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Eye
Eye
Most eye injuries are a result of dust or dirt blown into the eye by wind.
Since most foreign bodies in the eys can be located under the upper eyelid, invert it and try to isolate any dirt or dust.
-------------Gregory J. Davenport. Wilderness Survival.
Corneal Injury
The cornea is the clear covering of the front of the eye. It works with the lens of the eye to focus images on the retina. Injuries to the cornea are common. Superficial corneal injuries, called corneal abrasions, may be caused by foreign bodies (such as sand or dust), overuse of contact lenses or exposure to ultraviolet radiation.
Antibiotic ointment or drops may be prescribed until a corneal abrasion has healed. Getting rest and placing a patch over the affected eye may help.
Superficial corneal injuries normally heal very rapidly with treatment, and the eye should be back to normal within 2 days. Penetrating corneal injuries are much more serious and the prognosis will depend on the nature of the specific injury.
Chemical Injury
If chemicals are splashed in the eye, the eye should be IMMEDIATELY flushed with tap water. Any source of clean drinking water will do. It's more important to begin flushing than it is to find sterile water. Flushing with water will dilute the chemical.
Turn the person's head so the injured eye is down and to the side. Holding the eyelid open, allow running water from the faucet to flush the eye for 20 minutes. If both eyes are affected, or if the chemicals are also on other parts of the body, have the victim take a shower. If the person is wearing contact lenses and the lenses did not flush out from the running water, have the person try to remove the contacts AFTER the flushing procedure.
Continue to flush the eye for at least 20 minutes while seeking urgent medical attention. Or, after washing the eye thoroughly, close the eyelid and cover it with a loose, moist dressing.
With acid burns, the haze on the cornea often clears with a good chance of recovery. However, alkaline substances such as commercial drain cleaners may cause permanent damage to the cornea. Ongoing damage may occur in spite of prompt treatment.
Thermal Burn
Thermal burns damage eye tissue much as they do other skin tissues, but corneal burns may result in opaque scar tissue. Ultraviolet irradiation (e.g., unfiltered ocular exposure to an electric welding arc) can produce a superficial keratitis (which is painful but usually heals quickly).
Small Objects on the eye or eyelid
Foreign objects in the eye usually are flushed out through the natural blinking and tearing action of the eye. Do not rub the eye. Wash your hands before examining it.
To find the object, have the person look up and down, then side to side. If the foreign body can be seen on the inner surface of either the lower or upper lid, try to gently flush it out with water. If that does not work, try touching a cotton-tipped swab to the object to remove it. If you can't find the object, grasp the lower eyelid and gently pull down on it to look under the lower eyelid. To look under the upper lid, you can place a cotton-tipped swab on the outside of the upper lid and gently flip the lid over the cotton swab.
If the object is on the eye, try gently rinsing the eye with water. It may help to use an eye dropper positioned above the outer corner of the eye. DO NOT touch the eye itself with the cotton swab. Seek medical attention if the foreign body cannot be removed, or if there is still discomfort or blurred vision after removal.
OBJECT STUCK OR EMBEDDED IN EYE
Leave the object in place. DO NOT try to remove the object. DO NOT touch it or apply any pressure to it. Bandage both eyes. If the object is large, place a paper cup or cone over the injured eye and tape it in place. Cover the uninjured eye with gauze or a clean cloth. If the object is small, cover both eyes with a clean cloth or sterile dressing. Even if only one eye is affected, covering both eyes will help prevent eye movement.
* Some materials (e.g., glass or porcelain) may be tolerated and left alone, while others (e.g., copper or iron) must be removed because of later chemical reactions within the eye.
EYE CUTS, SCRATCHES, OR BLOWS
Gently apply cold compresses to reduce swelling and help stop any bleeding. DO NOT apply pressure to control bleeding. If blood is pooling in the eye, cover both of the person's eyes with a clean cloth or sterile dressing, and get medical help immediately.
SNOWBLINDNESS
Symptoms of snowblindness include scratchy or burning eyes, excessive tearing, sensitivity to light, headache, halos around light and temporary loss of vision. Bandage the victim's eyes and use cold compresses and a painkiller to control the pain. Vision will generally be restored after 18 hours without the help of a doctor. Always wear snow goggles or sunglasses in snowy areas to prevent snowblindness.
Drop instalation
The best way of installing ophthalmic solution is to ask the patient to tilt the head back and look upward. The lower eyelid is retracted outward and downward, creating a pouch between the eye and the globe. To prevent reflex blinking, the dropper bottle is brought up from an inferior position, out of the patient's line of sight. A drop of solution is delivered to the lower eyelid pouch, the patient is instructed to look downward, and the skin of the lower eyelid is released.
