A 28-year-old construction worker presents to the ED with a 3-inch nail penetrating his right eye. The patient is alert and oriented, with stable vital signs. Which of the following is the most appropriate next step in management?
Bandage both eyes to prevent movement and sympathetic ophthalmia
Carefully extract the nail and apply direct pressure to control bleeding
Administer IV pain medication and prepare for immediate nail removal
Apply a protective shield over the eye without applying pressure
The correct answer is to apply a protective shield over the eye without applying pressure. In cases of penetrating eye injuries, it's crucial to protect the eye from further damage while avoiding any pressure that could exacerbate the injury. A protective shield (such as a paper cup) should be placed over the eye to prevent accidental movement of the foreign body.
Administering pain medication, while important, is not the immediate priority. Removing the nail is absolutely contraindicated as it could cause severe damage and vision loss. Bandaging both eyes, while sometimes done for eye injuries to prevent sympathetic movement, is not the first step and could be disorienting for the patient in this scenario.
The primary goal is to stabilize the injury, prevent further damage, and prepare the patient for emergency ophthalmological evaluation and possible surgical intervention. After shielding the eye, other steps would include obtaining a detailed history, assessing visual acuity in the unaffected eye, and arranging for immediate ophthalmology consultation.
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BCEN CEN
Musculoskeletal and Wound Emergencies
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