From blows, burns, chemicals or haemorrhage. Hospital treatment may be required. Petechial haemorrhage (Witch Hazel douche). For infection, add Echinacea. For shock, German Chamomile tea.
Topical. Alternatives. Flashburns from welding etc – fresh juice Aloe Vera gave instant relief and speeded recovery. (New England Journal of Medicine, Vol 311, 6, p.413) Houseleek juice. Wounds that refuse to heal: cotton wool pad saturated with Castor oil overnight. Chamomile compress. Bathe with teas of Plantain, Horsetail, Chickweed, Blessed Thistle, Self-Heal, Comfrey especially commended to encourage epithelial healing.
Diet. Bilberries, rich in flavonoids which are anti-inflammatory and healing. As desired.
Supplements. Daily. Vitamin A 7500iu, Vitamin B-complex, Vitamin C 3g, Vitamin E 1000iu, Beta- carotene. Selenium 300mcg, Zinc 15mg.
Referral to a consultant ophthalmologist.
Serious eye injuries may be caused either by penetration of the eye by a foreign body (see eye, foreign body in) or by a blow to the eye.
A blow to the eye may cause tearing of the iris or the sclera, with collapse of the eyeball and possible blindness. Lesser injuries may lead to a vitreous haemorrhage, hyphaema, retinal detachment, or injury to the trabeculum (the channel through which fluid drains from inside the eye), which can lead to glaucoma. Injuries to the centre of the cornea impair vision by causing scarring. Damage to the lens may cause a cataract to form.
Victims of eye injuries are advised to seek prompt medical advice if the injury is at all serious or does not resolve with simple ?rst-aid measures – for example, by washing out a foreign body using an eye bath.
Blunt injuries These may cause haemorrhage inside the eye, cataract, retinal detachment or even rupture of the eye (see also EYE, DISORDERS OF). Injuries from large blunt objects – for example, a squash ball – may also cause a ‘blow-out fracture’ of the orbital ?oor resulting in double vision. Surgical treatment may be required depending on the patient’s speci?c problems.
Chemical burns Most chemical splashes cause conjunctivitis and super?cial keratitis in the victim (see EYE, DISORDERS OF); both conditions are self-limiting. Alkalis are, however, more likely to penetrate deeper into the eye and cause permanent damage, particularly to the cornea. Prompt irrigation is important. Further treatment may involve testing the pH of the tears, topical antibiotics and CORTICOSTEROIDS, and vitamin C (drops or tablets – see APPENDIX 5: VITAMINS), depending on the nature of the injury.
Corneal abrasion Loss of corneal epithelium (outermost layer). Almost any sort of injury to the eye may cause this. The affected eye is usually very painful. In the absence of other problems, the epithelium heals rapidly: small defects may close within 24 hours. Treatment conventionally consists of antibiotic ointment and sometimes a pad over the injured eye.
Foreign bodies Most foreign bodies which hit the eye are small and are found in the conjunctival sac or on the cornea; most are super?cial and can be easily removed. A few foreign bodies penetrate deeper and may cause infection, cataract, retinal detachment or haemorrhage within the eye. The foreign body is usually removed and the damage repaired; nevertheless the victim’s sight may have been permanently damaged. Particularly dangerous activities include hammering or chiselling on metal or stone; people carrying out these activities (and others, such as hedge-cutting and grass-strimming) should wear protective goggles.
Most blows to the head cause no loss of consciousness and no brain injury. If someone is knocked out for a minute or two, there has been a brief disturbance of the brain cells (concussion); usually there are no after-effects. Most patients so affected leave hospital within 1–3 days, have no organic signs, and recover and return quickly to work without further complaints.
Severe head injuries cause unconsciousness for hours or many days, followed by loss of memory before and after that period of unconsciousness. The skull may be fractured; there may be ?ts in the ?rst week; and there may develop a blood clot in the brain (intracerebral haematoma) or within the membranes covering the brain (extradural and subdural haematomata). These clots compress the brain, and the pressure inside the skull – intracranial pressure – rises with urgent, life-threatening consequences. They are identi?ed by neurologists and neurosurgeons, con?rmed by brain scans (see COMPUTED TOMOGRAPHY; MRI), and require urgent surgical removal. Recovery may be complete, or in very severe cases can be marred by physical disabilities, EPILEPSY, and by changes in intelligence, rational judgement and behaviour. Symptoms generally improve in the ?rst two years.
A minority of those with minor head injuries have complaints and disabilities which seem disproportionate to the injury sustained. Referred to as the post-traumatic syndrome, this is not a diagnostic entity. The complaints are headaches, forgetfulness, irritability, slowness, poor concentration, fatigue, dizziness (usually not vertigo), intolerance of alcohol, light and noise, loss of interests and initiative, DEPRESSION, anxiety, and impaired LIBIDO. Reassurance and return to light work help these symptoms to disappear, in most cases within three months. Psychological illness and unresolved compensation-claims feature in many with implacable complaints.
