Retrobulbar Hematoma, Whati Putanga Orbital, me te Syndrome Wāhanga Mata¶

Whai muri i te whiunga o te kanohi, ka pa te poipapa, te tuke ranei ki te mata, te hinga, te tukinga motoka ranei, he tino mamae, he toka-toka, he whatu te kanohi (proptosis) me te heke o te tirohanga, he ohotata pokanoa i te wa e kiia nei ko Orbital Compartment Syndrome (OCS) mai i te Retrobulbar Hematoma. Na te mea ko te turanga kanohi o te tangata (orbit) he pouaka kikokore e wha nga pakitara e tuwhera ana ki mua anake, ko te toto toto i muri o te poi kanohi ka tere te piki o te pehanga intraorbital ki runga ake i te pehanga o te uaua retinal pokapū, ka werohia te retina me te nerve optic i roto 60 ki te 120 meneti. Ahakoa karekau he toka toto retrobulbar, he whati o te papa angiangi o te turanga kanohi (Orbital Blowout Fracture) ka mau te uaua e neke ana te kanohi ki runga, ka puta he whakapoipoi ngakau kino (oculocardiac reflex), ka kaha ranei te hau sinus i muri i te poi kanohi ki te pupuhi te tangata i tona ihu. Ki te mea ka tupu te karu pupuhi, te ngaronga o te tirohanga, te matakite rua, te nausea me te puhoi o te ngakau, te ngongo ranei o te ngutu o runga me te paparinga, waea atu ki to nama whawhati tata. tau ohorere. Te arotake i nga kawa raru e pa ana ki wharanga kanohi me te tiaki ohorere, nga whara o te mahunga me te mahunga, a cellulitis orbital me te thrombosis sinus cavernous.

Mahia tenei inaianei¶

1. Waea wawe ki to nama whawhati tata (911 i te United States me Canada, 112 puta noa i te Kotahitanga o Europi, 999 i te United Kingdom) mena kei te pupuhi whakamua te kanohi whara (proptosis), ka raru, ka pakari te toka i raro i nga kamo tetere, he ahua pouri, he pouri ranei te tirohanga, he akonga karekau e whiti, ka kore te mamae e whiti ki roto i te tikanga. whakapairuaki.
2. Whakanoho tika te manawanui (i te iti rawa ki te 45 ki te 90 nga nekehanga) ki te kore e whakapaetia he whara i te taurakira. Ko te pupuri i te mahunga kia teitei ake i te taumata o te ngakau ka whakamahia te kaha ki te whakaheke i te pehanga toto toto me te paheketanga venous i roto i te putunga kanohi, ka whakaroa i te hanga o te retrobulbar hematoma.
3. Kia kaha te whakahau ki te turoro: "KAUA e pupuhi to ihu, kaua e tihe me te kati o te waha, kaua hoki e werohia." Na te whati orbital blowout ka pakaru te koiwi angiangi-pepa e wehe ana i te turanga kanohi mai i te maxillary me te sinus ethmoid. Ko te pupuhi i te ihu ka rite ki te papu hau pehanga nui, ka pehia te hau sinus i roto i te kapiti whati i muri tonu o te poi kanohi (tension orbital emphysema), ka whakapoapoa tonutia te kanohi ma te kopiri i te nerve optic.
4. Tirohia te tirohanga i roto i te kanohi i whara i naianei tonu (ka hipoki i te kanohi kare i whara) ka whakahoki ano i te haki ia 10 meneti. Me panui te tangata ki te ta, tatauhia e hia nga maihao e pupuri ana koe, tuhia ranei ka kite ia i nga nekehanga o te ringa, i te marama ranei. Mena ka heke te mohio o te tirohanga mai i te panui reta ki te tatau noa mai i nga maihao i muri i te whiunga o te kanohi, korero atu ki nga paramedics me te taote ruuma whawhati tata kua timata te heke o te tirohanga mo te meneti ka mahi tonu ratou i te taha moenga Lateral Canthotomy and Cantholysis (LCC) i roto i te 90-meneti ischemic window.
5. Tiakihia te karu ki te maataki maataki (te raro ranei o te kapu pepa/pahuka i mau ki te koiwi rae me te paparinga) me te pehanga ZERO ki te poi kanohi. Kaua rawa e takai he takai rapa ki te kanohi kua mamae, kaua rawa e pehi tika i te kete hukapapa ki runga i te kamo tetere; ki te kore e kitea he roimata kei roto i te pakitara poikiri kanohi (open globe whara) he retrobulbar hematoma ranei, ka pehia e te pehanga o waho nga mea o te kanohi ki waho, ka tere ake ranei te optic nerve ischemia.
6. Kaua rawatia te manawanui ma te waha (NPO) ka rongoa tonu i te nausea, te ruaki ranei. Ko te ruaki me te retching ka kaha te paheketanga o te pehanga toto me te toto i roto i te mahunga me te turanga kanohi, ka nui haere te rere retrobulbar, me nga turoro he uaua kanohi kua mau, he retrobulbar hematomas ranei e hiahia ana kia tere te whakakore i nga mahi, ki te whakatika i te ruma whakahaere.

