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Eye
Intraocular foreign body
An intraocular foreign body is determined by X-ray or clinical
examination.
Apply atropine 1%, dress the eye with a sterile pad and shield
and refer the patient to an ophthalmologist.
Immunize all patients with injuries to the globe for tetanus
Conjunctiva
Use sterile saline to wash out a foreign body embedded in the
conjunctiva or,
after administering a topical anaesthetic, wipe it away with a
sterile, cotton tipped applicator.
Eversion of the lid may be necessary to expose the foreign body
Eye
Cornea
If the patient complains of the feeling of a foreign body but
none is seen, instil two drops of 2% sodium fluorescein.
A corneal abrasion, which the patient cannot distinguish from
a foreign body, will be confirmed by the retention of green
pigment in the abrasion.
To remove a superficial corneal foreign body, use a 27-gauge
needle.
Apply antibiotic eye ointment and an eye patch for 24 hours.
Refer patients with corneal foreign bodies that cannot be
removed and ones that have corneal inflammation that
persists more than 3 days.
Ear
Accumulated ear wax is often confused with
foreign bodies.
Visualize
both
the
symptomatic
and
asymptomatic auditory canal to confirm the
presence of a foreign body.
Use a syringe to wash the ear;
this will remove most foreign bodies,
is contraindicated if the foreign body absorbs water:
for example, grain or seeds.
Ear
To remove a mobile insect from the ear,
immobilize it with glycerol irrigation followed by a wash with a
syringe.
Ear
To remove accumulated ear wax,
syringe the ear with warm water.
If the wax remains, instruct the patient to instil glycerol or
vegetable oil drops twice daily for 2 days then repeat the
syringe wash
Nose
Visualize nasal foreign bodies to determine
their nature and position.
Remove a foreign body with rough surfaces
with
angled forceps or pass a hook beyond it, rotate the
hook, and pull the object out.
Airway
Airway foreign bodies usually lodge in the right
main stem bronchus and follow an episode of
choking while eating.
Bronchoscopic removal is indicated.
Causes of upper airway obstruction could be:
Poor denture
Bolus: due to improper chewing
Pts expierence SOB while eating
Gastrointestinal tract
Oesophageal and stomach foreign bodies in children
Objects lodge at the
cricopharyngeus in the upper oesophagus,
the aortic arch in the midoesophagus and
the gastro-oesophageal junction in the distal oesophagus.
Gastrointestinal tract.
Smooth objects
that reach the stomach will generally pass through the entire
gastrointestinal tract and do not require retrieval.
Instruct patients or parents to check the bowel contents to
confirm passage of the object.
Gastrointestinal tract.
Colon and rectum
Sharp foreign bodies may perforate the colon during transit.
Remove foreign bodies placed in the rectum using general
anaesthesia with muscle relaxation.
Body cavities
Remove foreign bodies that penetrate the head, chest or
abdomen in the operating room
First the patients airway has been secured and preparations are
made for the consequences of removal, which could
include severe haemorrhage
Soft tissue
Confirm foreign bodies are present (often pins or needles)
in the foot or knee by X-ray.
Make one attempt to remove them under local
anaesthesia.
If that fails, perform the procedure with ketamine or
regional
anaesthesia
with radiological assistance,
preferably fluoroscopy.
Remove bullets in subcutaneous tissue or muscle if
they are grossly
contaminated or if the wound requires exploration for
other reasons.
Remove bullets from joint cavities.
Cellulitis And
Abscess
local pain,
tenderness,
swelling and
erythema.
Abscess
Treat abscess cavities with incision and drainage
to remove accumulated pus.
Diagnose by the presence of one or more of the
following signs:
extreme tenderness,
local heat and swelling causing tight, shiny skin.
Fluctuation is a reliable sign when present, although
its absence does not rule out a deep abscess or an
abscess in tissues with extensive fibrous components.
Abscess
These tissues include the
breast,
perianal area and
finger tips.
Dental abscess
Treat dental pain initially by cleaning the painful socket
or cavity and then packing it with cotton wool soaked in
oil of cloves or a paste of oil of cloves and zinc oxide.
Tooth extraction is the best way to drain an apical
abscess when there are no facilities for root canal
treatment.
Remove a tooth if it
cannot be preserved,
Is loose and tender, or
Retropharyngeal abscess
Retropharyngeal abscesses occur in children and may
compromise the airway.
They result from infection of the adenoids or the nasopharynx
and must be differentiated from cellulitis.
The child
cannot eat,
has a voice change,
is irritable and
has croup and fever.
The neck is rigid and breathing is noisy.
Retropharyngeal abscess
Ix.
A lateral X-ray: widening of the retropharyngeal space.
white-cell count and differential,
erythrocyte sedimentation rate
tuberculin skin test (Mantoux test).
DDx
tuberculosis.
Rx
Administer antibiotics and analgesics.
Treat a patient with tuberculosis with specific antituberculous
medication
Drian the abscess
Thoracic empyema
Thoracic empyema is the presence of pus in the pleural cavity.
It can complicate lung, mediastinal or chest-wall infections and
injuries.
Rarely the source is a liver abscess.
An empyema is either acute or chronic.
It can invade adjacent tissues or cause abscesses to form in
other organs.
The infection results from mixed flora including
staphylococci,
streptococci,
coliform bacteria,
tuberculosis.
Thoracic empyema.
Symptoms:
chest pain, fever and an irritating, dry cough.
Signs:
dull to percussion, with an absence of, or markedly reduced,
breath sounds.
Ix include
chest X-ray:fluid in the pleural cavity, often with features of
the underlying disease.
white cell count,
haemoglobin and
urinalysis.
Needle aspiration.
Treatment
Small acute empyema: should be treated by repeated aspiration.
Moderate or large collection: by placement of a chest tube attached
to an underwater seal (see Unit 16: Acute Trauma Management for chest
tube). Indications
pneumothorax,
haemothorax,
haemopneumothorax and
acute empyema.
Give systemic antibiotics (do not instil them into the pleural cavity)
and analgesics.
If there is evidence of loculation or failure of lung expansion, refer
the patient.
Chronic empyema: foot note.
Pyomyositis
Pyomyositis is an intramuscular abscess occurring in the
large muscles of the limbs and trunk, most commonly in
adolescent males.
It presents with
tender, painful muscles and fever.
Ix
Confirm the abscess with needle aspiration.
X-ray of the hand to determine if there is bone involvement
Gram stain on the pus.
Perianal/subcutanous,
ischiorectal,
inter-sphincteric /submucous abscess
Supralevator/pelvirectal
Sampling
Biopsy
Incisional
excisional
FNAC
Proctoscopy
sigmoidoscopy
Perianal hematoma
Anal fissure
hemorrhoids