Orbital Fracture in Emergency Medicine Treatment & Management
- Author: Thomas Widell, MD; Chief Editor: Trevor John Mills, MD, MPH more...
Airway, breathing, and circulation are the first priorities. Hold the airway open by jaw thrust or airway adjuncts, including endotracheal intubation. Because of the concern with intracranial placement of endotracheal tubes, severe facial injury is considered a relative contraindication to using the nasotracheal route of intubation.
Place patient on a backboard with a collar if cervical spine injury is a possibility.
Treat hypoventilation with intubation and bag ventilation.
Control actively bleeding wounds by applying direct pressure with a bandage.
If globe is open, cover it with a protective shield.
Emergency Department Care
Airway, breathing, and circulation are the first priorities. Reassess airway frequently. Intubation performed early on, before swelling occurs, makes airway control much easier than waiting until a problem arises from obstruction.
Do not focus on the obvious deformity, thereby neglecting to perform a complete primary survey. Rapidly diagnose other life threats and undertake appropriate resuscitation.
Diagnosis of orbital fracture in the ED is part of the secondary survey. Diagnose other injuries to the eye as well by performing a complete slit-lamp examination of the eye and tests for visual acuity.
In one study, treatment of ocular emergencies in trauma centers and treatment in traditional community hospital emergency departments were compared. The records of 1027 patients with ocular emergencies between July 2007 and November 2010 were reviewed. The incidence of patients requiring ophthalmic intervention was 77.2 per 100,000 in the community hospitals and 208.9 per 100,000 in the trauma centers. Orbital fractures were found in 86% of all orbital contusion cases in trauma centers; and in 66.7% of patients with fall injuries and open globe diagnoses, the result was legal blindness.
Depending on the institution, orbital fractures are cared for by an eye, ear, nose, throat (EENT) surgeon, oromaxillofacial surgeon, ophthalmologist, or plastic surgeon.
Patients with serious eye injuries and decreased visual acuity should have an ophthalmology consultation. Monitor minor injuries, such as corneal abrasions, on an outpatient basis.
Provide care for the patient with multiple injuries in conjunction with a surgeon with experience in trauma care.
The incidence of posttraumatic stress disorder is high in patients with facial injuries, and a consultation with a psychiatrist should be considered.[10, 5, 7]
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