Rakau Whakatau: Te whakamatautau i te whara o te periorbital puhuki, te proptosis, me te pakaru o te pupuhi¶

flowchart TD
    Start["Patupatu ki te Karu, Paparinga, Rae ranei (Pono, Poi, Hinga, Tutuki ranei)"] --> GlobeCheck{"Hipanga 1: Whakatauhia te Wehenga o te Ao Tuwhera (Ko te roimata/te konga kua piki, te kiko iris pouri e puta mai ana, te poihau conjunctival toto 360-tohu, te karu paopao ranei)?"}

    GlobeCheck -->|"ĀE: Te whakapae kua pakaru te ao tuwhera"| OpenGlobe["OPEN GLOBE PROTOCOL: 1. ZERO pehanga ki te kanohi; KAUA e tirohia te pehanga o roto o te kanohi (tonometry). 2. Whakapirihia te arai kanohi pokiha, he kapu pepa ranei ki runga i te rii kiko. 3. Waea atu ki 911 / 112 / 999 mo te whakatikatika ophthalmology moroiti, nga patu paturopi IV, me nga rongoa rongoa."]

    GlobeCheck -->|"KORE: Ka Puta Tonu te Papa o Globe"| OCSCheck{"Hipanga 2: Mata mo te Orbital Compartment Syndrome (Retrobulbar Hematoma): Te mamae o te kanohi pupuhi (proptosis), te tapo'io te toka-pakeke, te titiro takahanga, te tauira puhoi ranei (RAPD)?"}

    OCSCheck -->|"ĀE: Retrobulbar Hematoma / Ocular Compartment Syndrome"| Canthotomy["90-MINUTE HUPAPA KAUPAPA: 1. Waea 911 / 112 / 999 Inamata; noho tika 45-90 nekehanga. 2. Matohi ER Physician i te taenga mai: E hiahia ana i te taha o te moenga mo te Canthotomy Lateral & Cantholysis i mua i te CT Matawai. 3. Homai IV Mannitol / Acetazolamide / Methylprednisolone hei piriti."]

    OCSCheck -->|"KORE: Te Matakite Putea, Te Orbit Maeneene, Kare he Proptosis"| MuscleTrapCheck{"Hipanga 3: Tirohia nga Nekehanga Karu Aro (Tiro Whakarunga, Raro, Mauī, Matau): Kei te aukati te titiro whakarunga ki te rua o nga tirohanga, me te nausea, te ruaki, me te puhoi o te ngakau (<60 bpm)?"}

    MuscleTrapCheck -->|"ĀE: Te Matai Whakarunga Rahui + Bradycardia/Nausea (Otirā i te Tamariki/Tahiohi me te 'Karu Ma')"| Trapdoor["TRAPDOOR ORBITAL FLOOR FLOOR FLOOR WITH MUSCLE ENTRAPMENT: 1. Emergency Department Orbital CT Scan NOW. 2. Aroturuki ECG mo te Oculocardiac Reflex (vagal bradycardia / paraka ngakau). 3. Me tere te tuku pokanga i roto i te 24 ki te 48 haora hei aukati i te necrosis uaua."]

    MuscleTrapCheck -->|"KORE he uaua i roto i te uaua, he Bradycardia ranei"| SimpleBlowout["KAUPAPA KAUPAPA KAUPAPA ORBITAL BLOWOUT FRACTURE (Karu kua pahemo / enophthalmos, paparinga ngongo/ ngutu o runga, crepitus ranei): 1. KORE kia pupuhi te ihu mo te 4 ki te 6 wiki. 2. Te Tari ohorere CT o Orbits ki te arotake i te rahi o te whati me te sinuses."]

