Page 122 - 2022 Ranger Medic Handbook

Corneal Abrasions / Corneal Ulcers
DEFINITION: A traumatic disruption of the epithelial covering of the cornea with three major concerns: intense eye pain,
corneal ulcer (vision-threatening infection), and potential for ruptured globe.
S/Sx: History of eye trauma or contact lens wear; severe eye pain; tearing; blurred vision; light sensitivity; fluorescein
stain positive; white or gray spot on cornea for corneal ulcer (usually need tangential penlight exam to see); for sudden
onset of eye pain after trauma in a patient with LASIK surgery, consider LASIK flap dislocation.
MANAGEMENT:
1. Remove contact lens if worn.
2. Assess for visual acuity and document before/after all treatments.
3. Tetracaine 0.5%, 2 drops in the affected eye one time only for exam and pain relief. DO NOT dispense to patient.
SECTION 3 5. Moxifloxacin 0.5% drops (1 drop qid) OR erythromycin 0.5% ophth oint q4hr × 3–5 days OR fluoroquinolone ophth
4. Check for foreign body to include eyelid eversion of both upper and lower lids and assess using fluorescein stain for
abrasion/ulcer. Irrigate with normal saline prn.
drops – 1 drop in the affected eye q6hr while awake for 5d OR bacitracin ointment qid – all applied until the corneal
epithelium is healed.
6. Treat per Pain Management Protocol.
7. Reduce light exposure, stay indoors if possible – sunglasses if not possible.
8. For corneal abrasions: monitor daily for worsening signs and symptoms of a corneal ulcer (increasing pain and
development of a white or grey spot at abrasion site). DO NOT PATCH.
9. Assess using fluorescein stains daily — abrasions should get progressively smaller. Continue antibiotic drops until
24 hours after cornea becomes fluorescein negative (no bright yellow spot).
10. PO analgesics PRN IAW Pain Management Protocol.
11. IF CORNEAL ULCER PRESENT: Fluoroquinolone 1 drop in the affected eye q6hr while awake for 5 days. Urgent
evacuation to ophthalmologist. Moxifloxacin 400mg PO once a day may be added if evacuation is delayed or the
victim’s pain is becoming worse.
DISPOSITION: Reassess q24hr to ensure improvement. Evacuation may not be needed for corneal abrasion if improv-
ing with treatment.
Priority evacuation for Corneal Ulcer. Urgent evacuation for LASIK flap dislocation.
SPECIAL CONSIDERATIONS:
1. Contact lens corneal abrasions are at a high risk for development of a corneal ulcer. They should not be patched and
require more intensive antibiotic therapy.
2. Consider LASIK Flap dislocation for anyone that sustains eye trauma after LASIK surgery.
3. Consider Herpes Simplex or Fungal infections as well and contact a medical officer.

Cough
DEFINITION: Usually viral etiology but may also occur with high altitude pulmonary edema (HAPE) and pneumonia.
S/Sx: Cough with or without scant sputum production; often accompanied by other signs and symptoms of upper
respiratory tract infection (i.e. sore throat and rhinorrhea).
MANAGEMENT:
1. If associated with upper respiratory infection S/Sx, treat per protocol.
2. If absence of fever and URI S/Sx, treat per Bronchitis Protocol.
3. If fever, tachycardia. tachypnea, shortness of breath, treat per Pneumonia Protocol.
4. If at altitude, treat per Altitude Medical Emergency Protocol.
DISPOSITION: Correlate signs/symptoms to medical condition and manage by appropriate protocol.
DIFFERENTIAL: Causes of chronic cough include GERD, asthma, and PND.

108 SECTION 3 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) & SICK CALL