Stormwind Medical Handbook: Head & Eye Injuries

The Head & Eye Injuries chapter of the Stormwind Medical Handbook covers the terminology and treatment of common wounds to the eyes or head. All medical staff should be able to identify and treat these wounds and determine triage based on the severity. 
It is recommended that all medical personnel read and comprehend the Medical Theory & Anatomy, 
Soft Tissue Wounds, and Bone Fractures chapters of this handbook before attempting any treatment outlined in this chapter.
== Terminology ==
Common Head & Eye Injury Terminology will be defined and explained below.
=== Concussion ===
A Concussion is an internal injury in which the brain is bruised or damaged during a forceful impact to the head. Depending on the severity of the impact, the victim may lose awareness, brain function, or even pass unconscious. If the victim is still conscious, they should be questioned on topics they are known to be able to answer in order to determine their mental awareness. Concussion victims may vomit and their eyes may appear dilated. Victims should be given fluids to drink in order to balance their humours. 
=== Brain Hemorrhage ===
Bleeding within the skull is often a life threatening injury where blood will build up pressure against the brain, causing lasting insanity and often death. Should a patient have sustained a significant blow to their head and their mental state progressively worsens; their skull may be trepanned in order to cut a hole through which blood may escape. If bleeding continues with no sign of slowing, the patient will surely perish to an imbalance of humours unless brought to a magical healer. Once the bleeding stops, the hole cut into the skull should be patched, cleaned and dressed in order to avoid infection.
=== Chemical Burns ===
They eyes are particularly susceptible to chemical burns, be it from animal venom, acid, or other volatile compounds. Chemical burns to the eyes should immediately be rinsed with copious amounts of clean water. Once the chemical is deemed rinsed away completely, they eyes should be patched to allow proper healing. Permanent vision impairment or loss almost always follows a chemical burn to the eyes, though there are cases of restoration of vision with time.
=== Closed Globe Injury ===
A closed globe injury is one in which the victim’s eye has been bruised or damaged by blunt force without piercing or rupturing the layers of the eye. The eye is typically still intact after a closed globe injury and restoration of sight is likely. Minimal treatment is required; the eye should be rinsed with clean water and then patched until swelling subsides and function is restored.
=== Ruptured Globe Injury ===
A ruptured globe injury is one in which the victim’s eye has been ruptured or pierced, either by blunt force or penetrating trauma. Any debris should be removed carefully with tweezers and the eye should be rinsed with clean water. Stitching may be attempted if the rupture is wholly within the white of the eye. The eye should be patched and examined once a day for infection until swelling subsides. Without advanced healing magics, vision will most likely be permanently impaired or lost if the wound damages the lens. 
=== Orbital Blowout ===
An orbital blowout is a condition in which the eye sockets of the skull are broken or damaged due to blunt force trauma. The eye within may be ruptured and displaced after the injury. Some signs and symptoms of an orbital blowout include swelling of the eye socket, double vision, sunken eyes, and loss of sensation within the cheek or upper gums. Orbital blowout fractures almost always require advanced reconstructive surgery or healing magic due to the intricacies of the skull. Initial treatment before such surgery should include rinsing the eye with clean water and patching it with cloth.
== Treatment ==
Common Treatment Methods for head and eye injuries shall be defined and explained below.
=== Trepanning ===
Trepanning is a surgical intervention in which a hole is drilled into the skull of the patient to alleviate pressure upon the brain. There has been cases of trepanning assisting with the removal of evil spirits from the brain as a form of exorcism. This is an advanced, risky procedure that may well end in fatality if the drilling perforates the underlying brain tissue, but a necessary one at times after trauma-induced internal bleeding. Should trepanning be necessary, one should first cut or shave off any hair around the location to be drilled. The head of the patient should be secured to prevent movement in an adjustable wooden frame fit to their head. 
After ensuring the area is free of any debris, the surgeon should cut an opening on the scalp. The surgeon should then pad the site dry of blood as much as possible before drilling into the skull. Blood or pus should be drained from the opening until it ceases, whereupon the opening in the skull should be cleaned and dressed.
=== Irrigation ===
Irrigation, or rinsing the eye with room temperature water, is the most common preparatory treatment to rid the eye of any debris or chemicals that irritate the eye tissue. Clean water naturally soothes the eye and rinses away particles.
The water should be boiled and filtered before use in order to ensure that it is clean enough for medical purposes. If unclean water is used, more debris may enter the eye and cause further trauma.
=== Drainage ===
In cases where the eye is bruised or cut, blood or other fluid may build up in the lens that obscures the victim’s vision. These fluids may be drained if one carefully pierces the edge of the eye’s lens with a heated metal knife. One should be doubly careful to not pierce or damage the center of the lens, as such may cause permanent blindness.
Once pierced, the eye should be gently pressed with a cloth in order to absorb any fluids that escape the lens. Once the fluid is removed from the lens, the eye should be covered and checked regularly to ensure that additional fluid buildup does not occur.
=== Eye Patch ===
A cloth or leather patch is a common treatment for most eye injuries, affixed over the eye in question with a strap that wraps around the head. An eye patch’s primary function is to protect the eye and eye socket from the environment and sunlight to promote healing. An eye patch can be supported with a soft cloth pad that prevents moisture and other debris from entering the eye. 
=== Eye Removal ===
In the case that vision cannot be restored to an eye, an eye becomes infected beyond saving, or an eye is damaged and causes chronic pain to the patient, eye removal may be the best option. Often a painful procedure, eye removal should be performed as quickly as possible with care given to not damage the eye socket tissue. Once removed, the socket should be cleaned of any debris and patched in order to protect it from the elements.
=== Prosthetic Replacement ===
In the case that an eye must be removed due to severe injury, an option in lieu of simply patching the eye socket is to procure a prosthetic replacement. Often cast from glass, a prosthetic eye will fit within the eye-socket and underneath the eyelids. Prosthetic eyes help to maintain the structure of the face; without an eye in the socket, a patient’s cheek may appear sunken or drooping.
Category:Medical Handbook