Patients should close their eyes gently, avoiding excessive squeezing of the eyelids. Digital pressure over the inferior medial canthus of the eye occludes the lacrimal puncta, prevents loss of drug into the nose. In case with uncooperative children, a drop of solution placed at the medial canthus of the closed eye. When the patients open the eye and the small reservoir of the medication will flow in.
Corneal abrasions are from fingers, paper, blowing dust, and sand may denude parts of the corneal epithelium. Foreign bodies retained in the upper tarsal plate produce additional scratches whenever the patient blinks. Double eversion of the lid with a retractor or cotton-tipped applicator is necessary to remove the foreign bodies.
Eye patching
Oxygen, nutrients, and lubrication of the cornea are provided by the adjacent tear film and aqueous humor. Corneal injuries heal via migration of epithelial cells that spread and reattach to deeper layers of the cornea. Eyelid blinking continually denudes these healing areas. A semipressure patch should be used to immoblize the eyelid in cases of corneal injury.
A semmipressue patches are applied over a closed eye with some antibiotic first applied to the lower conjunctival sac. One eye pad is folded in half vertically, rotated 90 degrees, and placed with the fold just under the eyebrow. A second patch is placed horizontally on top of the first. The patch is taped tightly in an oblique fashion from the center of the forehead to the midportion of the cheek. Elevate the cheek before taping to ensure adequate stretching of the tape. Avoid taping across the midline of over the nasolabial fold. The patch should not be removed the patch before in 1 to 2 days.
Chemical injuries
Treatment of the chemically injured eye should begin before hospital admission. Immediate institution of irrigaton with any available clean water source is critical . Alkali splash to the eye is a true ocular emergency. Strong alkaline chemicals are found in drain cleaners, chemical detergents, and industrial solvents and as lime in plaster and concrete. Alkaline substances produce a liquefactive necrosis that continue to dissolve and penetrate tissues until the alkaline agent is removed. Acid burns are less devastating because acidic substances produce coagulation and not liquefaction necrosis. Irrigation is most easily accomplished with a standard intravenous solution bad and tubing.
Thermal burns primarily affect the lids, sparing the globe, because of reflex blinking and upward rotation of the globe (Bell's phenomenon). Ultraviolet light reflected from sun, snow, or welder's arc is absorbed by and damages corneal epithelium, producing edema and ultimate sloughing. There is usually a latent periods of 6 to 10 hours after exposure until symptoms appear. As the injured corneal epithelium breaks down, patients develop a foreign body sensation and tearing followed by intense pain.
Nose
Nasal Bleeding
Most nosebleeds occur on the tip of the nasal septum, which contains many fragile, easily damaged blood vessels. Generally, this can be stopped by placing a gauze in front of your nose to catch the blood and then pinching the nostrils together. Some like to apply pressure over the upper lip at the base of the nose. Others like to apply ice to the forehead. If the bleeding persists for more than 5 minutes or if it is truly profuse it is best to go to a medical facility.
FOR A BROKEN NOSE: Have the injured person breathe through the mouth and lean forward in a sitting position in order to keep blood from going down the back of the throat. Apply cold compresses to the nose to reduce swelling. If possible, the injured person should hold the compress so that excessive pressure is not applied. DO NOT try to straighten a broken nose. Avoid blowing the nose for 24 hours. Elevate the head with pillows when lying down. Sneeze with the mouth open. Try not to touch the nose at all for 24 hours. If there is clear fluid draining continuously from the nose(this is cerebrospinal fluid), see immediately for emergency medical assistance.
Foreign body in the nose
Do not probe the nose with cotton swabs or other tools. Doing so may push the object further into the nose.
Have the victim breathe through the mouth. He or she should avoid breathing in sharply (which may force the object in further).
Once it is determined which nostril is affected, gently press the other nostril closed and have the victim blow gently through the affected nostril. Avoid blowing the nose too hard or repeatedly. If this method fails, get medical help.
Nasal stuffiness(Nasal congestion)
A congested nose happens when the membranes lining the nose become swollen from inflamed blood vessels. Congestion can be caused by most of the same reasons as a runny nose -- including colds, allergies, sinus infections, and the flu. Overuse of some nasal sprays or drops can also lead to congestion. A stuffy nose is usually caused by a virus and typically resolves spontaneously within a week.