People who have had brain injuries, and their relatives, can obtain help and advice from Headwat and from www.neuro.pmr.vcu.edu and www.biausa.org... brain injuries
The Industrial Injuries Scheme provides money for people who have suffered injury or illness because of their work. Bene?ts for employment-related disability (selfemployment is excluded) have been altered many times since they were introduced in 1948. There is now a mix of bene?ts, eligibility for which depends on several factors: the date, onset and type of disability are among the most important. ‘Industrial’ includes almost all forms of employment. In addition to accidents, there is a long list of prescribed industrial diseases ranging from BURSITIS, hearing loss, ASTHMA and viral HEPATITIS to unusual ones such as ORF. Psychological as well as physical disablement may attract bene?t, which is calculated on a percentage basis according to the extent of disability. The onus is on the individual to claim, and trade unions and representative organisations can advise on procedures. Injured employees should always report details of an accident to their employer and record it in the accident book promptly: even seemingly minor injuries may subsequently lead to some disability. Relevant information lea?ets are available – for example, from local bene?t agencies, local-authority advice centres and public libraries.... industrial injuries benefit
Scoliosis A condition where the spine is curved to one side (the spine is normally straight when seen from behind). The deformity may be mobile and reversible, or ?xed; if ?xed it is accompanied by vertebral rotation and does not disappear with changes in posture. Fixed scoliosis is idiopathic (of unknown cause) in 65–80 per cent of cases. There are three main types: the infantile type occurs in boys under three and in 90 per cent of cases resolves spontaneously; the juvenile type affects 4–9 year olds and tends to be progressive. The most common type is adolescent idiopathic scoliosis; girls are affected in 90 per cent of cases and the incidence is 4 per cent. Treatment may be conservative with a ?xed brace, or surgical fusion may be needed if the curve is greater than 45 degrees. Scoliosis can occur as a congenital condition and in neuromuscular diseases where there is muscle imbalance, such as in FRIEDREICH’S ATAXIA.
Kyphosis is a backward curvature of the spine causing a hump back. It may be postural and reversible in obese people and tall adolescent girls who stoop, but it may also be ?xed. Scheuermann’s disease is the term applied to adolescent kyphosis. It is more common in girls. Senile kyphosis occurs in elderly people who probably have osteoporosis (bone weakening) and vertebral collapse.
Disc degeneration is a normal consequence of AGEING. The disc loses its resiliance and becomes unable to withstand pressure. Rupture (prolapse) of the disc may occur with physical stress. The disc between the fourth and ?fth lumbar vertebrae is most commonly involved. The jelly-like central nucleus pulposus is usually pushed out backwards, forcing the annulus ?brosus to put pressure on the nerves as they leave the spinal canal. (See PROLAPSED INTERVERTEBRAL DISC.)
Ankylosing spondylitis is an arthritic disorder of the spine in young adults, mostly men. It is a familial condition which starts with lumbar pain and sti?ness which progresses to involve the whole spine. The discs and ligaments are replaced by ?brous tissue, making the spine rigid. Treatment is physiotherapy and anti-in?ammatory drugs to try to keep the spine supple for as long as possible.
A National Association for Ankylosing Spondylitis has been formed which is open to those with the disease, their families, friends and doctors.
Spondylosis is a term which covers disc degeneration and joint degeneration in the back. OSTEOARTHRITIS is usually implicated. Pain is commonly felt in the neck and lumbar regions and in these areas the joints may become unstable. This may put pressure on the nerves leaving the spinal canal, and in the lumbar region, pain is generally felt in the distribution of the sciatic nerve – down the back of the leg. In the neck the pain may be felt down the arm. Treatment is physiotherapy; often a neck collar or lumbar support helps. Rarely surgery is needed to remove the pressure from the nerves.
Spondylolisthesis means that the spine is shifted forward. This is nearly always in the lower lumbar region and may be familial, or due to degeneration in the joints. Pressure may be put on the cauda equina. The usual complaint is of pain after exercise. Treatment is bed rest in a bad attack with surgery indicated only if there are worrying signs of cord compression.
Spinal stenosis is due to a narrowing of the spinal canal which means that the nerves become squashed together. This causes numbness with pins and needles (paraesthia) in the legs. COMPUTED TOMOGRAPHY and nuclear magnetic resonance imaging scans can show the amount of cord compression. If improving posture does not help, surgical decompression may be needed.
Whiplash injuries occur to the neck, usually as the result of a car accident when the head and neck are thrown backwards and then forwards rapidly. This causes pain and sti?ness in the neck; the arm and shoulder may feel numb. Often a support collar relieves the pain but recovery commonly takes between 18 months to three years.
Transection of the cord occurs usually as a result of trauma when the vertebral column protecting the spinal cord is fractured and becomes unstable. The cord may be concussed or it may have become sheared by the trauma and not recover (transected). Spinal concussion usually recovers after 12 hours. If the cord is transected the patient remains paralysed. (See PARALYSIS.)... spine and spinal cord, diseases and injuries of
a state benefit payable to a person disabled by injury or a prescribed industrial disease sustained or contracted in the course of employment (see occupational disease; prescribed disease). The benefit is payable as a weekly amount. The amount of the benefit depends on the degree of disablement as determined following assessment by a specialist. To be entitled to benefit, the disablement must be assessed as being at least 20% of total disability (1% in the case of pneumoconiosis, byssinosis, and diffuse mesothelioma). The benefit is payable if the claimant is still suffering disability two months or more after the date of the accident or onset of the disease. It is payable for a period assessed as the time for which the claimant is likely to suffer the disability. The assessment can be reviewed if the claimant’s condition deteriorates or if he or she is still disabled at the end of the period of assessment.... industrial injuries disablement benefit
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