in-service exam review 2009 emergency medicine
TRANSCRIPT
IN-SERVICE EXAMREVIEW 2009
EMERGENCY MEDICINEDavid Lee Pierce, M.D
Assistant Professor of Clinical Emergency MedicineUniversity at Buffalo
Objectives
• Review High Yield Material• Pass the exam
• ****Gives me the chance to study and stay one step ahead of interns
Mesenteric Ischemia/Infarction• Elderly• Atrial fibrillation• Excruciating Abd Pain• Abdominal Exam
Relatively Benign• (pain out of
proportion to exam)• Lactate Elevated• Phosphate Elevated• Leukocytosis > 15,000• Metabolic acidosis
Giardia• Diarrhea (no blood)• Hiking
• Crampy abdominal pain• Frothy awful smelling stool• Flatulence
• Stool Ova/Parasites
• Most common cause of parasitic disease in US
• Rx – Flagyl
Diarrhea1. Shigella2. Salmonella3. E.coli 0157:H74. Campylobacter5. Yersinia enterocolitis6. C. Diff7. Staph8. Bacillus cereus
1. Explosive diarrhea, seizures2. Eggs, poultry3. HUS,TTP, (beef or unpast. milk)4. #1 bacterial enteritis (Adults)5. Profuse watery diarrhea RLQ pain6. Hx of antibiotics 7. #1 Food Poison, ham, mayo 8. Fried rice
Diarrhea1. Vibrio cholera2. Vibrio parahemolyt.3. Scombroid
4. Ciguatera5. Entamoeba histolyica6. Giardia7. Cryptosporidium
1. Rice water diarrhea2. Raw seafood3. Histamine reaction, metallic,
bitter or peppery taste4. Hot/cold reversal, neuro findings5. Liver abscess (Only 1/3 diarrhea)6. Backpackers diarrhea 7. #1 chronic diarrhea AIDs
Wall thickening> 3 mm
Stone
Ultrasound of Cholecystitis
Sludge
Confirmatory Test? HIDA
Splenic injury• 20 yo F s/p MVC
• 11th rib Fx on left
• LUQ Pain
• Left shoulder pain• Kehr’s sign
(Phrenic Nerve)
• Most common organ injured in blunt abdominal trauma
Intussusception• 1 mo male
• Soft tissue mass• Colon cut-off
• Cyclical severe abdominal pain• Vomiting• Bloody stools (Current jelly)
• Dx/RX:– Contrast Enema
• Most common cause of bowel obstruction in first 2 years
Colonic Cut-Off
Gastrointestinal Pearls1. Level Cricopharyng. Muscle
2. #1 Level FB Child
3. Level Esophagus Terminates
4. #1 Level FB Adult
5. Globus hystricus
1. C6
2. C6
3. T11
4. T11
5. FB sensation throat
Gastrointestinal Pearls
1. Odynophagia
2. Dysphagia
3. Medication for Food Impaction
4. Size of Objects Require Removal?
1. PAIN with swallowing
2. DIFFICULTY swallowing
3. Glucagon (1mg IV2mg IV)
4. -5cm LONG -2cm WIDE -SHARP
Best Method Esophogeal FB Removal?
Button Batteries
1. Asymptomatic in stomach
2. In Esophagus
3. D/C Summary Instructions
1. Observe/ Repeat Xray
2. Emergent Endoscopy (Perforation in 4-6 h)
3. Stop eating button batteries!!
Foreign Body!!!
• Who’s your consultant?
