralEyelid Lacerations: Exclude coexisting injuries Lachrymal duct (medial)

Epistaxis: Little`s Area Digital compression (sitting

upright) Cold compression on the

bridge > 20min - Refer

Nasal Fractures Septal Hematoma

Auricular Hematoma : Cauliflower Ear External contusion Bleeding between layers Swelling, pain & tender Refer: medical

managementTympanic Membrane Rupt:

Blow to side of head Pain, bleeding & hearing

impairment Refer: medical

examination

Fractures: Common – blow to jaw Associated injuries More than one site (both sides

of the midline) Swelling, tender & painful Misalignment of teeth &

bleeding Airway (conscious/

unconscious): Positioning (ABC) Forward sitting &supporting

jaw with both hands Cervical collar, immediate

referral

Dislocation (TMJ): Blows to mandible Common Pain Malocclusion Inability to close Management:

Reduce (down & back

Refer

Fractures, luxated, avulsed: Common-blows against the

head Thorough examination of

oral cavity Missing tooth – swallow >

complication Management:

Protect fragment (milk, saline, under tongue

Handled by crown Reposition/ place back Replace within 60 min Unconscious (replaced <

2hrs)

Laceration: Accidental bite Bleeding General Principles:

Rinse/ pressure

Extensive Injuries needs careful suturing

Thank You

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