Pediatric Head Injuries and Facial Trauma

1

A 12-year-old male steps too close to another golfer’s backswing and is hit in the right eye by the club. How can you prevent further eye damage on the way to the emergency department (ED)?

You should physically protect the eye as well as avoid an increase in intraocular pressure (IOP), which can cause secondary injury. Anchor the protective shield on bones around the eye. If no eye shield is available, you can use a styrofoam or plastic cup. To avoid an IOP increase:

• 1.

  Elevate the head of the bed to 30 degrees if not otherwise contraindicated.

• 2.

  Give analgesia to avoid pain—narcotics are preferred to nonsteroidal anti-inflammatory drugs (NSAIDs) due to bleeding risk.

• 3.

  Give antiemetics to avoid Valsalva with vomiting, sedatives if needed to avoid agitation and hypertension.

2

This same patient has a piece of plastic from his sunglasses lodged in his eye. Should you remove it?

Do not remove ocular foreign bodies in the prehospital setting. These foreign bodies can lodge deep in the eye, paranasal sinus, or intracranial space, and removing it can damage the surrounding structures. Wait until the patient is evaluated in the ED with imaging.

3

What are the important initial steps in care of chemical burns to the eye?

Both acids and alkali burns can cause large corneal defects. Irrigate the eye immediately. You can use nasal cannula tubing to direct the flow of normal saline, lactated Ringer’s solution (LR), or water away from the corner of the eye (away from the lacrimal punctum). It is also important to bring the container of the offending agent to the hospital, if available.

4

Which pediatric dental injuries require immediate medical attention?

For primary teeth (kids under 5, and some teeth of kids 6–12 years): luxation (displacement of tooth) should be referred to a dentist to be seen within 1–2 days. Avulsion (completely displaced from socket) is urgent only if the tooth was not found, due to need for x-rays to evaluate for aspiration.

For permanent teeth (some teeth age 6–12 years, all teeth over 13 years): luxation and avulsion. Avulsion is the most serious and the goal should be immediate replantation.