• GI
• Esophageal FB
FB “Throat”
ENTTrachea
GIEsophagus
Boerhaave’s Syndrome• 45 yo male • Choking• Vomits large piece steak
• Severe Chest Pain• Unstable
• Stabilize• Surgery
NG TUBE
Mallory-Weiss Tear• 45 yo male • ETOH• Hiatal hernia
• Mult. Dry Heaves• Mild hematemesis• Vitals stable
• Rx: – Antiemetics– PPI
Sigmoid Volvulus• Elderly schizophrenic
• Chronic severe constipation
• Abdominal Distention
• “Bent Inner-Tube”– Loop out of the left side of the
pelvis and its superior aspect projects upward
• Rx: NGT, Surgery
Cecal Volvulus• 30 year old male• Marathon runner • Prior abdominal surgeries
• Sudden onset abdominal pain
– COFFEE BEAN shape– Several distended small bowel
loops
– Rx: NGT, Surgery
Midgut Volvulus• Newborn• Emesis• Abdominal Distention• Shock• “Birds Beak”
Lower GI Bleeding1. Elderly Lower GIB
2. #1 Congenital LGIB
3. Cirrhotic
4. AAA Repair then LGIB
1. Diverticulosis/ Angiodysplasia
2. Meckels Diverticulum
3. Esophageal Varices (Large volume)
4. Aortoenteric Fistula
SBO
• 50 yo female• Hx 20 surgeries• Hx Multiple Hernias
• Rx: ?• NPO• NGT• Surgery Consult
Most Common Obstructions
1. Small Bowel
2. Large Bowel
• Adhesions• Hernias• Neoplasm• Inflammation
(Crohn’s)
• Cancer• Diverticulitis• Volvulus
Free Air PeritoneumPerforation PUD
Cardiac-Acute Coronary Syndromes EKG 101
Einhoven’s Triangle
Anterior/Septal STEMI
*
Note Reciprocal Changes (ST depression)
*
Anterior/Septal STEMI
Anterior V1-V4 Septal V1-V2Left Anterior Descending (LAD)
Thrombus
Lateral Wall STEMI
Lateral Wall STEMI(aVL, I, V5, V6)
Circumflex Artery (Cx)
Lateral on Einhoven’s Triangle!
Where’s the Thrombus?LAD + Cirx = Left Main (WIDOW MAKER) or 2 critical lesions
Inferior Wall STEMI
*Reciprocal Changes
Inferior Wall STEMI
(II,III,aVF)Right Coronary Artery
Inferior on Einhoven’s Triangle!
Posterior Wall STEMI
Posterior Wall STEMI
• Treatment: • Same ACS • Fluids (Gentle on NTG)
• Often Accompanies an Inferior Wall MI
V1• Large R (> S wave) • ST Depression
(Equivalent to STEMI)
Heart Block and ACS
1. Heart Block-Inferior MI
2. Heart Block-Anterior MI
1. Second Degree Type 1 (Wenckebach)
1. 2nd Degree Type 22. High Grade AV Block
(Get Pacer Ready)
Aortic Pathology 101
Dissection• Intimal tear• Blood leaks into media
Aneurysm (True Aneurysm)• All 3 layers arterial wall
Ruptured Aneurysm (Leaking Aneurysm)
Thoracic Aortic Dissection
• 60 yo smoker • HTN• Sudden tearing CP• Crack Cocaine• Radiates to his back
• Cold Pulseless Arm• DIASTOLIC Murmur
• EKG STEMI (Inferior)
• CTA Chest
Thoracic Dissection
Debakey
Stanford
Treatment
Ascending DescendingMedical!! Medical!!Surgical!
• BBNitroprusside (Prevent reflex tachycardia)
or• Labetolol
Ruptured AAA• 80 yo Smoker HTN PVD
• Flank Pain• Scrotal swelling • Anesthesia Medial Thigh
• Pulsatile Mass• Unequal pulses• Hypotensive
• Airway• IV• T&C 10 Units• Surgery
Hypertensive Emergencies
1. HTN Encephalopathy
2. HTN Aortic Dissection
3. HTN Hemorrhagic CVA
4. HTN with SAH
1. BBNitroprusside or (Labetolol)
2. BBNitroprusside or (Labetolol)
3. Labetolol/ BB
4. CCB (Nimodipine)
Hypertensive Emergencies1. HTN with ACS
2. HTN Pulmonary Edema
3. HTN Eclampsia
4. Pheochromocytoma/MAOI
5. HTN Cocaine Intoxication
1. NTG, BB
2. NTG, Lasix, Morphine, CPAP
3. Magnesium, Hydralazine, BB
4. Phentolamine BB (No BB 1st-Unopposed alpha )
5. BZD, IVF (Labetolol)
Hypothermia
• Osborne (J) wave
Bidirectional VTach
Dig toxicity
Digoxin Toxicity
• Yellow Halos
• Nausea/ vomiting
Dig bind criteria1. K+ > 5.5
2. Cardiovascular collapse
3. Blocks (Mobitz II , 3rd Degree)
4. Ventricular Dysrhythmia
5. Dig level >10
• Dig Toxic + Hyperkalemic
• What medication contraindicated?
• Calcium Gluconate/Chloride!!– Worsens intracellular Calcium derangement
WPW
SHORT PR
DELTA WAVE
Cardiac-Pacemaker
Pace Sense Trigger Program Shock
Cardiac-Pacemakers
Effect of magnet on:
1. Pacemaker
2. AICD
1. Resets to Fixed Rate
2. Turns it Off
Cardiac-AICD
• #1 Electrolyte Abnormlality AICD Dsyrhythmias?
