June 7, 2024

This week’s UH EMS-I’s Pharmacy Phriday focuses on Tetracaine, a medication provided to assist the paramedic provider in treating eye injuries. It is used rarely in the field, but one that can be extremely helpful. 

Tetracaine is a rapid but short-acting topical local anesthetic ophthalmic solution referenced in the “Maxillofacial Trauma” protocol to treat pain associated with non-traumatic eye injuries that might include: 

• Flash burns from ultraviolet light produced from arc welders, tanning booths, the sun, etc. 

• Foreign bodies in the eye that cause irritation 

• Chemical burns in the eye

• To facilitate the use of the Morgan Lens device in flushing the eye after a chemical exposure 

Tetracaine works by blocking sodium channels that prevent depolarization of the nerves, which will cause local anesthesia. More simply, the medication works by blocking the pain signals at the nerve endings in the eye. The onset of actions usually occurs within 30 seconds but lasts only about 15 minutes or less. 

UH protocol permits one drop to the affected eye(s), repeated once to a maximum of 2 drops for adult patients. In the pediatric patient, limit the dose to just one drop in the affected eye(s). Tetracaine should not be used if the patient has suffered a penetrating injury to the eye or has an existing allergy to any of the “-caine” family of medications (i.e., novocaine, lidocaine, etc.). 

Following the administration of the Tetracaine drops, the patient may complain of a burning sensation, sensitivity to light, tearing, or redness of the eye, but it is imperative to keep the patient from rubbing or scratching at the eye and to continue to protect the eye from injury while it is still numb. Any patient receiving Tetracaine drops is also required, per protocol, to be transported for further evaluation.  

When administering medication to the eye, the paramedic should wear gloves. If the patient is wearing contact lenses, have the patient remove them or remove them for the patient. If possible, have the patient lie flat or tilt their head back. The medic should apply light pressure just below the lower eyelid on the cheekbone with their finger or thumb and pull down to expose the conjunctival sac. (Remember, the patient will often want to close or rub the injured eye, so one will need to physically open the eyelid and keep the patient from rubbing or scratching at the eye.) Without touching the eye with your finger or the dropper, place the drop on the conjunctival sac. After administration, have the patient close their eye.  

The UH EMS Institute hopes you find these and other educational offerings such as the Monday Morning Medical Director’s Message, the Great Cases presentations, the weekly Prehospital Paradigm Podcasts, and the archived monthly UH continuing education presentations easily accessible and beneficial. Offerings can be accessed through various means including UHEMS.org or PrehospitalParadigm.com, or using your FireRescue 1 accounts.  

A new feature of the offerings is the free Ohio EMS CE credits one can receive through the Prehospital Paradigm Podcasts. Watch monthly installments of Prehospital Paradigm, complete a short quiz, and receive approved CE. It is simple to sign up! Click here for more information.

Until the next installment of Pharmacy Phriday, stay safe!  

Sincerely,



The UH EMS-I Team

University Hospitals

June 6, 2022

Dear colleagues:

This week during our Pharmacy Phriday CE article, we will focus on Tetracaine, a medication provided to assist in the treatment of eye injuries.  It is a rarely used medication in the field, but one that can be extremely helpful in such cases.

Tetracaine (Pontocaine) is a rapid but short-acting topical local anesthetic ophthalmic solution referenced in the “Maxillofacial Trauma” protocol to treat pain associated with a non-traumatic eye injuries that might include:

• Flash burns from ultraviolet light produced by arc welders, tanning booths, the sun, etc.

• Foreign bodies in the eye causing irritation

• Chemical burns in the eye

• To facilitate the use of the Morgan Lens device in flushing the eye after a chemical exposure

For our anatomy and physiology enthusiasts, Tetracaine works by blocking sodium channels that prevent depolarization of the nerves.  This will cause a local anesthesia.  More simply, the medication works by blocking the pain signals at the nerve endings in the eye. The onset of actions usually occurs within 30 seconds but lasts only about 15 minutes or less.

UH protocol permits one drop to each eye, repeated once to a max of 2 drops for adult patients.  In the pediatric patient, limit the dose to just one drop in the affected eye(s).   Tetracaine should not be used if the patient has suffered a penetrating injury to the eye or has an existing allergy to any of the “caine” family of medications (i.e., novocaine, lidocaine, etc.)

Following the administration of the Tetracaine drops, the patient may complain of a burning sensation, sensitivity to light, tearing, or redness of the eye.  It is very important to keep the patient from rubbing or scratching at the eye and to continue to protect the eye from injury while it is still numb.  Any patient receiving tetracaine drops is also required per protocols to be transported for further evaluation. 

When administering a medication to the eye, the medic should be sure to wear gloves.  Remove contact lenses in the patient’s eyes if they are wearing them.  Have the patient lie flat if possible or tilt their head back.  The medic should apply light pressure just below the lower eyelid on the cheekbone with their finger or thumb and pull down to expose the conjunctival sac.  (Remember, the patient will often want to close or rub the injured eye, so one will need to physically open the eyelid and keep the patient from rubbing or scratching at the eye.)  Without touching the eye with your finger or the dropper, place the drop on the conjunctival sac. Have the patient close their eye after administration.

The UH EMS Institute hopes you find these weekly articles educational.  These articles are now posted to the Fire Rescue 1 Academy educational platform and can be accessed by signing in using your personal account provided to you by the UH-EMS Institute HERE. Once logged in to your account, tab on University Hospitals Cleveland CE organization and follow the directions to view and complete UH-specific content.   If you do not have a UH account, have difficulty accessing the site, are unable to find the content, or have any other questions regarding the Fire Rescue 1 Academy offering, please feel free to contact Mike Monahan at michael.monahan@uhhospitals.org. 

Till next time, stay safe!

Sincerely,



The UH EMS-I Team

University Hospitals