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Session 4 ER -1
ER -1- Intro/ocular trauma
| Question | Answer |
|---|---|
| What is required for a hospital to be considered trauma 1 | 24hr availability of all subspecialties |
| Pt has mucopurulent discharge and inflammation of the conjunctiva and their eyes are stuck together what do they have going on | Bacterial Conjunctivitis |
| What is the best tx for bacterial conjunctivitis | Poly-Trim opth gtts |
| If your pt has bacterial conjunctivitis and is a contact wearer what do you need to add coverage for | pseudomonas with quinolone |
| If you suspect the bacterial conjunctivitis is caused by neisserial what tx should you give | urgent referral and Rocephin IM and oral doxy to cover for possible concomitant chlamydial infection |
| Pt has recently had an URI and now has an eye infection what is the likely etiology | viral |
| What is the tx for viral conjunctivitis | cool compresses, naphcon A, artificial tears |
| Patient has ocular discharge and itching what are they likely suffering from | allergic conjunctivitis |
| What is the tx for allergic conjunctivitis | Cool compresses, Topical antihistamines/decongestants/mast cell stabilizers |
| Pt has dendrites that show up on fluorescein staining of the cornea what are they likely suffering from | HSV keratitis |
| Why don't you want to miss HSV keratitis | it can progress to corneal scarring and requires prompt tx with antiviral (Viroptic) if outbreak is less than 4 days old could also use acyclovir |
| T/F steroids are helpful in tx of HSV keratitis | F NO topical steroids |
| IF pt presents with shingles on their face what do you need to do | make sure you do an eye exam looking for herpes in the cornea |
| What is the most common cause of preseptal/periorbital cellulitis | staph aureus |
| T/F preseptal cellulitis is most common in adults | F it is most common in kids |
| T/F preseptal cellulitis has extensive involvement of the eye its self | F eye itself is not involved but the structures surrounding the eye are |
| Would you send a kid home if they came in with a preseptal cellulitis | no admit them for IV Ab and pediatric consult |
| what is the difference between orbital cellulitis and preseptal cellulitis | orbital cellulitis will have involvement of the eye. EOM impairment, pain, fever, proptosis where preseptal cellulitis will not have these findings |
| How can you detect a corneal ulcer | use fluorescein dye |
| Why do you need to aggressively treat a corneal ulcer | if it is caused by pseudomonas it can destroy a cornea in 6-12 hrs tx with topical fluoroquinolone |
| Pt has come in for the third time with an unexplained subconjunctival hemorrhage what may this indicate | may be first indication that their INR is out of whack from anticoagulants |
| You have just put fluorescein dye in your pt eye and see vertical scratches you suspect a corneal abrasions what should you do apart from looking in the eye itself | flip the eyelid with a cotton swab |
| T/F every corneal abrasion needs to be patched for proper healing | F abrasion will heal with or without patch abrasions from organic sources have potential for fungal infections don't patch them |
| IF pt has a corneal foreign body how can you remove it | use an 18gauge needle and scrape it out gently |
| If the foreign body was metal and it has left a rust ring what do you need to do | drill or buff out the rust ring |
| T/F a lid laceration less than 1mm will heal on its own | T they don't need stitching |
| If the lid laceration is a full thickness laceration what needs to happen | Pt needs referral to have ophthalmologist repair within 24hrs |
| If a pt has a blunt trauma of the face and a hyphema present what do you need to get | ophthalmology consult. |
| If you do a EOM test on a pt with a blunt trauma and they can't look up what might be happening | entrapment of the eye because of a blowout fracture |
| T/F the pupil peaks away from the site of penetration or rupture of the globe | F it peaks toward site of penetration or rupture |
| What is the first test you should perform on a stable pt with blunt trauma | visual acuity |
| If you suspect a ruptured globe what should you do for the pt | get an emergency consult and metal shield check tetanus and get them IV Ab |
| Where is the most common location for a blowout fracture | inferior wall and medial wall |
| What x-ray view is best for visualization of blowout fx | water's view |
| Is a blowout fracture an emergency or outpt referral | outpt referral generally |
| T/F a chemical injury to the eye is urgent not an emergency | F it is an emergency especially alkali burns because they are generally not painful and can rapidly penetrate the cornea and damage the iris/lens |
| What is the tx for chemical splash in the eye | irrigate, irrigate, irrigate check ph and irrigate some more until ph is 7.5-8 then check for particulate matter, corneal clouding, or epithelial defects |
| What is a common cause of spontaneous hyphema | sickle cell anemia |
| Pt present with a hyphema what do you want to check | elevate pts head and check IOP instill mydriatic to avoid pupillary play |
| What education should you give a pt about hyphema before sending them home | that it may rebleed in 3-5 days and if so IOP could increase needing a surgical wash out of anterior chamber |
| You perform a slit lamp exam on a pt and notice superficial punctate keratitis what is the likely cause | UV damage to the eye from welding, sun tanning, or Snowblindness |
| What is the tx for UV keratitis | cycloplegic, Ab ointment, oral analgesic consider a pressure patch and refer to ophthalmologist |
| Pts presents with cloudy vision, eye ache/pain, HA and N/V You check the IOP and find that it is 50 what is likely going on | acute angle closure glaucoma |
| What is the tx for acute angle closure glaucoma | miotics (pilocarpine), reduce aqueous humor formation with beta blockers (Timoptic), Alpha agonist (loridine), and carbonic anhydrase inhibitors (acetazolamide) and reduce vomiting volume with mannitol |
| pt complains of HA and sensitivity when they touch the side of their head they are a 65 y/o female with fever, fatigue and anorexia | Temporal Arteritis |
| What is the tx for temporal arteritis | IV steroids, and Ophthalmology Consult for temporal artery biopsy |
| What cranial nerve is affected in bells palsy | CN 7 Facial nerve |
| What is the tx for bell's palsy | eye lubricants, consider oral steroids or antiviral (acyclovir) and refer to ophthalmologist for cornea monitoring |
| What is Horner's syndrome | ipsilateral ptosis, myosis, and anhidrosis from interruption of sympathetic nerve innervation |
| IF pt has Horner's syndrome and neck pain what do you need to r/o | carotid artery dissection |
| Pt has papilledema what does this indicated typically (in general) | Increased intracranial pressure |
| What conditions can cause papilledema | malignant HTN, pseudotumor cerebri, intracranial tumors, hydrocephalus |
| If pt has unilateral papilledema what is the likely cause | Optic nerve edema, papillitis not from elected ICP |
| What is the tx for pseudotumor cerebri | weight loss, serial Lumbar Punctures, and diuretics |
Created by:
smaxsmith
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