• Paddle over AICD during code?
• Hypomagnesemia
• Don’t place close to the AICD generator
Most Specific Troponin
Trop I most specific (~100%)
Ventricular Dysrhythmias
Ventricular Fibriallation Arrest
• 1st Thing you do?
Torsades
• What now?
• Shock
• Magnesium IV• Overdrive Pacing• Isoproterenol
Multifocal Atrial Tachycardia
Pulmonary Disease (COPD)
Treatment: Treat Underlying Pathology (COPD)
Multiple P Waves (Multiple Atrial Foci)
P1 P2 P3
Atrial Flutter
Saw-Tooth F-Waves
Supraventricular TachycardiaRhythm Breaks
PACSVT NSR PAC
Atrial Tachycardia
• Stable SVT (AVNRT)
• Stable AFib/ Aflutter
• Unstable
• Vagal Maneuvers • Adenosine 6mg 12mg 12mg• CCB/BB
• CCB/BB• Amiodarone• Ibitilide• Anticoagulate
• Cardioversion
Cardiomyopathy
1. Hypertrophic CM
2. Restrictive CM
3. Idiopathic Dilated CM
1. Beta Blocker
2. Diuretics/ Digoxin
3. Diuretics/ Digoxin/ Vasodilators
Tamponade
Beck’s Triad• Hypotension• Muffled Heart Sounds• JVD
Diff Dx• Tension PTX• Massive PE• Acute Pulm Edema• Severe Asthma
Pericardial DisordersDisorder
1. Pericarditis
2. Tamponade• (Stable Vitals)
• Hypotensive
• Penetrating Chest Trauma (No Vitals)
Treatment• ASA, NSAIDs
• IVF, Surgery Urgently (Window)
• IVF, Inotropes, Pericardiocentesis, Surgery Emergently
• ER Thoracotomy
Electrical Alternans Tamponade/ Large Pericardial Effusion
Pneumococcal Pneumonia
• Cough productive of rusty colored sputum
• Fever
• Single shaking chill
Lobar Infiltrate
Staph Pneumonia
• Cough• Fever• Hemoptysis
• Recent Influenza• Toxic appearance
Air Fluid Level
Legionella Pneumonia
• Non-Productive cough
• Elevated AST/ALT
• Hyponatriema
• Gram stain with PMN’s but no organisms
– Relative Bradycardia (Despite Fever)
– Diarrhea (GI Symptoms)***
Mycoplasma Pneumonia
• Non productive cough
• Clinically well appearing with awful CXR
• Rx: Macrolide
Atypical Pneumonias
1. Legionella (Macrolide)2. Mycoplasma (Macrolide)3. Chlamydia (Tetracyclines/Macrolide)
Klebsiella Pneumonia• Alcoholic
• Cough
• Black/maroon sputum
• Abscess/ Empyema
• Gram (-) bacilli in pairs
• Rx:– Cephalosporin + AG
PCP Pneumonia• Weight loss
• SOB
• Cough
• Hypoxic
• Bilateral Interstitial Infiltrates
• LDH Elevated
• Rx:– Bactrim
– Pentamidine
– Steroids if PaO2 < 70
Pneumonia with Abscess
1. Staph2. Klebsiella3. Pseudomonas
Upper lobe infiltrate? Think….
1. Aspiration
2. TB
3. Klebsiella
Peritonsillar Abscess
• MEDIAL TO CAROTID!!
• Sore throat• Drooling • Muffled Voice
• Organism?– Polymicrobial (GABHS)
• Rx:– Aspiration– Abx (PCN, Clinda)
Ludwigs Angina• Sore throat• Drooling • Muffled Voice• Swelling floor mouth• Chest Pain
• Organism?– Polymicrobial
(aerobic-anaerobic)
• Rx:– Airway! Airway! Airway!– ENT– ABX (clinda, unasyn)
Retropharyngeal/Prevertebral Abscess
• Sore throat• Drooling • Muffled Voice
• Neck Stiff• Extension more comfortable
• ENT• IV ABX (clinda/ unasyn)• Admit ICU
Greater than 6 mm prevert. tissue
ENT Trauma
Injury
1. Nasal Septal Hematoma
2. Ethmoid Fx (Cribiform Plate)
3. Hematoma Auricle
Complication
1. Avascular Necrosis
2. CSF Rhinorrhea/ Meningitis
3. Cauliflower Ear
Septal Hematoma• Complication?
