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Now, let's cover the topic of eye injuries, of which there can be a couple of main types. One is an object embedded in the eye. The other is a chemical in the eye. In this case, we're going to be first addressing the object in the eye. In this case we know that the worker was by a grinding wheel, and potentially one of the brushes may have flown off the wheel and embedded in their eye. They're in a great deal of pain. We've gone ahead and assessed for scene safety, our gloves are on, and also the patient is not suffering from airway, breathing, or circulation problems at this time, so they're remaining fairly stable. We guided them to a place where they could be sat down carefully and now treated, and here's what we do. We find a cup. It's important to understand that we want to actually get something that goes over the wounded eye so that we don't put any pressure on the object that's embedded in the eye. So here we are. Go ahead and take your hand away. Now can you hold that cup in place? You could also use a Dixie cup or a drinking cup, a styrofoam cup, a coffee cup. Go ahead and let go of the cup side. I'm going to put a bandage around. Let me know if that hurts at all, okay? Now I'm going to go ahead and wrap around this. You can let go. And I'm just going to continue here. I know that's over your eye, but I'll move that in just a second, okay? I'm going to continue to bandage around, and probably just a good couple times. You just want to make sure that the cup is not going to slip. And then once you come back around to the other side, we tuck the excess in underneath the bandage, as long as it's not putting too much pressure. Or you could always tape it in place. And ideally we're going to transport this patient via EMS, because there's things that we can do en route that might not be able to be done in a private car. Now the patient is packaged and ready to go. And now let's take a look at the other type of eye injury, which is chemical burns. Whether a dry chemical or a liquid chemical, it can cause a great amount of damage to this eye and the mucous membrane of the eye in a relatively short amount of time. So getting the person to a position where we can actually start to dilute the chemical as soon as possible is essential. Now we would like to use a balanced solution as far as pH goes, but if you only have the tap water out of a sink, or you have bottled water, drinking water, anything is going to be better than nothing. If it's a dry chemical, we're going to brush as much of the excess off as we can before we begin to dilute it and flush the eye. If it's a liquid, we're just going to begin flushing. A key point here: If it's one affected eye, we want to go from the inside of the eye and rinse to the outside. We don't want to cross-contaminate eyeballs. We don't want to flush from outside in, as it can then run over the bridge of the nose into the non-affected eye. Now we've got chemical exposure to both eyes. Remember that we're going to flush for no less than 20 minutes to dilute and to bring this solution into a position where it's not causing damage. We're going to transport this person to an emergency room as soon as possible, and we're going to watch for other life-threatening issues. Remember, the chemical that went in the eye could have also gotten into the mouth, nose, or airway, so we don't want to take for granted that this is an isolated injury. So we're going to continue to assess our patient from head to toe, looking for life-threatening situations like airway, breathing, circulation, or shock symptoms, and treat accordingly, and then continue to flush those eyeballs out so that we can get the chemical out and stop the burning from happening.
Injuries to the eye can involve the eyeball, the bone, and the soft tissue surrounding the eye. Blunt objects, like a fist or a baseball, can injure the eye and/or the surrounding area. Or a smaller object could penetrate the eyeball. Care for open and closed wounds around the eye as you would for any other soft tissue injury.
In this lesson, when we talk about treating an eye injury, assume we're referring to treating an injury from an object. Near the end we'll present some information on the other type of eye injury – chemical injuries.>
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim.
"Hi, my name's _____. I'm a paramedic. I'm going to help you."
Once you've ensured that the patient isn't suffering with airway, breathing, or circulation issues, the first thing you want to do is assess what type of eye injury you're dealing with – object or chemical? Both are serious!
This section will mirror the last lesson on the importance of, and strategies for, diluting chemical burns. Only with the eyes, and particularly the mucous membrane, damage can occur very quickly. Meaning your quick actions are essential.
There are two types of chemical eye injuries – dry or wet. If you're dealing with dry chemicals, brush as much off the eye as you can before beginning to flush with a solution. If you're dealing with a wet chemical, go right into flushing the eye.
While readying the patient for transport, and during your secondary survey, make sure the victim didn't get any chemicals into their mouth, nose, ears, etc. if they did, treat accordingly.
The single most effective measure for both chemical and foreign object injuries is wearing appropriate protective eyewear — ANSI-approved safety glasses or goggles have been shown to reduce workplace eye injuries by up to 90%. For environments involving chemicals, the CDC and OSHA recommend using sealed, indirect-vent goggles rather than standard safety glasses, since chemical splashes can travel around unprotected frames; additionally, knowing the location of the nearest eyewash station and flushing affected eyes with clean water for a minimum of 15–20 minutes is critical to minimizing damage after exposure.