Pathophysiology: Me pehea te take o te kanohi ka huri hei tunu kai pehanga whakamate¶

1. Ko te ahua pakari o te omio kikoo me nga uaua canthal¶

Kia mohio ai koe he aha te iti o te kohinga toto me te hau kei muri o te kanohi ka tere te matapo, whakaarohia te hoahoa miihini o te orbit tangata: - E wha nga pakitara maariki: Ko te turanga kanohi he pear te ahua, e wha nga taha te rahi o roto noa 30 milliliters (\(30\text{mL}\)), kei te taha o runga (wheua mua / tuanui orbital), o waho (kiwi zygomatic me sphenoid / pakitara taha taha), raro (maxilla / orbital orbital wall), me raro (maxilla / orbital orbital wall). - Te Kuaha o Mua kua hiri: I te whakatuwheratanga o mua o te tara, ka mau tonu te poi kanohi (ao) me te ngako orbital ki roto i te turanga e tetahi pepa uaua (te orbital septum) me te tutau ano he aho kitā ki nga riu koiwi e te medial canthal tendonf medial and ** lateral canthal tendonflicorically**) - Te Anau Whakaaetanga Pee-Rohe: I te nuinga o te wa, ko te okiokinga i roto i te orbital me te pehanga intraocular (IOP) he 10 ki te 20 mitamano mēkuri (\(\text{mmHg}\)). Na te mea kaore e taea e nga pakitara koiwi te toro atu ki waho, ka aukatia e te tendon canthal lateral te karu kia neke atu i te torutoru mitamano whakamua, ka taea e te orbit te uru noa ki te 4 ki te 5 mira o te wai taapiri i mua i te ngenge katoa o te kiko. - I te wa i pakaru ai te aariki infraorbital, atanga ethmoidal o mua, muri ranei, te peka ophthalmic artery neke atu i te 5 miramira ki roto i te koeko uaua retrobulbar (i muri ranei i te pehanga o te hau sinus i raro i te pehanga), ka piki te pehanga intraorbital i runga i te pihi taupū ki te 40, 60 mmH, neke atu ranei.

2. Ko te riipene whakakakao i te toto (Ocular Compartment Syndrome)¶

Pērā i te mate o te wehenga whakapeka i roto i te waewae o raro kua maru, i te ringa ranei (tirohia whara kuru me te mate wehenga), i te mea ka nui ake te pehanga o roto i te wahanga orbital kapi i te pehanga perfusion o nga uaua iti e whangai ana i te kanohi me te nerve optic: 1. Venous Outflow Collapse (\(>25\text{ to }30\text{ mmHg}\)): Ko te angiangi-taiepa i waenganui o te retina me nga uaua vortex ka katia i te tuatahi, ka mau te toto venous i roto i te kanohi me te kino o te paheketanga. 2. Short Posterior Ciliary and Vasa Nervorum Ischemia (\(>35\text{ to }45\text{ mmHg}\)): Ko nga waka moroiti iti e whangai ana i te upoko nerve optic o mua me te nerve optic retrobulbar ka hinga, ka pa te ** ischemic optic neuropathy**. 3. Ka paheketanga o te Arery Retinal Central (\(>60\text{ to }80\text{ mmHg}\)): Ina tata atu te pehanga orbital me te intraocular ki te pehanga toto arai diastolic, ka mutu te rere o te arai retinal pokapū i te wa o te diastole (ka kitea i runga i te ophthalmoscope he uaua e pa ana te uaua retinal pokapū) ka kati rawa. 4. Ko te Matapihi Whakaoranga 60-ki-120-Minute: Ko nga rangahau o mua me te mate haumanu ka whakapumautia ka timata te ischemia retinal me te nerve optic i te Orbital Compartment Syndrome, Ko te whakahekenga pokanga i mahia i roto i te 60 ki te 90 meneti ka whakahoki i te tirohanga noa, tata-noa ranei i roto i te 85 paiheneti o nga turoro, engari i tua atu i te 412 meneti te roa o te 4000 meneti ki te **) he maha tonu nga wa ka waiho matapo tonu te turoro i taua kanohi.

