Emergency 911Emergency 911

Shane R. Kannarr, OD

Grene Vision Group

Define

EmergencyEmergentUrgentRoutine

Our PatientsOur Patients

Key QuestionsKey Questions

When did it start?Which eye is impacted?Has it happened before?What problems are you noticing?Do you have loss of vision?Do you have flashes or floaters?

Key Questions cont:Key Questions cont:

Are you having discharge? What type?Is your eye red?Has there been trauma to your eye?

Key responses to watch forKey responses to watch for

Loss of VisionFlashes or FloatersSevere PainSevere RednessLight SensitivityForeign Body

Follow up QuestionsFollow up Questions

Loss of Vision– All or part of the vision?– Is it transient?– Did it happen immediately or was it proceeded

by flashes and floaters

What could it be?What could it be?

Loss of Vision

Papilledema, TIA, migraine,CRAO, glaucoma, blood pressure change

Emergency, Emergent, Routine

Follow Up QuestionsFollow Up Questions

Flashes and Floaters– One eye or both?– Do they move around?– What were you doing when it started?– History?

How you ask mattersHow you ask matters

What could it be?What could it be?

Flashes and Floaters:

RD or break, PVD, migraine, posterior uveitis, vitreous hemorrhage

Emergency, Emergent, or Routine

Follow up QuestionsFollow up Questions

Pain

History of trauma? Contact lens wear?Is it mild or severe?Is it in the eyes or around the eyes?Does anything relieve the pain?Duration?

What could it be?What could it be?

In the eye (Ocular)– Dry eye, bleph, FD, episcleritis, or SPK– Abrasion, erosion, Anterior Uveitis

– Around the eye Sinusitis, orbital pseudotumor

Emergency, Emergent, Routine

Follow Up questiosFollow Up questios

Redness:– Is there discharge? What type?– Is there pain? How severe…?– When did it start? Is it getting progressively

worse?– Have you been treating the redness– Contact lens history?

What could it be?What could it be?

Redness:– CLARE

Conjunctivitis– Dry Eye– Sub conjunctival hemorrhage

– Emergency, Emergent, Routine

Follow Up Questions:Follow Up Questions:

Photophobia (Light Sensitivity)– Is it mild moderate or severe?– Contact lens history?– History of trauma?– Duration?

What could it be?What could it be?

Corneal issue, uveitis, conjunctivitis, migraine

Less common Meningitis

Emergency, Emergent, Routine

Follow Up QuestionsFollow Up Questions

Do you have any idea what it could be?What is your pain level?Has it impacted your vision?When did it happen?What steps did you take to help yourself?

What could it be?What could it be?

A foreign body

Emergency, Emergent or Routine

Talking to PatientsTalking to Patients

Instill confidenceKnow what you are talking aboutAsk pertinent questionsInstill ConfidenceProvide the patients ways to contact the

office after hours

Key pointsKey points

Have a plan in placeKnow the office protocolIt is not wrong to say “let me check with the

doctor and I will get back to you”Put yourself in the patients shoes

If it is not an emergencyIf it is not an emergency

Remember while it is not an emergency to the office, the patient is still very concerned

If at all possible the patient should be in the office if 24-48 hours

Ask the doctor if any thing can be done to make the patient more comfortable until they can be seen