August 11, 2016
Ocular Trauma
Please review the following web resources for this Trauma CBL
Case 1
You are starting your Friday night shift, when the charge RN comes to get you to evaluate a patient in the WR so that she can expedite his workup. The patient is a 17 year old male who was involved in a physical altercation that resulted in a closed fist blow to the left side of his face. Subsequently, he experienced significant pain and has associated nausea and vomiting. He is reporting a headache with blurry vision and feeling dizzy.
After primary survey, describe your secondary survey for this patient. What other historical questions are important to ask?
Here is this patient's exam. Play this video:
You are starting your Friday night shift, when the charge RN comes to get you to evaluate a patient in the WR so that she can expedite his workup. The patient is a 17 year old male who was involved in a physical altercation that resulted in a closed fist blow to the left side of his face. Subsequently, he experienced significant pain and has associated nausea and vomiting. He is reporting a headache with blurry vision and feeling dizzy.
After primary survey, describe your secondary survey for this patient. What other historical questions are important to ask?
Here is this patient's exam. Play this video:
- What is the diagnosis?
- What is the next step in management? What kind of imaging would you consider ordering?
- From the ED perspective, should this patient be admitted or discharged?
Case 2
Your shift progresses and you pick up your first chart: "eye irritation." You talk to the patient and discover that she was welding under her car with sunglasses on. She did not feel any problems initially but subsequently both eyes started to water and burn. She feels like there is something in her eyes. You perform a fluorescein test and see the following pattern.
Your shift progresses and you pick up your first chart: "eye irritation." You talk to the patient and discover that she was welding under her car with sunglasses on. She did not feel any problems initially but subsequently both eyes started to water and burn. She feels like there is something in her eyes. You perform a fluorescein test and see the following pattern.
- What do you think is going on with this patient?
- What is the management?
- What kind of pain medications can you use?
Case 3
A little bit later in the shift you are called into the resuscitation area for a patient involved in a severe motor vehicle crash. The patient was apneic and was intubated by EMS. The left side of his face is extremely swollen and you are unable to examine his left eye, and he is unable to provide any information about the vision in his left eye. Whats more he has free fluid in the belly and surgery chief is waiting for the Trauma attending to arrive in the next 20 minutes to take the patient to the OR.
A little bit later in the shift you are called into the resuscitation area for a patient involved in a severe motor vehicle crash. The patient was apneic and was intubated by EMS. The left side of his face is extremely swollen and you are unable to examine his left eye, and he is unable to provide any information about the vision in his left eye. Whats more he has free fluid in the belly and surgery chief is waiting for the Trauma attending to arrive in the next 20 minutes to take the patient to the OR.
- Describe his secondary survey. How can you evaluate his eye in this condition?
- What is on your differential for this patient?
- What are hallmark physical exam findings and management for each of the things on your differential?
Case 4
A patient comes to the ER after being hit in the eye with a beer bottle.
A patient comes to the ER after being hit in the eye with a beer bottle.
- What is the diagnosis?
- What is the chief concern with this entity?
- How do you manage?
- What are some findings that indicate a high risk of re-bleed?
Case 5
A patient comes in after a moderate mechanism MVC in which the windshield was shattered. After a normal primary survey and a detailed secondary survey, right before discharge, he reports a gritty sensation in his eyes. You perform a detailed eye exam and find the following on the fluorescein exam. What is this and how do you treat?
A patient comes in after a moderate mechanism MVC in which the windshield was shattered. After a normal primary survey and a detailed secondary survey, right before discharge, he reports a gritty sensation in his eyes. You perform a detailed eye exam and find the following on the fluorescein exam. What is this and how do you treat?
Case 6
A patients comes to the ER complaining of severe burning in both eyes after accidently splashing industrial grade ammonia on his face.
A patients comes to the ER complaining of severe burning in both eyes after accidently splashing industrial grade ammonia on his face.
- What is the next step in management?
- How do you perform this?
- What are the criteria for discharge, emergent ophtho consultation and admission?
Learner Resources
+ Seidel Test
+ Seidel Test
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