3. Ko nga mahi a te Orbital Blowout Fracture (Hydraulic vs. Buckling Theory)¶

He aha i pakaru ai te papa, te pakitara o roto ranei o te karu i te wa e noho kore pakaru ana te riu koiwi taumaha huri noa i waho o te kanohi? - Te Hanga Hangarau: Ki te pa tetahi mea porowhita nui ake i te 5 henimita (2 inihi) te whanui (pēnei i te ringa, te poiporoporo, te poi kirikiti, te poi tenehi ranei) ki mua o te kanohi, ka pana whakamuri te kanohi ki roto i te 30-milliliter cone o te ngako orbital incompressible. Ka pupuhi te ngaru pehanga waipēhi ohorere ki waho ki nga pakitara koiwi e wha, ka pupuhi atu i nga koiwi "haumaru-whakarere" tino angiangi i roto i te angaanga: 1. Te Papa Orbital o muri-Medial (Roof of the Maxillary Sinus): Ko 0.5 millimeters anake te matotoru, ka ngoikore ake e te riu me te awa e mau ana i te infraorbital nerve (\(V_2\)). 2. Ko te Taiepa Orbital Medial (Lamina Papyracea of ​​the Ethmoid Sinus): He mea whakamaoritia hei "papa-papa angiangi" ( 0.2 ki te 0.4 millimeters anake te matotoru). - Ko te Hangaia o te Buckling: Ko te whiunga tika ki te riu orbital iti rawa atu (te taha o te paparinga) ka tuku i te ngaru whakamuri miihini e whakamuri ana i te papa orbital angiangi ki muri tonu me te kore e pakaru te poi kanohi.

Te whakataurite matawhānui o te 4 ohotata orbital i muri i te mamae¶

He aratohu haumanu mo te 4 orbital trauma ohorere¶

1. Retrobulbar Hematoma me te Moenga-Lateral Canthotomy & Cantholysis (LCC)¶

He aha te take ka ngaro tonu te tirohanga o nga turoro me te retrobulbar hematoma i nga hohipera hou? Ko te take #1 he tatari mo te karapa CT orbital ranei e tatari ana ki te ine i te pehanga intraocular ki te Tono-Pen i mua i te tapahi i te tendon canthal lateral. - Maaramatanga Haumanu i te Taha Moenga (Kaore he CT e Hiahia): Mena ka pa mai tetahi turoro whawhati (he turoro ranei i pa ki te blepharoplasty kamo, he pokanga sinus, he paraka anesthetic retrobulbar ranei) te "4 Ps of Orbital Compartment Syndrome": 1. Te mamae (te mamae nui, te mamae o te orbital). 2. Proptosis (te pupuhi whakamua o te ao me te toka-pakeke te atete ki te whakahokinga mamati ngawari ki runga i nga taupoki kati). 3. Ko te mate o te tauira (he koha konga afferent [RAPD] i runga i te whakamatautau rama-piu, he akonga puhoi ranei kua toha). 4. ** He Matakite He Rarawa / Whakahekea** (he kore ranei e kaha ki te aromatawai i te tirohanga i roto i te turoro whanoke kua werohia he kanohi toka-pakeke me te RAPD, Intraocular Pressure ranei \(>40\text{mmHg}\)). - Me pehea te Lateral Canthotomy me te Inferior Cantholysis e whakaora i te kanohi i roto i te 2 meneti: - I roto i te kokoru whakaora a te Tari Ohotata, ka werohia e te rata te 1 ki te 2 miramira o te lidocaine me te epinephrine ki te kokonga taha o nga kamo (lateral canthus), ka awhi puta noa i te canthus lateral mo te 30 hēkona me te hemostat hei kuru i nga oko toto, ka mahia he 1-henimita tapahia ki te iris scisthomys**). - He aha te Canthotomy Kore e Raka: Ma te tapahi noa i te kiri i te kokonga o te kanohi ka heke noa te pehanga orbital e etahi mitamano mēkuri. Me kumea e te rata te kamo o raro mai i te poi kanohi, ka rongo ki nga pito o te kutikuti mo te kutikuti, te aho kitā-rite raro o raro o te tendon canthal lateral, ka tapahia rawatia taua uaua (inferior cantholysis). - I te wa ka tapahia te kiri o raro, ka tino marumaru te kamo o raro, ka neke whakamua te poi kanohi 4 ki te 6 mitamano ki te whakaheke i te waahi retrobulbar, ka heke te pehanga intraorbital e 20 ki te 40 mmHg i roto i te hēkona, ka hoki mai te toto totika ki roto i te arai retina pokapū me te nerve optic.

