Blunt injuries - spleen

Left upper quadrant pain, tenderness and moderate rigidity; left shoulder pain (Kehr’s sign)
Hypotension; weak, thready pulse; increased respirations (shock)

1. Lay patient flat
2. Institute shock measures

1. Assess respiratory and hemodynamic status
   1. Maintain airway and ventilation as indicated
   2. Institute infusions of colloid or crystalloids as ordered
   3. Insert both CVP and arterial monitoring lines
   4. Insert Foley catheter
2. Prepare for splenectomy

Eye and Ear Emergencies

Blunt injuries secondary toflying missiles, e.g., balls.striking face against car dashboard

Decreased visual acuity, diplopia, blood in anterior chamber
Pain, conjunctiva reddened, edema of eyelids

1. Prevent victim from rubbing eye
2. Cover with patch to protect eye
3. Seek medical help immediately

1. Test visual acuity of each eye
   using Snellen or Jaeger chart
2. Assist with fluorescein administration - to facilitate identifying breaks in cornea

Sharp ocular trauma - secondary to small or larger foreign bodies

Reports feeling as if something were hitting eye
Pain, tearing, reddened conjunctiva
Blurring of vision
Foreign object may be visible

1. Keep victim from rubbing eye
2. Cover very lightly - do not apply pressure

1. Check visual acuity in both eyes
2. Check pupils
3. Instill 1% tetracaine HCI as ordered to relieve pain
4. Administer antibiotic drops or ointment as ordered
5. Apply eye patch
6. Provide instructions for subsequent care and follow-up

Foreign bodies in ears —beans, peas, candy, foxtails, insects

Decreased hearing; pulling, poking at ear and ear canal; buzzing, discomfort

1. Do not attempt to remove object
2. Seek medical assistance

1. Inspect ear canal
2. Assist with sedating children - restraint may be necessary
3. Assist with procedures to remove object:
   1. Forceps or curved probe for foxtails, irregularly shaped objects
   2. 10F or 12F catheter with tip cut squarely off and attached to suction to remove round object
4. Irrigate external auditory canal to flush out insects, materials that do not absorb water; do not irrigate if danger of perforation