It’s difficult to miss a raging STEMI or a CVA with unilateral flaccid paralysis, but there are other, less-sexy diagnoses that we have the opportunity to make in the Emergency Department that can be as important and impactful to the patient’s health. Endophthalmitis is a difficult word to spell and equally as difficult to diagnose if you’re not looking for it. Check out Dave Traficante’s recent post on EM Resident on Endophthalmitis.
- Always screen patient for an Afferent Pupillary Defect (APD)!
- A negative Seidel Test does not rule out a Globe rupture
- Avoid NSAIDS and aspirin in Hyphemas and Globe Rupture
- CT Scan of the Orbit is only 56-68% sensitive for identifying a Globe Rupture, so don’t solely rely on it for the diagnosis!
- Order a Sickle Cell Protein Hemoglobin Electrophoresis test for every patient that is African American and presents with a traumatic hyphema.
- Avoid Topical Pain control, such as Tetracaine 0.5%, in Hyphemas
- Avoid Carbonic Anhydrase Inhibitors such as Acetazolamide in Sickle Cell patients with hyphema
- Retrobulbar Hematoma is a clinical Diagnosis: If IOP > 40mmHg, proptosis and APD, then immediately treat! Do not wait for CT scan!
- In, Acute Angle Closure Glaucoma, pupil must be mid-dilated!
- If no APD, then it cannot be Central Retinal Artery Occlusion!
Post by: Yenis Paez-Perez, DO