– Septal Necrosis (cartilage death within 24 hours)– Saddle nose deformity
• Rx:– Surgical drainage, packing and antibiotics
Epistaxis
• Frequent cause?
Epistaxis
Anterior (90%)• Murocele • Rapid Rhino• Cautery has high
incidence return visits
Posterior (10%)• Epistat• ENT
Treatment1. Blow Nose**
2. Topical Anesthetic (Lidocaine/Cocaine)3. Vasoconstrictor (Neosynephrine)
4. Pressure5. Evaluate
Sinusitis1. Most common site
2. Cavernous Sinus thrombosis
3. Pott’s Puffy Tumor
4. Periorbital/Orbital cellulitis
1. Maxillary
2. Sphenoid (Ethmoid)
3. Frontal
4. Ethmoid
Acute onset. Diagnosis?
Angioedema
Which is the most common medication that causes angioedema?
ACE inhibitors
Facial Fractures
Tripod Fracture
• Zygomaticofrontal Suture
• Zygomatic Arch
• Infraorbital Foramen
• Punched in cheek
Flat cheekPeriorbital swellingDiplopiaAnesthesia of the cheek, upper teeth, lip and gums
Five clinical signs of basilar skull fracture
1. Periorbital ecchymosis (Raccoon eyes)
2. Retroauricular ecchymosis (battle’s sign)
3. CSF Otorrhea or rhinorrhea
4. Hemotympanum
5. CN I, II, VII, or VIII deficits
Ellis Type III Dental Fracture• Broken tooth • Blood on tooth (pulp involved)
• Rx?• Calcium Hydroxide Paste
Seat Belt Injuries
Chance Fx
Rectus Sheath Hematoma
Intestinal Perforation
Trauma Pearls
You see…
1. Blunt Abd. Trauma
2. Penetrating Abd. Trauma
3. Ustable after MCV/ Fall
4. Sternal Fracture
5. Pelvic Fracture
6. Lap Belt Mark
Think…
1. Spleen Laceration
2. Liver Laceration
3. Traumatic Aortic Rupt
4. Myocardial Contusion
5. Bladder Injury
6. Jejunal/Mesenteric Lac.
Painful ulcer
• Friable
• Jagged edges
• Inguinal Bubos
• Etiology– H. Ducrei
• Rx?– Azithro 1 gram or CTX 250 mg IM
Chancroid
Molar pregnancy• 10 week preg
• Hyperemesis
• HTN (Preeclampic Sx)
• Uterus is larger than expected
• B-HCG is higher than expected
• Ultrasound = snowstorm appearance
Abruptio Placenta• Painful bleeding during 3rd trimester• Severe Abdominal Pain• Hypotensive• Smoked Crack
• OB• Deliver
Pre-Eclampsia
• 3 rd Trimester Hypertension
• Proteinuria
• Edema
• Hypertriglyceridemia
• Treatment– Hydralazine
– Labetalol
– MgSO4 (eclampsia)
Trichomonas Vaginitis
• Strawberry cervix
• Profuse, yellow-green discharge
• Rx: – Flagyl
STD1. Strawberry cervix
2. Painful necrotic ulcer
3. Painless indurated ulcer
1. Beefy-red, velvety ulcers
1. Trichomonas
2. Chancroid
3. Primary Syphilis
4. Granuloma Inguinale
Toxicology - Antidotes1. Acetaminophen2. Beta blockers3. Bromides4. CCB5. Carbon monoxide6. Cholinergics7. Cyanide8. Digoxin
1. NAC2. Glucagon3. Chloride (NSS)4. Calcium, glucagon5. O26. Atropine, pralidoxime7. Nitrate, thiosulfate8. Digibind
Toxicology - Antidotes1. Methanol2. Ethylene glycol3. Iron4. Isoniazid5. Lead6. Arsenic7. Mercury8. Nitrites9. Opiates10. TCA11. Warfarin
1. ETOH, 5MP, dialysis2. ETOH, 5MP, dialysis3. Defuroxime4. Pyridoxine, Vit B65. BAL6. BAL7. BAL8. Methylene Blue9. Narcan10. Sodium Bicarbonate11. Vit K, FFP
Drugs that are Radioopaque
CHIPESC = Chloro Hydrate
H = Heavy Metals
I = Iron
P = Phenothiazines
E = Enteric Coated
S = Solvents
Drugs that are Dialyzable
BLIST MED1. Barbituates2. Lithium3. Isoniazide/Iron4. Salicylates5. Theophyline6. Methanol7. Ethylene Glycol8. Depakote
Charcoal
Useless• Lithium
• Alkali/Acids
• Heavy Metals
• Iron
Toxic Overdoses
1. Phenytoin
2. Iron
3. Lithium
4. NMS
5. Wernicke’s
1. Folate deficiency, osteomalacia, lupus like syndrome
2. Abdominal pain, hematemesis, coma and shock
3. Tremors, hyperreflexia, seizures, N/V/D
4. Altered MS, muscular rigidity, hyperthermia, rhabdo
5. Oculomotor deficits, ataxia, AMS
Caustics
Acid Ingestion• Coagulation Necrosis
Alkali Ingestion• Liquefaction Necrosis
(Worse/Deeper Burn)
Tylenol Toxicity (APAP)
