Case Review: Eye-catcher

It’s a cool fall afternoon, and the Attack One crew is surprised to be dispatched to a location on a large lake for an unknown injury. This area can be very busy on warm summer weekends and holidays, but not traditionally at this time of year. The only additional information the dispatcher gives the crew is to “meet the patient at the boat dock.”

They are on scene quickly, but there is no one at the dock. Some distance out on the lake, they see a boat moving toward them, and soon they notice the driver is signaling to them. The boat is moving at a relatively slow speed. They see only two occupants on board, one man driving and another sitting in a front seat with his head down. As they approach, only the pilot, a middle-aged man, speaks.

“We have a serious injury here! My friend has a fishhook in his eye!”

The story is accurate: Protruding from the front of the other man’s left eye is a fishing line, which is cut off about 6 inches away from the eye. The injured man doesn’t want to speak, preferring to keep his head in a stable position with his eyes closed; he has vomited once, and feels like he may again. The driver explains that the two of them were friends out fishing on the lake. The injured man cast his line with bait on the end, it got caught on something in the lake, and the man pulled back forcefully to try to dislodge the hook. When he did, he felt something snap, and then something hit him in the eye. Since it had his fishing line attached to it, he assumed a piece of the fishhook was at the end of the line and in his eye.

His friend cut the line so the pole could be detached, then used a cellular phone to call for help. As they began to power toward the dock, the patient developed a severe headache, and then became very nauseated lying on the floor of the boat. He found his discomfort was significantly reduced if he sat up and faced forward in the boat, and the driver moved the boat slowly. Now the patient begs the Attack One crew to let him sit upright, keep his eyes closed, and face forward in the ambulance.

The crew leader, a paramedic, asks the man to open his eye so he can see the full extent of the injury. He suspects light will make the patient uncomfortable, so he shields the patient from the sunlight, has him open his eyelids and checks the injury. He sees a single small puncture wound in the clear surface of the eye (cornea), with the fishing line coming out of it. There is no obvious blood. The patient can’t move his eye up or down, and can only see light in that eye. He cannot count fingers held in front of him with the other eye closed.

The paramedic checks the right eye and the patient’s nose and eyelids, and finds no other injuries. The paramedic then tells the patient everything he found, and tells the man the most important things they can do are to keep his eye still, have him sit upright and take him safely to the hospital. The patient complains of a general headache and severe nausea, and is worried about vomiting again. Knowing that vomiting causes a dramatic increase in pressure in the eyes, and that pressure will worsen any injury or bleeding present in the eye, the paramedic wants to make every effort to prevent that from happening.

“Let’s do everything we can to prevent that,” he tells the man. “You tell us, sir, what makes you feel less nauseated. We will keep your head up and use a cold washcloth on your head. If you want to sit facing forward in the ambulance, we will position the cot so you can. We can start an IV line and give you medication. If you need something for your headache, we can give you some medicine for that also. As we treat and transport you to the hospital, just keep us informed of what makes you feel better.”

“Can I keep my eyes closed?” the patient requests.

“Yes,” the medic says. “You can either keep them closed yourself, or we can tape patches lightly over both eyes to keep them both comfortable and at rest. We will do whichever makes you feel more comfortable.”