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LAST MINUTE EMERGENCY MEDICINE - PART 10

Chỉ định: Tất cả các giác mạc FBS kim loại và vòng gỉ nên được gỡ bỏ một cách kịp thời để tránh thiệt hại thêm cho giác mạc. Chống chỉ định: Vi phạm các khoang phía trước bởi một FB là một chống chỉ định để loại bỏ trong ED. X-quang cho nhãn FB | HEAD AND NECK 545 trauma cancer radiation etc. there is a potential for bowel perforation and the risk benefit ratio should be considered. Complications Complications including bowel perforation intra-abdominal viscera or pelvic organ injuries bleeding vascular injury peritonitis hematuria infection are potential issues. Use of ultrasound may decrease the complication risk. HEAD AND NECK Corneal Rust Ring Removal Indications All metallic corneal FBs and rust rings should be removed in a timely fashion to avoid further damage to the cornea. Contraindications Violation of the anterior chamber by a FB is a contraindication to removal in the ED. X-rays for intraocular FB are indicated if there is any concern for this. Complications Avoid multiple attempts at removing stubborn rust rings as excessive scraping or burring may cause unneeded injury. Comments Always refer to the ophthalmologist for evaluation within 24 hours. A cycloplegic may improve ciliary spasm and pain. The patient should be prescribed a suitable ocular antibiotic as well as pain medication and their tetanus status should be addressed. Control of Epistaxis Indications When local measures fail to control epistaxis anterior or posterior packing of the effected nares is indicated. Contraindications No absolute contraindications. Technique The bloody clots in the nares should be removed with the simple technique of the patient blowing their nose unless contraindication by a sinus fracture. Further clearing of the nares can be done with suction. Topical anesthetic and vasoconstrictive agents are then used generally by soaking cotton pledgets and placing into the nares. Locate bleeding by inspection and cauterize if possible. Pack using Vaseline gauze or any of the newer nasal tampons or balloons if bleeding persists. Complication Patient may not be able to tolerate packing. Obstruction of sinus ostia may lead to infection. Posterior packing will require admission to observe for possible dislodgment into the