1. Time 1st level
2. Charcoal/Cathartic?
3. Phases Poisoning?
4. Toxic Metabolite APAP?
5. Treatment?
1. 4 Hours After Ingestion
2. Yes (<1 Hour)
3. 4 Phases
4. NAPQI
5. NAC
Indication for Dialysis
• Acidosis
• Electolytes
• Ingestions (Toxins)
• Overload (Fluid)
• Uremic Symptoms
• A
• E
• I
• O
• U
Rotator Cuff Tears
• Subscapularis• Supraspinatus• Infraspinatus• Teres minor
• Most Commonly Injured?– Supraspinatus*
Nerve Injury with FracturesFracture
1. Humeral Shaft2. Elbow Fx3. Shoulder Dislocation4. Colles’/Smith’s Fx5. Sacral Fx6. Acetabular Fx7. Posterior Hip Dislocation8. Anterior Hip Dislocation9. Femoral Shaft Fx10. Knee Dislocation11. Lateral Tibial Plat. Fx
Nerve Injured
1. Radial2. Median/Ulnar3. Axillary4. Median 5. Cauda Equina6. Sciatic7. Sciatic8. Femoral9. Peroneal10. Peroneal/ Tibial11. Peroneal
You See…1. Scapular Fx
2. Supracondylar Fx
3. High-Pressure Injection (grease/paint gun)
4. Flexor Tendon Injury Finger (FDP)
Think…1. Associated Injuries
2. Volkmann’s Ischmic Contracture
3. Consult ortho immediately despite benign exam initially (amputation!!!)
4. Ortho Consult (OR repair)
Compartment Syndrome
• Pain out of proportion to injury (earliest sign)• Paralysis• Parasthesia• Pulselessness• Poikilothermia• Pallor
Normal Pressure = 10 mmHgAbnormal >30 mmHg
Lisfrank Fracture
• Fracture dislocation at the base of the 2nd metatarsal
•Unstable fracture•Keystone of Midfoot•Requires ORIF
Jones Fracture
• Fx 5th Metatarsal• High incidence of
delayed/nonunion
Amputated Digits
• Wrap Sterile Gauze moistened with NS
• Place in water-tight container
• Place container in ice water
Don’t Submerge in Ice Water!!
Anterior Hip Dislocations (10%)
• ABducted• Externally rotated• Flexed
Complication:• Femoral Vein/Artery
thrombosis Pulm Embolus
Posterior Hip Dislocation (90%)
• Flexed Knee strikes dashboard
• Short• ADDucted• Internally rotated• Flexed
• Avascular necrosis Femoral Head
Scaphoid Fracture
• Proximal or Distal Worse?– Proximal– (Blood supply is
distal)
• Complication?– Avascular Necrosis
• Thumb spica if unsure!
Bucket Handle Fracture
• R/O Child Abuse!
Galeazzi Fracture
• Distal Radioulnar dislocation
• Distal Radial Shaft
• ORIF
Monteggia’s Fracture
• Fracture Proximal 1/3 Ulna
• Dislocation radial head
• Draw line radial shaft• Should interect the
capitellum
• ORIF
Colle’s Fracture
Maisonneuve Fracture
•Consult or send home with splint?•Consult! (High energy injury)
Maisonneuve Fracture
Felon
• Staph Aureus• I&D• ABX
Flexor Tenosynovitis
• Organism?– Staph/Strep
• Rx?– Hospitalization– Ortho– IV ABX
(PCN/Cephalo)
Bell’s Palsy (CN 7 lesions)Peripheral• Unable to wrinkle forehead on same side
• Rx?
– Steroid burst
– Acyclovir
– Eye patch
Central• Able to move forehead on same side
• Dx?
