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-Ocular Chemical Burns-
“Chemical burns to the eye are among the
most urgent of ocular emergencies…
Copious irrigation is ...
The Morgan Lens®
The World’s Leading Method of Ocular Irrigation
• Effective, easy to use ocular
irrigation
• Frees medica...
Uses of the Morgan Lens
• Alkali Burns
• Acid Burns
• Thermal Burns
• Irritants (gasoline, detergents, etc.)
• Non-embedde...
Alkali Burns (Bases)
• Most Serious of all Ocular Burns
• Penetrate Rapidly, increasing pH of anterior chamber
• Can cause...
Acid Burns
• Immediately denature proteins
– opacifies cornea which slows deep penetration
• Eye initially may look worse ...
Irritants
• Cause more discomfort than actual damage
• Common Irritants:
– Gasoline
– Pepper Spray
– Household Detergents
...
Materials Necessary for Irrigation
with The Morgan Lens
• 2 Morgan Lenses
Note: Pain in one eye may mask pain in other--ir...
INSERTION
Step One:
• Instill topical ocular
anesthetic (if available)
• Attach Morgan Lens to
Morgan Lens Delivery Set
or...
INSERTION
• Have patient look down
• Insert Lens under upper lid
• Have patient look up, retract
lower lid, drop Lens in p...
INSERTION
Step Three:
• Secure a fluid collection
device such as the Medi-Duct
to the side of patient’s face
• Continue ir...
REMOVAL
• Continue flow
• Have patient look up
• Retract and hold lower lid
• Slide Morgan Lens outSlide Morgan Lens out
T...
Irrigation Times
*Recommendation from*Recommendation from Goldfrank’s Toxicologic EmergenciesGoldfrank’s Toxicologic Emerg...
Questions for Patients
Do NOT delay irrigation to take patient history*
• When did injury occur?
• What substance was invo...
Contraindications
• Protruding foreign body
• Penetrating eye injury
• Suspected or actual rupture of the globe
• Instilli...
Lactated Ringer’s
vs. Normal Saline
MorTan recommends the use of lactated Ringer’s
• pH more like that of tears
– pH of te...
Suggestions for theSuggestions for the
““Difficult Patient”Difficult Patient”
Reassure patient: insertion willReassure pat...
Benefits of the Morgan Lens
• 100% of irrigating solution is delivered directly
to cornea, cul-de-sac and conjunctiva
• Fr...
Summary
• Burns are among the most urgent of ocular
emergencies
• Copious irrigation must be started quickly (at
scene of ...
The Morgan Lens
The Leader in Ocular Irrigation
• MorTan, Inc.
P.O. Box 8719
Missoula, MT 59807 USA
1-800-423-8659
1-406-7...
Morgan Lens
Instructional Video
Double-click on the above box to view the Morgan LensDouble-click on the above box to view...