2. Te whati o te mahanga "White-Eyed" mo nga tamariki me te Reflex Oculocardiac Reflex.¶

I roto i nga tamariki, taiohi, me nga taiohi pakeke i raro i te 20 tau, ko nga koiwi o te papa orbital he taonga nui ki te collagen elastic, kaore ano kia pakarukaru penei i te wheua pakeke: - Ka pa te kanohi o te tamaiti e te poi, te tuke, te turi ranei, ka piko te papa orbital angiangi ki raro penei i te hiu rakau kaakaariki, te ngako orbital me te te uaua rectus inferior (e noho tika ana ki runga i te papa) ka pupuhi i te wa poto i roto i te kapiti, ka hoki ano te koiwi rapa ** ka hoki ano ki tona turanga ano he mahanga kei roto i te taha o te puna**, kei roto ranei i te mahanga i te taha o te puna. - He aha te take i pohehetia ai he aruaru: Na te mea ka hoki whakamuri nga koiwi rapa o nga tamariki kaore e pakaru, kare he kanohi pango, he kore whakaheke toto, he "kanohi ma" te ahua o waho. Heoi, ka totoro te uaua o raro o raro, ka pupuhihia he tohu afferent kaha ki runga i te ** wehenga ophthalmic o te nerve trigeminal (Cranial Nerve V)** ki te roro, ka toro tika atu te vagus nerve (Cranial Nerve X) ki te ngakau me te puku (The Oculocardiac Reflex/A). - Te Rore Hukarere: Na te mea kei te ruaki te tamaiti, he koma te ahua me te werawera, ka ngenge/moe, me te mahunga o te kanohi ki waho, ka pohehe nga kaimahi ohorere i te tamaiti he te wharanga mahunga, te mahunga ranei ka tono he CT roro e ngaro ana i te orbit o raro. - Me pehea e kitea ai inamata: Tirohia te retere o te ngakau o te tamaiti (he tino puhoi ki te 35 ki te 55 pao i ia meneti, me nga pao mawhiti mai i te taunga, me nga whiu hopu sinus) me ** tono i te tamaiti kia whai i to maihao ka titiro tika ki runga ki te tuanui**. Ki te kore e taea e te kanohi whara te huri whakarunga ki mua i te raina waenga ka titiro ki runga ka pa mai te ngaru o te nausea, te mamae o te kanohi, me te heke o te pupuhi i runga i te aroturuki ngakau, kei te tamaiti he mahanga whati orbital doordoor me tere te tuku pokanga i roto i te 24 ki te 48 haora i mua i te mamae o te uaua kua kowhakina ki te necrotic necrosis pumau.

3. Nerve Infraorbital (\(V_2\)) Te Maama: Te Tohu Huna ki te Whati Papa Orbital¶

Me pehea e taea ai e koe te korero i te waahi o te aituā he whati noa te karu pango kua tetere ("he tiaho"), he koiwi kei raro ranei he pakaru o te papa orbital? - Purihia to maihao ki runga i te **maui me te taha matau o raro paparinga o te tangata, te taha o te pongaihu, te ngutu o runga, ka patai atu mena he "rakau" ranei o mua o mua o te tangata (penei i muri i te werohanga niho Novocain). - Ko te infraorbital nerve (he peka o te wehenga maxillary o te nerve trigeminal, \(V_2\)) ka rere tika i roto i te kauhanga kikokore pepa ki roto i te papa o te turanga kanohi i mua i te puta ki te paparinga hei whakamomori ki te kanohi o waenganui me nga niho o runga. - Mēnā ka pā te whatu ki te ngoi, titi-me-ngira ranei i te ngutu o runga, te kapia/niho o runga, me te paparinga ki te taha kotahi, he ka pakaru te papa orbital i roto i te awa infraorbital kei reira tae noa ki te whakamatauhia e te karapa CT orbital.