– Brain Imaging (MRI)
Bilateral Bell’s Palsy Caused by?Lyme Disease
Jefferson’s Fracture (C1 Blowout Fracture)
Hangman’s Fracture (C2)• Bilateral C2 Pedicle Fractures
• Mechanism--Ext/Flex?– Hyperextension!
Anterior Cord syndrome
• Motor paralysis distal to the lesion
• Loss of pain and temperature
• Retention of posterior cord function – Vibration– Proprioception
• Flexion Injury
Central Cord Syndrome
• Paralysis – Upper > Lower Extremities
• Distal > Proximal
• Clumsy Hands
• Extension Injury
Brown Sequard Syndrome
• Penetrating injury
• Ipsilateral loss of motor, position, vibration, touch
• Contralateral loss of pain and temperature
Cauda Equina Syndrome
• Lower back pain
• Hyporeflexia
• Asymmetric finding
• Saddle anesthesia
• Decreased rectal tone
• MRI• Neurosurgery
In what situation is an MRI the emergent study of choice for back pain?
• Cauda Equina
• Spinal Epidural Abscess
Trigeminal neuralgia
• Facial pain (right side more common)
• Electrical shock like
• Lancinating pain
Treat: • Tegretol
Pontine hemorrhage
• Pinpoint pupils• Occipital Headache
• Hyperventilating
• Coma
• Decerebrate posturing
Anterior Cerebral Artery Infarct
• Contralateral Paralysis– Legs >> arms
• Gait disturbance
Middle Cerebral Artery
• Contralateral paralysis– Arms >> legs
• Expressive aphasia
• #1 CVA
Subdural
• HA
• Decreased LOC
• Crescent shape on CT
• Airway!
• Neurosurgery
• Reverse Anticoagulation
Epidural
• Head Trauma• Brief LOC• HA• Lenticular shape lesion• Temporal/Parietal skull fx
• Airway!• Manage BP• Neurosurgery• Reverse Anticoagulation
Temporal arteritis
• > 50 yrs old
• Eye pain
• Temporal HA
• Malaise
• Associated with Dz:– Polymyalgia rheumatica
Blood Test:• ESR
What is the most common complication?
• Blindness
Management?• Prednisone/Biopsy
Multiple Sclerosis
• Optic neuritis• Sensory symptoms that don’t follow a pattern• Female in 30’s with bizarre neuro findings
Double vision on lateral gaze
Kidney Stones
• <4 mm will pass
• 4-6 mm will pass
• >6 mm will pass
• 95%
• 50%
• 10%
Fournier’s Gangrene
• Immunocompromised• Diabetic• Polymicrobial (anaerobes)
• Treatment:– IVF– Broad spectrum antibiotics– Surgical debridement
Erythema Multiforme (Minor)
• Mycoplasma
• Malignancy
• Drugs (SOAP)– S = Sulfa
– O = Oral hypoglycemic
– A = Anticonvulsants
– P = PCN
Stage I Lyme Disease
• Annular erythematous lesion
• Spares palms and soles
• Associated with arthritis
• Erythema chronicum migrans
• Rx?
• Doxycycline
Retinal Artery Occlusion• Sudden painless monocular loss of vision
• Marcus-Gunn pupil – Dilated pupil unreactive to direct, reactive to indirect light
• Cherry red spot
Rx: • Digital massage• Cycloplegics• Acetazolamide• Ophtho
Diagnosis?
Papilloedema
Corneal Ulcer• Localized whitish
corneal infiltrate
• Organism?– Pseudomonas
• Rx: – Ophtho consult
– Antibiotics (Cipro)
– No contact lenes
Pterygium
Diagnosis?Hypopyon
Normal IOP
10- 21 mm hg
Retinal Detachment
• Painless loss vision
• Flashes of light
• Floaters
• Lowering of a curtain
Associated with:
• Myopia
• Trauma
• Marfan’s
Horner’s Syndrome
• Ptosis
• Miosis
• Anhydrosis
• Facial flushing
• Iris Heterochromia
Rotary nystagmus
Eye findings in a PCP Overdose?
Ramsey-Hunt Syndrome
• Vesicular rash Ear/ TM
• Bell’s palsy
• Loss of taste
• Caused by?– Herpes Zoster
Electrical Shock
• AC (Alternating)• Vfib
– Household and commercial
– Explosive exit wounds
– Worse effects with equivalent voltage
• DC (Direct)• Asystole
– Industrial, batteries, welding supplies
– Produces discrete exit wounds