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Morgan Lens for ALS Providers

Application of the Morgan Lens

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Morgan Lens for ALS Providers

  1. 1. -Ocular Chemical Burns- “Chemical burns to the eye are among the most urgent of ocular emergencies… Copious irrigation is the most important emergency treatment of the chemically-burned eye… This procedure probably has more of an influence on the outcome of the injury than any other therapeutic approach.” “Prompt Irrigation of Chemical Eye Injuries May Avert Severe Damage”, Frank R. Burns, MD Occupational Health & Safety, April, 1989
  2. 2. The Morgan Lens® The World’s Leading Method of Ocular Irrigation • Effective, easy to use ocular irrigation • Frees medical personnel to treat other injuries • Developed by a practicing ophthalmologist • Used in 95% of U.S. emergency departments
  3. 3. Uses of the Morgan Lens • Alkali Burns • Acid Burns • Thermal Burns • Irritants (gasoline, detergents, etc.) • Non-embedded Foreign Bodies • Foreign Body Sensation With No Visible Foreign Body • Routine Pre-Operative • Eyelid Surgery • Severe Infection
  4. 4. Alkali Burns (Bases) • Most Serious of all Ocular Burns • Penetrate Rapidly, increasing pH of anterior chamber • Can cause severe damage to collagen, nerve endings, keratocytes, iris, and ciliary body • Loss of corneal epithelium leads to increased risk of infection • Common Sources That Contain Alkali: – Lye (in drain cleaners) – Lime (in plaster, cement) – Ammonia (in fertilizers, cleaning agents) – Motor vehicle airbags
  5. 5. Acid Burns • Immediately denature proteins – opacifies cornea which slows deep penetration • Eye initially may look worse than alkali burn although damage often is not as severe • Common Acids: hydrofluoric sulfuric sulfurous hydrochloric nitric acetic • Most Common: – Industrial accidents and automobile battery explosions • Hydrofluoric Acid Burns-very serious – Penetrate quickly and act like alkali burns
  6. 6. Irritants • Cause more discomfort than actual damage • Common Irritants: – Gasoline – Pepper Spray – Household Detergents Irritants are substances with a neutral pHIrritants are substances with a neutral pH
  7. 7. Materials Necessary for Irrigation with The Morgan Lens • 2 Morgan Lenses Note: Pain in one eye may mask pain in other--irrigate both unless injury is known to be limited to one eye. • Morgan Lens Delivery Set® • I.V. Solution (lactated Ringer’s recommended) • Medi-Duct® or towels to absorb outflow • Topical ocular anesthetic if available • pH paper
  8. 8. INSERTION Step One: • Instill topical ocular anesthetic (if available) • Attach Morgan Lens to Morgan Lens Delivery Set or syringe or I.V. tubing **If possible, remove contact lenses (if necessary) BEFORE starting irrigation. IrrigateIf possible, remove contact lenses (if necessary) BEFORE starting irrigation. Irrigate over contacts if unable to remove. Removal may be easier after a period of irrigation.over contacts if unable to remove. Removal may be easier after a period of irrigation.
  9. 9. INSERTION • Have patient look down • Insert Lens under upper lid • Have patient look up, retract lower lid, drop Lens in place *Solution acts as a cushion, suspending the Lens above the cornea and protecting*Solution acts as a cushion, suspending the Lens above the cornea and protecting injured surfaces from the eyelids.injured surfaces from the eyelids. Step Two:Step Two: Start Minimal FlowStart Minimal Flow BEFORE* Inserting LensBEFORE* Inserting Lens
  10. 10. INSERTION Step Three: • Secure a fluid collection device such as the Medi-Duct to the side of patient’s face • Continue irrigation until pH of eye returns to normal DO NOT RUN DRY Tape tubing to patient’s forehead to prevent accidental removalTape tubing to patient’s forehead to prevent accidental removal
  11. 11. REMOVAL • Continue flow • Have patient look up • Retract and hold lower lid • Slide Morgan Lens outSlide Morgan Lens out TERMINATE FLOWTERMINATE FLOW
  12. 12. Irrigation Times *Recommendation from*Recommendation from Goldfrank’s Toxicologic EmergenciesGoldfrank’s Toxicologic Emergencies •For Irritants: -20 to 30 minutes minimum •For Acids and Alkalis: -Irrigate with 2 liters fluid per eye-Irrigate with 2 liters fluid per eye -Wait 5-10 minutes-Wait 5-10 minutes -Measure pH of cul-de-sac-Measure pH of cul-de-sac -Repeat until pH is between 7.5 and 8-Repeat until pH is between 7.5 and 8 For strong acids or any alkali, continue irrigation for 2 hoursFor strong acids or any alkali, continue irrigation for 2 hours after reaching surface pH of 8 to ensure neutralization ofafter reaching surface pH of 8 to ensure neutralization of anterior chamber*anterior chamber*
  13. 13. Questions for Patients Do NOT delay irrigation to take patient history* • When did injury occur? • What substance was involved? • Is the patient on any medication or allergic to any medications? • Was the patient wearing safety glasses when injury occurred? • Are there any other injuries? • Did patient receive any prior treatment? From Nursing 2000, Volume 30, Number 8 **If possible, remove contact lenses (when necessary) BEFORE starting irrigation butIf possible, remove contact lenses (when necessary) BEFORE starting irrigation but DO NOT DELAY irrigation--removal may be easier after a period of irrigation.DO NOT DELAY irrigation--removal may be easier after a period of irrigation.
