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Heart injury, open — Clinical Guidelines

Overview

Open globe injuries involve lacerations or ruptures of the eyeball, often requiring urgent surgical intervention to prevent severe visual impairment or loss. These injuries can result from various mechanisms, including trauma, occupational accidents, and combat-related incidents.

Diagnosis

Clinical Presentation: Presence of corneal or scleral laceration, vitreous hemorrhage, or prolapsed intraocular contents 5 6.

Recommended Tests: Slit-lamp examination, ultrasound biomicroscopy, and imaging studies (e.g., CT scan) to assess extent of injury 5 6.

Grading: Utilize the Ocular Trauma Classification System (OTCS) to categorize severity 5.

Management

First-Line Treatment: Urgent surgical repair under appropriate anesthesia (topical anesthesia and IV sedation in selected cases) 19.

Antibiotics: Prophylactic broad-spectrum antibiotics to prevent infection 5.

Postoperative Care: Regular follow-up to monitor healing and visual acuity, potential need for additional surgeries 5.

Emergency Department Observation: Consider virtual observation units for monitoring post-discharge patients to reduce ED length of stay 1.

Special Populations

Pediatrics: Specific considerations for anesthesia and surgical techniques tailored to smaller eye structures 5.

Elderly: Increased risk of comorbidities affecting surgical outcomes; comprehensive geriatric assessment recommended 5.

Occupational Injuries: Higher incidence in agricultural settings; workplace safety interventions crucial 6.

Key Recommendations

Urgent Surgical Repair: Immediate surgical intervention is critical for open globe injuries to preserve vision (Evidence: Strong 5).

Prophylactic Antibiotics: Use broad-spectrum antibiotics to prevent postoperative infections (Evidence: Moderate 5).

Enhanced Postoperative Monitoring: Implement structured follow-up protocols to ensure optimal healing and visual recovery (Evidence: Moderate 5).

Utilize Virtual Observation Units: For appropriate patients, virtual observation can effectively reduce ED length of stay without compromising care (Evidence: Moderate 1).

References

1 Hayden EM, Grabowski BG, Kishen EB, Zachrison KS, White BA. The Value of an Emergency Medicine Virtual Observation Unit. Annals of emergency medicine 2024. link 2 Tomaiuolo M, Woreta FA, Li A, Yonekawa Y, Zhang QE, Sharpe JE et al.. Open-Globe Injury Repairs in the American Academy of Ophthalmology IRIS® Registry 2014 - 2018: Incidence, Risk Factors, and Visual Outcomes. Ophthalmology 2023. link 3 McCarthy ML, Zheng Z, Wilder ME, Elmi A, Li Y, Zeger SL. The Influence of Social Determinants of Health on Emergency Departments Visits in a Medicaid Sample. Annals of emergency medicine 2021. link 4 Ballesteros Peña S, Fernández Aedo I, Vallejo de la Hoz G. Impact of football matches on number of visits to an emergency department. Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias 2020. link 5 Morikawa S, Okamoto F, Okamoto Y, Mitamura Y, Ishikawa H, Harimoto K et al.. Clinical characteristics and visual outcomes of work-related open globe injuries in Japanese patients. Scientific reports 2020. link 6 Patikulsila D, Choovuthayakorn J, Supreeyathitikul P, Chaovisitsaree T, Chaikitmongkol V, Watanachai N et al.. Trends in occupational-related open globe injury presenting to a tertiary referral centre of Northern Thailand. Injury 2020. link 7 Robb JP. Worth Its Weight in Gold. The American journal of nursing 2019. link 8 Pines JM, Ladhania R, Black BS, Corbit CK, Carlson JN, Venkat A. Changes in Reimbursement to Emergency Physicians After Medicaid Expansion Under the Patient Protection and Affordable Care Act. Annals of emergency medicine 2019. link 9 Hysenbegasi M, Hubloue I, Vanobberghen R, Kartounian J, Devroey D. Evolution over 11 years of the characteristics of walk-in patients at the emergency department of a university hospital in Brussels. Journal of medicine and life 2019. link 10 Lundgren AD. Establishing financial literacy: what every resident needs to know. Cutis 2018. link 11 Morris T, Mason SM, Moulton C, O'Keeffe C. Calculating the proportion of avoidable attendances at UK emergency departments: analysis of the Royal College of Emergency Medicine's Sentinel Site Survey data. Emergency medicine journal : EMJ 2018. link 12 Goldman MP, Monuteaux MC, Perron C, Bachur RG. Identifying discordance between senior physicians and trainees on the root cause of ED revisits. Emergency medicine journal : EMJ 2017. link 13 Apostolova E, White HA, Morris PA, Eliason DA, Velez T. Open Globe Injury Patient Identification in Warfare Clinical Notes. AMIA ... Annual Symposium proceedings. AMIA Symposium 2017. link 14 Li EY, Chan TC, Liu AT, Yuen HK. Epidemiology of Open-Globe Injuries in Hong Kong. Asia-Pacific journal of ophthalmology (Philadelphia, Pa.) 2017. link 15 Cook R, Thakore S, Morrison W, Meikle J. To ED or not to ED: NHS 24 referrals to the emergency department. Emergency medicine journal : EMJ 2010. link 16 Wilensky GR. What can we really expect from healthcare reform?. Healthcare financial management : journal of the Healthcare Financial Management Association 2009. link 17 Whiticar R, Webb H, Smith S. Re-attendance to the emergency department. Emergency medicine journal : EMJ 2008. link 18 Chen CI, Liu CY, Li YC, Chao CC, Liu CT, Chen CF et al.. Pervasive Observation Medicine: The Application of RFID to Improve Patient Safety in Observation Unit of Hospital Emergency Department. Studies in health technology and informatics 2005. link 19 Boscia F, La Tegola MG, Columbo G, Alessio G, Sborgia C. Combined topical anesthesia and sedation for open-globe injuries in selected patients. Ophthalmology 2003. link00485-8) 20 Colgan CS, Hartke KN. An overview of economics. Occupational medicine (Philadelphia, Pa.) 2001. link 21 Liu T, Sayre MR, Carleton SC. Emergency medical care: types, trends, and factors related to nonurgent visits. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 1999. link 22 Foldes SS, Fischer LR, Kaminsky K. What is an emergency? The judgments of two physicians. Annals of emergency medicine 1994. link70322-1)

Heart injury, open