4. Orbital Emphysema: He aha te ihu i huri ai i te whati ngawari hei huarahi rererangi ki te Orbit¶

Ina pakaru te pakitara waenga (lamina papyracea) te papa ranei o te orbit, ka hono tika te ngako o te turanga kanohi ki nga ethmoid or maxillary nasal sinuses kua whakakiia e te rangi: - I raro i te manawa noa, ka iti te pehanga hau i roto i te ihu. - Heoi ano, ** ma te pupuhi kaha te ihu ka puta te pehanga i roto i te ihu o te 60 ki te neke atu i te 100 mmHg** (he rite ki te pupuhi i te potae motoka). - Ko te pupuhi o te hau kino me te hūpē ka pupuhi i roto i te kapiti wheua ki roto i nga kamo (ka poihau ohorere nga kamo me te paheketanga "Rice Krispies" subcutaneous crepitus karekau i raro i ou maihao) me muri o te poi kanohi. - Mēnā ka mahi te pā o te sinus mucosa, te ngako orbital ranei hei pooro-poro (ka kuhu te hau i te wa e pupuhi ana te ihu engari ka mau ki roto kia kore ai e mawhiti ki roto i te sinus), ka kopaki te pute hau e mau ana i te anga retina o te puku me te nerve optic (Tension Orbital Emphysema), ka puta he matapo nui e mate ai te pukoro ngira ohotata. - I tua atu, ko te akiaki i nga huakita nasal sinus poke ki roto i te ngako orbital parakore ka nui te tupono o te whakararu i te tirohanga cellulitis orbital me te thrombosis sinus cavernous, koia te take i aukatihia ai e nga turoro me nga whati orbital-sinus-communicating orbital ki te pupuhi i to ihu, ki te ruku scuba, ki te purei i nga taonga hau mo 4 ki te 6 wiki.

I nga wa katoa te whakakore i te wahanga o te Open Globe Rupture i mua i te pa ki te kanohi¶

I nga wa katoa ka pa te ringa o te ringa, poiporoporo, BB pellet, puru pounamu, karaihe pakaru ranei ki te kanohi, ko te kaha e whati ana i nga wheua orbital ka pakaru ano te pakitara o te poi kanohi tonu (Open Globe Rupture). I mua i te tuku i tetahi ki te pehi i nga kamo, ki te tirotiro ranei i te awangawanga o te orbital, tirohia te kanohi mo te Six Signs of an Open Globe Rupture: 1. He "Teardrop" or Peaked Pupil: Kua kore te tauira i te porotaka; ka kumea ki roto i te ahua o te roimata roimata e tohu ana ki te kokonga o te kaokao, te sclera ranei i pakaru ai te pakitara poikiri kanohi, ka purua e te iris te poka. 2. 360-Degree Bloody Ballooning of the Conjunctiva (Bullous Hemorrhagic Chemosis): Ko te kirikiri marama i runga i te ma o te kanohi ka tetere ki roto ki te mowhiti matotoru, toto, rite te tiēre e karapoti ana i te kiri, e huna ana i te pakaru o te scleral i raro. 3. Pouri Parauri Pouri, Pango Pango ranei (Uveal Prolapse) Ka Puta Mai i te Ma o te Karu: Kaua rawa e ngana ki te muru i te pango pouri, parauri ranei "waahi paru" i runga i te sclera i muri i te whara; ko te iris, te tinana ciliary ranei o te turoro e puta mai ana i roto i te sclera kua pakaru. 4. He rūma hōhonu, pāpaku/flat anterior (he Hyphema rānei): Ko te mokowā kei muri o te kao ka ki tonu i te toto paparanga (hyphema, tirohia. wharanga kanohi) he ahua tiango ranei ki tera atu kanohi. 5. Te Tohanga o te Tire Maama (Vitreous Humor) ki te mata o te kanohi. 6. Te Tino Ngaronga Matakite me te Karu Maamaa, He Karu Te titiro.

Mena kei te kitea he tohu o te pakaru o te ao tuwhera, whakamutua nga mahi a-tinana katoa, ripiripia he whakangungu rakau pokiha maro, te raro ranei o te kapu pepa ki runga i te rae rae me te paparinga kia kore e pa ki te kanohi, kia noho tika te manawanui, waea atu ki 911/112/999.