Decongestants– these may help relieve congestion by shrinking the blood vessels in the lining of the nose. They only help with stuffiness, not a runny nose or other symptoms. Decongestant nasal sprays and drops should not be used for more than 3 days, because then they can make the congestion worse. Antihistamines thicken your secretions and therefore impair the mucociliary transport system and so they are potentially harmful in treating the common cold. For those who are not allergic, antihistamines can only thicken secretions and will probably do little to benefit you.
Nasal irrigation is very useful for the common cold. You can keep the bowl filled and whenever your nose becomes impossibly congested, irrigate both sides to wash out the thick secretions. This will provide you relief and improvement for an hour or two. This may have to be repeated four to ten times a day. You will have to make your own adjustments for salt concentration, temperature and volume. 처음에는 식염수를 묽은 농도로 시작해서 점차 농도를 높여 주면 점막의 충혈도 가라앉힐 수 있다. 이비인후과 학회에서는 식염수 세척은 금하고 있다. 콧 속에 내용물이 많이 있을 경우에는 컵에 뜨거운 물을 담아 김을 10분 정도 코에 쐰 후에 세척하면 내용물이 잘 씻겨 나온다.
The first and only thing you should try would be a saline nasal solution. Try putting two drops of coconut oil in each nosetril with a dropper and absolutely avoid cold air draught.
For a baby too young to blow his or her nose, an infant nasal aspirator (bulb) can help remove the mucus. If the mucus is thick and sticky, loosen it by putting 2 or 3 saline nose drops into each nostril. Don't insert cotton swabs into a child's nostrils. Instead, catch the discharge outside the nostril on a tissue or swab, roll it around, and pull the discharge out of the nose. Congestion is often worse when you are lying down. Keep upright, or at least keep the head elevated. This is especially helpful for young children. If your stuffy nose is accompanied by swelling of the forehead, eyes, side of the nose, or cheek, or a stuffy nose lasts longer than 2 weeks and significantly interferes with your life, call your health care provider.
Dry nose
As the nose ages, the mucosa shrinks and all of a sudden the secretions become thick and difficult to manage. This is usually perceived as a tenacious postnasal drip. People will often snort continuously and may complain of snorting, coughing and even hoarseness. For these cases, nasal irrigation is a wonderful cure. Nasal irrigation can be done once, twice or three times a day. It really does not matter what salt concentration and what temperature are used. Nasal irrigation washes away these thick secretions. It takes 4-6 hours to reaccumulate.
NASAL TIP INFECTION
These infections occur because there are hairs lining the inside of your nasal tip. The infection develops at the base of one of these hairs (a condition which is called folliculitis). These are potentially dangerous for not only are they uncomfortable and ugly but, the infection can spread through the nasal veins into your brain.
First, apply an antibiotic ointment such as mycitracin, or bacitracin to the inside surface of the nose four times daily. Second, apply a hot pack to the outside of the nose for 5 minutes, 4 times a day.
Mouth
Choaking
To perform the Heimlich maneuver on yourself: Position your own fist slightly above your navel. Grasp your fist with your other hand and bend over a hard surface — a countertop or chair will do. Shove your fist inward and upward
To perform the Heimlich maneuver on someone else:
Stand behind the choking person and wrap your arms around his or her waist. Bend the person slightly forward.
Make a fist with one hand and place it slightly above the person's navel.
Grasp your fist with the other hand and press hard into the abdomen with a quick, upward thrust. Repeat this procedure until the object is expelled from the airway.
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Oral ulcers (Aphthous Ulcers, canker sores)
The cause of canker sores is not well understood. More than one cause is likely, even for individual patients. An allergy to a type of bacterium commonly found in the mouth may trigger them in some. The sores may also be an allergic reaction to certain foods. In addition, there is research which suggests that canker sores may be caused by a faulty immune system that uses the body's defenses against disease to attack and destroy the normal cells of the mouth or tongue.
Other causes of canker sores are injury to the gums from brushing and illnesses in which the immune system causes swelling or inflammation of the body tissues (autoimmune disorders).
Some measures to speed the healing process include the following:
Keep the area clean and clear of food scraps. Clean the area gently with a very soft brush and mild (1-1/2%) hydrogen peroxide or a warm salt water solution made by adding 1/2 teaspoon salt to a full glass of warm water). Treatments for reducing the pain include numbing ointments such as benzocaine. Any ulcer of the mouth or lips that lasts longer than a week should be considered as a serious condition. If your mouth ulcers persist for longer than 3 weeks, call your health care provider.