  14. 14. Contraindications • Protruding foreign body • Penetrating eye injury • Suspected or actual rupture of the globe • Instilling anesthetic agents with known allergies
  15. 15. Lactated Ringer’s vs. Normal Saline MorTan recommends the use of lactated Ringer’s • pH more like that of tears – pH of tears: approximately 7.1 – pH of lactated Ringer’s: 6.0 to 7.5 – pH of Normal Saline: 4.5 to 7.0 • High buffering capacity – lactated Ringer’s solution returns pH to neutral more quickly with either acidic or basic contaminants* • Increased patient tolerance Normal Saline may cause discomfort and/or morphological changes* *from independent studies
  16. 16. Suggestions for theSuggestions for the ““Difficult Patient”Difficult Patient” Reassure patient: insertion willReassure patient: insertion will quicklyquickly relieve pain.relieve pain. Any delay will cause further damage.Any delay will cause further damage. Seconds count!Seconds count! •Irrigating solution provides soothing sensationIrrigating solution provides soothing sensation •Injured cornea is separated from “squeegie” action of eyelidsInjured cornea is separated from “squeegie” action of eyelids •Eye may be closed during procedureEye may be closed during procedure •Some chemicals generate heat when mixed with water-irrigation coolsSome chemicals generate heat when mixed with water-irrigation cools Note: Cornea will not be touched by Morgan LensNote: Cornea will not be touched by Morgan Lens Topical anesthetic may relieve anxietyTopical anesthetic may relieve anxiety Note: Additional anesthetic may be instilled without removing Lens.Note: Additional anesthetic may be instilled without removing Lens. Pinch tubing and instill drop into cul-de-sac.Pinch tubing and instill drop into cul-de-sac.
  17. 17. Benefits of the Morgan Lens • 100% of irrigating solution is delivered directly to cornea, cul-de-sac and conjunctiva • Frees medical staff to attend to other injuries • Patient can be ambulatory during irrigation • Patient rests comfortably • Highly cost effective
  18. 18. Summary • Burns are among the most urgent of ocular emergencies • Copious irrigation must be started quickly (at scene of accident if possible) • All surfaces of eye (cornea, sclera, cul-de-sac, and inner eyelid) must be flushed thoroughly • Irrigation should be continued until pH of eye returns to normal (alkali burns may require hours of irrigation; severe infections may require irrigation for hours or even days) *See Morgan Lens Uses Chart available on MorTan’s website or from MorTan
  19. 19. The Morgan Lens The Leader in Ocular Irrigation • MorTan, Inc. P.O. Box 8719 Missoula, MT 59807 USA 1-800-423-8659 1-406-728-2522 FAX 1-406-728-9332 www.morganlens.com e-mail: mortan@morganlens.com © 2002 MorTan, Inc. MorTan is an ISO 9001 registered company© 2002 MorTan, Inc. MorTan is an ISO 9001 registered company Do not duplicate or modify without permission from MorTan, Inc.Do not duplicate or modify without permission from MorTan, Inc. Advance to the next slide for the Morgan Lens Instructional VideoAdvance to the next slide for the Morgan Lens Instructional Video
  20. 20. Morgan Lens Instructional Video Double-click on the above box to view the Morgan LensDouble-click on the above box to view the Morgan Lens Instructional Video.Instructional Video. (Note: if the video does not play, double-click on “My Computer” and double-click on the icon for the CD-ROM. From there, open the file “mlvideo.mpg”)(Note: if the video does not play, double-click on “My Computer” and double-click on the icon for the CD-ROM. From there, open the file “mlvideo.mpg”)

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