Nga nama ohorere a rohe me nga tikanga umanga¶

• Te Hononga o Amerika me Kanata: Waea 911 mo te kawe tere ki te Taumata I, Taumata II Trauma Center ranei me te 24/7 Te rongoa ohorere me te Ophthalmology / Oculoplastic Surgery te kaha. I raro i te American College of Emergency Physicians (ACEP), Advanced Trauma Life Support (ATLS), me American Academy of Ophthalmology (AAO) nga aratohu, kua whakangungua nga rata ohorere ki te mahi i te taha moenga tonu Lateral Canthotomy and Cantholysis (LCC) i mua i te CT Compartment.
• United Kingdom: Waea 999 (ranei 112). I raro i te Royal College of Emergency Medicine (RCEM) me Royal College of Ophthalmologists (RCOphth) nga aratohu whara, ko te whakaheke toto retrobulbar me te ngaro o te tirohanga ka whakarōpūhia hei ohotata whakahekenga pokanoa ka mahia i roto i te Whare Whakaora o te Tari Ohotata i mua i te whakawhiti irarangi.
• Uniana Pakeha: Waea 112. Whaia Kaunihera Whakaora Whakaora Pakeha (ERC) me nga huarahi whaanui a-motu mo te whakahekenga orbital me te angiography CT maxillofacial.
• Ahitereiria me Aotearoa: Waea 000 i Ahitereiria, 111 ranei i Aotearoa. Whaia a RANZCO (Royal Australian and New Zealand College of Ophthalmologists) me ANZCOR nga aratohu whara kanohi.
• India me Ahia-Kiwa: Waea 112 i Inia, 119 i Hapani me Korea ki te Tonga, 995 ranei i Singapore. Tonoa te kawe tika ki te hohipera whaanui tuatoru e mau ana i te atahanga CT, nga huarahi rongoa ohorere/nga kaha pokanga, me te kapinga ophthalmology.

Tirohia tau ohorere mo nga tau tuku ohorere katoa o te ao.

Pātai auau¶

He aha te take e kore ai e taea e au te tuu tika i te kete tio ki runga i te kanohi mangu tetere i muri tonu i te whiunga?¶

Kia tirohia ra ano e te taote te poi kanohi me te whakau kei te mau tonu te pakitara o te ao me te kore he retrobulbar hematoma, he mea kino te whakanoho i te taumaha o te kete tio, te pehi tika ranei i te kopeke makariri ki runga i te kamo. Mena kua pakaru te scleral scleral (te ao tuwhera), ka taea e te taumaha o te kete hukapapa te pehi i te arotahi o roto me te tiēre vitreous i te kanohi; ki te mea he retrobulbar hematoma, ka taapiri atu te pehanga o waho ki te pehanga kino kua werohia te nerve optic. I nga wa katoa, tiakina te karu ki runga i te riu koiwi.

He aha i pupuhi ai toku kanohi ano he poi korowha i te wa i pupuhihia e ahau toku ihu i muri i taku pa ki te kanohi?¶

He iti iho i te haurua mirimita te matotoru o te koiwi e wehe ana i roto me te raro o to turanga kanohi mai i te ihu o te ihu, ka pakaru i te wa o te mamae o te kanohi, ahakoa he pai te ahua o waho o to kanohi. Ka whakawirihia e koe ou pongaihu ki te pupuhi i to ihu, neke atu i te 60 ki te 100 mmHg te pehanga hau i roto i o ihu, e pupuhi ana te hau sinus me te huakita tika na roto i te pakaru o te wheua ki roto i ou kamo me muri o to kanohi (**orbital emphysema**); ki te hee te matakite, ka raru ranei te kanohi i muri i te pupuhi o to ihu, haere tonu ki te ruma ohorere.

He aha te tamaiti e ruaki ana me te puhoi o te ngakau i muri i te pa ki te kanohi ka pohehehia e te maru?¶

He koiwi papa orbital ngawari o nga tamariki ka tuwhera i runga i te paahitanga, ka kapohia te tuara matau ka tutakina ano he mahanga kua utaina ki te puna, ka kowiri i te uaua o te kanohi totika me te kore e waiho he kanohi pango ki waho. Ko te toronga o te uaua kanohi kua mau ki te whakaihiihi i te trigeminal-vagal **oculocardiac reflex**, e puta ai te nausea nui, te ruaki, te kiri koma, te ngenge, me te puhoi o te ngakau (bradycardia). Me tono i nga wa katoa ki te tamaiti he mamae te kanohi kia titiro tika ki runga ki te tuanui; ki te kore e taea e tetahi kanohi te neke ki runga, he whati orbital entrapped, e hara i te maru noa.