Chapped Lips / Dry Lips
Chapped Lips refers to dry, cracking, painful skin on and around the lips and mouth area. Chapped lips are caused by the loss of moisture in lip skin. The natural oils in the skin is often lessened by exposure to sun, cold, wind and dry air. Repeatedly wetting the lips without protecting them first can also lead to chapped lips.
Avoid frequent lip licking. Avoid excessive sun exposure. Apply cool, salt-soaked cloths to the lips everyday to hydrate the lips. Seal in the moisture with a lip balm containing waxes or lanolin.
Broken or knocked out tooth
Try to replace the tooth in the socket, to the level of adjacent teeth. Bite down gently on gauze or a wet tea bag to help keep it in place. DO NOT handle the roots of the tooth. Handle only the chewing edge (the crown portion of the tooth). If the tooth cannot be replaced in the socket, place it in a container and cover with a small amount of whole milk or saliva. The tooth can also be carried between lower lip and lower gum or under the tongue. The sooner dental attention is received, the better the chances are for successful reimplantation.
If a tooth has been partially fractured, a non-emergency dental appointment can be made.
Dental care
Brush your teeth at least twice daily, preferably after every meal and at bedtime.
Floss at least once per day.
CARING FOR AN INFANT'S TEETH
Use a damp washcloth to wipe your infant's gums after each meal.
DO NOT put your infant or young child to bed with a bottle of milk, juice, or sugar water. Use only water for bedtime bottles.
Begin using a soft toothbrush instead of a washcloth to clean your child's teeth as soon as his first tooth shows (usually between 5-8 months of age).
CARING FOR A CHILD'S TEETH
When your child gets permanent teeth, he or she should begin flossing each evening before bed.
Ear
Wax blockage
The ear canal is lined with hair follicles and glands that produce a waxy oil called cerumen. This protects the ear by trapping dust, microorganisms, and other foreign particles, preventing them from entering and damaging the ear. The ear wax slowly slides out of the ear canal. Sometimes ear wax builds up. People produce different types of ear wax. Studies have found two kinds -- dry wax, which has about 20% lipid (fat), and wet wax, which has 50% lipid. The latter variety can be harder and lead to buildup. As people age, more ear wax may build up. Even working in dusty environments can cause dirt to get stuck in the ear and lead to blockages.
People who have a history of middle ear infections, swimmer's ear, or a hole in the ear drum should NOT try irrigation, nor should they allow a physician to irrigate their ears, as such methods can lead to a painful and/or dangerous ear infection. People with a history of any ear disease should go to an ENT for wax problems and not try treating the problem themselves.
Irrigation or "syringing" is a standard method of wax removal when there is no perforation. Most cases of ear wax blockage can be treated at home.
Before irrigation, mineral oil, baby oil, glycerin, or commercial drops can be used to soften wax in the ear. Detergent drops such as hydrogen peroxide or carbamide peroxide may aid in the removal of wax. Put in the drops, let it sit in there for a few minutes, then lie down on a towel to let it drip out again.It doesn't hurt to put a few drops of clean olive oil or baby oil into each ear every day. Swimmers often do this prior to their daily swim.
Then, clean your ears using an irrigation syringe. Sufficient water force is needed to remove earwax build-up. Body-temperature water should be used. With the head upright, straighten the ear canal by holding the external ear and gently pulling upward. Use a syringe to gently direct a small stream of water against the ear canal wall next to the wax plug.
The straight tip on the syringe isn't safe for self-use, in case it slips. Tip the head to allow the water to drain. Irrigation may need to be repeated several times. Never irrigate the ear if the eardrum is not known to be intact. After the wax is removed, the ear should be dried thoroughly.
How can one keep wax from blocking the ear ? There are several methods.
One method is to put baby oil or olive oil into the ear on a regular basis. Put in the drops, let it sit in there for a few minutes, then lie down on a towel to let it drip out again. Individuals who suffer from frequent blockages may benefit from weekly irrigations. Never attempt to clean the ear by placing any object into the ear canal, such as a Q-tip. It is better to clean the outer ear canal by using a cloth or paper tissue wrapped around your finger. More commonly, the ear canal may be blocked by wax when attempts to clean the ear push wax deeper into the ear canal and cause a blockage.
INSECT or OBJECTS IN THE EAR
DO NOT let the person put a finger in the ear, since this may make the insect sting.
Turn the person's head so that the affected side is up, and wait to see if the insect flies or crawls out.
If this doesn't work, try pouring mineral oil, olive oil, or baby oil into the ear. As you pour the oil, pull the ear lobe gently backward and upward for an adult, or backward and downward for a child. The insect should suffocate and may float out in the oil. AVOID using oil to remove any object other than an insect, since oil can cause other kinds of objects to swell.
