Discuss the role of an ophthalmic surgeon in management of head injuries. ROLE OF OPHTHALMOLOGIST IS AS A LIFE SAVER IF NOT ATTENDED BY COMPETENT TEAM AND TREAT RELEVANT OCULAR DISEASE AND GUIDE THE NEUROSURGEON . A=Air way patency(ANY OBSTRUCTION AND RELIEVE,CPR) B=Breathing; rate,rhythm(OXYGEN ADMINISTRATION) C=Circulation;shock or hypertension(START AN IV LINE AND TREAT AS REQUIRED) D=Deformity(NECK FOR CERVICAL SPINE=STABILISE FIRST BY COLAR) E=Exposure PROMPT PRIMARY EXAMINATION TO DEFINITIVE LIFE SAVING MEASURES. (GLASGOW COMA SCALE= 8 OR MORE ) SEND ALERT MESSAGE TO DEFINITE NUMBER LIKE 199 ETC OR YOUR TEAM. SHORT HISTORY REGARDING THE CAUSATIVE FACTORS,TIME PASSED,ANY TREATMENT GIVEN. EPILEPSY,LAST FOOD,DIABETES,HYPERTENSION,DRUG SENSITIVITY,RELATIVES,FINANCIAL STATUS,INSURANCE. AS AN OPHTHALMOLOGIST 1.if the patient can NOT be aroused=ascending reticular system affected ,which is most dangerous. if can be aroused,then cortex is affected. 2.external examination-Panda eye;fracture of base of skull, eye lid injury,orbital fracture by palpating the orbital rim(deformity,commonest is floor fracture), lid separation by lid retractors;rupture of globe,hyphaema,cornea, VISION=IN COMA -FINGER THURSTING IN FRONT OF PUPIL.PT.TRIES TO AVOID OR BLINKS=CAN SEE.EACH EYE SEPARATE. If eye ball is intact and eye is protruded,the retrobulbar haemohhage and possibility of COMPARTMENT SYNDROME. PUPIL & ITS REACTION;DIRECT AND CONSENSUAL.IOP BY TONOPEN. PIN POINT PUPIL=PONTINE HAEMORRHAGE, DILATED PUPIL=MIDBRAIN TRAUMA, ONE EYE DILATED=COMPRESSION OF 3 RD N AGAINST TENTORIUM ON ONE SIDE=HERNIATION OF BRAISTEM IN EVOLUTION. LENS;ANY DAMAGE,FOREIGN BODY(FB) FUNDUS;(WITHOUT DILATING PUPIL)RETINAL DAMAGE,SUBHYALOID HAEMORRHAGE & AROUND OPTIC NERVE =SUBARACHNOID HAEMORRHAGE.FB OPTIC NERVE FOR AVULSION OCULAR MOTILITY,IF CERVICAL SPINE IS NOT INVOLVED.IF INVOLVED BETTER TO AVOID DOLL’S EYE MOVEMENT SUMMARISE FINDING; LIFE THREATENING- PIN POINT PUPIL,FIXED AND DIALTED PUPIL,SUBHYALOID HAEMORRHAGE. URGENT=RETROBULBAR HAEMORRHAGE WITH RAISED IOP,RUPTURED GLOBE AND CORNEA.RET. DETACHMENT-MACULA OFF OR RD THEATENING MACULA CAN BE DELAYED IF LENS IS AFFECTED OR HYPHAEMA.
Posted on: Fri, 01 Nov 2013 16:57:55 +0000
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