Ka waiho e te Lateral Canthotomy me te Cantholysis he nawe kino ki te kokonga o te kamo?¶

Kao; Ko te canthotomy taha taha o te taha o te moenga me te cantholysis iti he mahanga iti, 1 henimita te ma ki te rekoo taiao o waho o te kamo, ka werohia e nga taote oculoplastic. Ka mutu te pupuhi o te retrobulbar i roto i nga ra maha, ka taea e te kaimatai kanohi, te taote kirihou ranei te tuitui i te uaua me te kokonga o te kamo ki muri me te nawe kore e kitea, engari ki te kore e mahia te tapahi i roto i te 90 meneti ka noho matapo tonu.

Ko nga pakaru katoa o te pupuhi orbital e hiahia ana kia pokaia kia hoatu he pereti ki roto i te turanga kanohi?¶

Kao; neke atu i te haurua o te papa orbital pakeke me nga whati pakaru o te pakitara waenga ka ora pai me te kore pokanga. Ka mahi tonu nga tohunga ophthalmologists me nga taote maxillofacial (i roto i te 24 ki te 48 haora) mena ka mauhia te uaua kanohi ka puta te ahua o te oculocardiac reflex, te kore ranei e whakatau i te tirohanga rua, i te Subacutely ranei (i roto i te 7 ki te 14 ra ka heke te pupuhi) mena ka pakaru te whati i te papa o te 50, ka nui atu i te 50 paiheneti te papa o te mata. kia totohu whakamuri te poi kanohi (**enophthalmos**) neke atu i te 2 mirimita.

Ka taea e au te rere i runga i te waka rererangi me te ruku ruku wai me te pakaru o te pupuhi orbital kare i rongoatia?¶

Ko te nuinga o nga korero a nga waka rererangi me nga tohunga matao kia tatari kia arotakea, kia whakawāteatia hoki te whati orbital me te korero sinus, te hau orbital ranei (pneumo-orbit) (te nuinga o te 1 ki te 2 wiki mo nga rerenga waka arumoni mena he hau retrobulbar kei roto, na te mea ka piki te hau i roto i te turanga kanohi ma te 25 ki te 30 paiheneti i te teitei o te cabin e ai ki te ture a Boyle's optic). Ka tino rahuitia te ruku scuba kia ora ra ano te tinana (4 ki te 8 wiki), na te mea ka kotēhia te kanohi kanohi me te sinus barotrauma ka pa mai te mate orbital orbital, emphysema ranei.

Nga kaiarahi e pa ana¶

• Nga whara kanohi me te tiaki ohorere
• Ko te kanohi he ahanoa ke, ko te abrasion o te kao, me te uira hiko
• Nga whara o te mahunga me te paheketanga
• Cellulitis orbital, cavernous sinus thrombosis, me nga mate kanohi tapatoru kino

Nga puna me nga aratohu whai mana¶

• Ko te Komihana o nga Kairangahau o Amerika (ACS, United States) Komiti mo te Trauma: *Te Tautoko mo te Ora Trauma Ake (ATLS) Pukapuka Akoako Akoranga * (Ocular Trauma and Emergency Orbital Compartment Syndrome / Lateral Canthotomy and Cantholysis protocols).
• American Academy of Ophthalmology (AAO, United States): EyeWiki me nga Tauākī Haumanu mo te Whakahaerenga o te Orbital Blowout Fractures, Pediatric White-Eyed Trapdoor Fractures, and Retrobulbar Hemorrhage.
• Royal College of Emergency Medicine (RCEM) me Royal College of Ophthalmologists (RCOphth, United Kingdom): Te Aratohu Mahinga Pai: Traumatic Orbital Compartment Syndrome me Emergency Lateral Canthotomy and Cantholysis.
• Kareti o Amerika mo nga Taonga Ohotata (ACEP, United States): Nga Tikanga Hauora i roto i te rongoa ohorere: Whakahaere Acute of Ocular and Maxillofacial Trauma.
• Royal Australian and New Zealand College of Ophthalmologists (RANZCO): Aratatohu Hauora mo Acute Ophthalmic Trauma and Open Globe Protection.