If you think a small object may be lodged within the ear, but you cannot see it, DO NOT reach inside the ear canal with tweezers. You can do more harm than good. Try using gravity to get the object out by tilting the head to the affected side. DO NOT strike the person's head. Shake it gently in the direction of the ground to try to dislodge the object.
RUPTURED EARDRUM
The person will have severe pain. Place sterile cotton gently in the outer ear canal to keep the inside of the ear clean. Get medical help. Eardrum ruptures in children will usually heal completely within a few weeks.
DO NOT block any drainage coming from the ear.
DO NOT try to clean or wash the inside of the ear.
DO NOT attempt to remove the object by probing with a cotton swab, pin, or any other tool. To do so will risk pushing the object farther into the ear and damaging the middle ear.
DO NOT reach inside the ear canal with tweezers.
Avoid cleaning the ear canals altogether.
DRAINAGE FROM INSIDE THE EAR
Cover the outside of the ear with a sterile dressing shaped to the contour of the ear, and tape it loosely in place.
Have the person lie down on the side with the affected ear down so that it can drain.
Ear barotrauma (Ear popping), Barotitis media, Aerotitis
If the eustachian tube is blocked, the air pressure in the middle ear is different than the pressure on the outside of the eardrum, causing barotrauma. Swallowing or yawning opens the eustachian tube and allows air to flow into or out of the middle ear, equalizing the air pressure on both sides of the eardrum. Barotrauma commonly occurs with altitude changes, such as with flying, scuba diving, or driving in the mountains. If you have a congested nose from allergies, colds, or upper respiratory infection, barotrauma is more likely.
To relieve ear pain or discomfort, first attempt to open the eustachian tube and relieve the pressure. Suck on candy, chew gum, or yawn. Or inhale, then gently exhale while holding the nostrils closed and the mouth shut.
Try to avoid altitude changes during upper respiratory infections or attacks of allergies. Nasal decongestants or antihistamines may be used before altitude changes. When flying, do not sleep during the descent. Frequently open the eustachian tube by these measures. Allow infants and children to nurse or sip a drink during descent. Divers should descend and ascend slowly. Diving while you are suffering with allergies or a respiratory infection is dangerous, because barotrauma may be severe.
How is Eustachian tube blockage treated?
Normally, the Eustachian tube is closed.
Partial or complete blockage of the Eustachian tube can cause popping, clicking, and ear fullness.
Altitude changes can cause symptoms in persons with Eustachian tube problems.
Several maneuvers can be done to improve Eustachian tube function.
There are several maneuvers that can be done to improve Eustachian tube function. The simple act of swallowing activates the muscles in the back of the throat which help open the Eustachian tube. Chewing gum, drinking, or eating promotes swallowing. Yawning is even better because it is a stronger muscle activator. If the ears still feel full, you can try to forcibly open the Eustachian tube by taking a deep breath and blowing while pinching your nostrils and closing your mouth. When you feel a pop, you know you have succeeded.
Babies traveling on airplanes cannot intentionally pop their ears, but may do so if they are sucking on a bottle or pacifier. While descending on an air flight, it is best to feed your baby and not allow him to sleep.
Modern jet aircraft, including the supersonics, maintain cabin pressure equivalent to 5,000 and 8,000 feet. At such altitudes, free air in body cavities tends to expand by about 25 percent and may aggravate certain medical conditions. The occasional loss of cabin pressure and the fact that some airplanes are unpressurized can present problems.
During a sudden increase in ambient pressure, gas must move from the nasopharynx into the middle ear to maintain equal pressure on both sides of the tympanic membrane. If the eustachian tube is not functioning properly, as in upper respiratory tract infections or allergy, the pressure in the middle ear is lower than the ambient pressure. The relative negative pressure in the middle ear results in retraction of the tympanic membrane and a transudate of blood from the vessels in the lamina propria of the mucous membrane forms in the middle ear.
Frequent yawning or closed-nose swallowing during descent, decongestant nasal sprays and antihistamines taken before or during flight often prevent or relieve these conditions.
Children are particularly susceptible to barotitis media and should be given oral fluids or feeding during descent to encourage swallowing (chewing gum or hard candy is even more effective than eating).
MedicineNet. Eustachian tube. Available from URL:http://www.medicinenet.com/eustachian_tube_problems/page3.htm
Healthscout. Barotitis media. Available from URL:http://www.healthscout.com/ency/424/438/main.html#DefinitionofBarotitisMedia