# Morgan Eye Lenses



## keith10247 (Sep 16, 2008)

All,
I recently had to look over the county protocols and one of the protocols I had to demonstrate, for testing purposes, was the use of the morgan eye lense.  

In our protocols, it lists that the BLS provider should use Tetricaine to numb the eye before placing the morgan eye lense.  We have to wait for a medic to arrive before we can use tetricaine since it is stored in the drug box.  

Is it common for this to be a BLS skill?  We are instructed to ask the patient if they have any allergies to the *caine family of drugs, but I fear that it is not always common knowledge to the person whether or not they have any allergies to it.  

Thoughts?


----------



## Epi-do (Sep 16, 2008)

Now that I know what one is, I can say that this isn't a common skill (ALS or BLS) around here.  We don't carry them at all.


----------



## flhtci01 (Sep 16, 2008)

Currently licensed in 3 states and don't know of any protocol that allows a Basic to administer anything more than O2, glucose, glucagon, activated charcoal, Epi-pen, ASA and assist patient with NTG and nebs.

In one state, the BLS protcol for eye splash/burn is flush with saline and load and go, the ALS protocol is Tetracaine, flush with saline, load and go.

If a person is allergic to a *caine drug, they are usually aware of it.  That's why you ask and document their response.

I wonder what the ramifications would be if the flush was delayed while waiting a drug.


----------



## boingo (Sep 16, 2008)

The Morgan lens are great, we carry them with tetracaine, however its an ALS only treatment option.


----------



## KEVD18 (Sep 16, 2008)

flhtci01 said:


> Currently licensed in 3 states and don't know of any protocol that allows a Basic to administer anything more than O2, glucose, glucagon, activated charcoal, Epi-pen, ASA and assist patient with NTG and nebs.
> 
> In one state, the BLS protcol for eye splash/burn is flush with saline and load and go, the ALS protocol is Tetracaine, flush with saline, load and go.
> 
> ...



add narcan at the bls level for massachusetts.


----------



## Ridryder911 (Sep 16, 2008)

Morgan lenses are great tools (which looks like large contact lenses) but I would agree that Tretracaine would have to be a ALS skill. Sorry, it as well as many other medications it too has side effects but also a good and proper eye exam should be performed before 
insertion. 

R/r 911


----------



## keith10247 (Sep 16, 2008)

It confuses me that Tetricaine is a BLS drug but yet we need an ALS provider to retrieve it from the drug box.  This may be because there is a medic there to oversee the whole procedure.  Essentually you can't do this BLS skill without an ALS provider nearby.


----------



## marineman (Sep 16, 2008)

We were trained with the lens but I haven't seen any BLS carry it. We hook up a nasal cannula to saline and set it on the bridge of the nose with one point going into each eye, doesn't work as well as the lens but it works, it's BLS and it makes you feel like MacGyver using your equipment in different ways. h34r:


----------



## Buzz (Sep 16, 2008)

marineman said:


> We hook up a nasal cannula to saline and set it on the bridge of the nose with one point going into each eye, doesn't work as well as the lens but it works, it's BLS and it makes you feel like MacGyver using your equipment in different ways. h34r:



:lol: I almost had to do that last night when my partner nearly accidentally put  protein remover in his eye instead of his eye drops.


----------



## mycrofft (Sep 16, 2008)

*My experience is different.*

I've tried the cannula trick a few times and it was poorly tolerated. The ideal I found was chilled sterile normal saline (SNS), or a refrigerated drinking fountain. The key is to do it FAST, and if it can't be copious, then it has to be judicious and followed ASAP with a real wash. 

Tetracaine can defeat the corneal protective reflex. The ALS angle may be that they can make the call as to whether any matter on the eye is already embedded or will become embedded by the lens, both contraindications. If you tetracained the eye then the lens crammed an undetected foreign object into the corneal, there would be no warning shriek.


----------



## CANDawg (Jun 3, 2012)

Yes, I'm bumping a thread from 2008 - hooray for the search function! 

I just read about this recently, and was disappointed to see that it is not in any of the scopes here in Alberta. It seems like it could be quite useful in certain types ocular trauma, especially where there are other more serious injuries elsewhere that also require continuous treatment.

Do you think it is essential enough that it should be included as a standard ALS skill everywhere?


----------



## Shishkabob (Jun 3, 2012)

I really don't see how it should be ALS only.  My last employer stocked them on the trucks, my current one does not.

For the most part you can get the same outcome by using a nasal cannula, or poking holes in a sterile water bottle with an 18g cath.


----------



## CANDawg (Jun 3, 2012)

I think the ALS issue is that you should probably be using Tetracaine before inserting the lens. 

BLS doesn't get to play around with the fun drugs. :glare:


----------



## mycrofft (Jun 4, 2012)

To avoid driving any foreign objects deeper into the cornea or put the lens over an abrasion, you really need to numb it THEN used a fluorescine strip and UV to look for them. This is not a basic level skill.


----------



## Tigger (Jun 5, 2012)

Linuss said:


> I really don't see how it should be ALS only.  My last employer stocked them on the trucks, my current one does not.
> 
> For the most part you can get the same outcome by using a nasal cannula, or poking holes in a sterile water bottle with an 18g cath.



Hmmm now to come up with a way to connect a Sterile Water bottle to a NC since my BLS ambulance has either caths nor NS bags.


----------



## mycrofft (Jun 5, 2012)

Even if you connect a sterile water BOTTLE to tubing, you will need a vent to make it run unless you just gronch down and squeeze it. I've seen the IV tubing male adapter that used to plug by friction into the IV catheter shoved into the female end of the NC hose, but while it seems really neat, my experience is that pts don't tolerate the cannula thing well and the irrigation is haphazard.

Enroute, irrigation is going to be problematic at best. Where will you catch the runoff so you aren't slipping around in it? (If it isn't toxic, just dam it up on the sides and top of the pt head so it goes down their back).


----------



## Tigger (Jun 5, 2012)

mycrofft said:


> Even if you connect a sterile water BOTTLE to tubing, you will need a vent to make it run unless you just gronch down and squeeze it. I've seen the IV tubing male adapter that used to plug by friction into the IV catheter shoved into the female end of the NC hose, but while it seems really neat, my experience is that pts don't tolerate the cannula thing well and the irrigation is haphazard.
> 
> Enroute, irrigation is going to be problematic at best. Where will you catch the runoff so you aren't slipping around in it? (If it isn't toxic, just dam it up on the sides and top of the pt head so it goes down their back).



A vent for the water bottle? Finally a patient care use for a knife!:rofl:

Duly noted that it's not all that effective, six quarts of sterile water should be enough for transport even if I don't have some sort of limiting action when I irrigate.


----------



## jwk (Jun 6, 2012)

Why not just hook up to a bag of IV saline?  I'm not sure why you'd irrigate with water unless that's all you have.


----------



## Hunter (Jun 6, 2012)

jwk said:


> Why not just hook up to a bag of IV saline?  I'm not sure why you'd irrigate with water unless that's all you have.



Well since they're talking about a BLS Rig I think the only thing they cary is sterile water.


----------



## bigbaldguy (Jun 6, 2012)

I had to googe this as I'd never heard of it. Looks like a neat gizmo but I can't see that it would be used enough to be trained for it at a basic level. Maybe in an industrial or combat setting but it seems like just using lots of water and driving fast would be just as useful. It looks like one of those devices that would be really really useful in very very few calls.

I agree with the nasal cannula thing it really doesn't work very well. If you have plenty of sterile water I think just pouring it over the eye was the easier option and it was what we eventually did.


----------

