In this episode of the EM Res Podcast, we welcome back Dan Kaminstein, MD. Dr. Kaminstein is our director of the section of International Medicine in the Emergency Department at Wellspan York Hospital, and a guru of ultrasound. Dan got in touch with an old residency pal, Dr. Emory Patterson from Athens, GA to talk about all things Emergency Ophthalmology. Lots of great leaning points and practical tips to be had. Some of the highlights from the discussion:
You must know three things when you call the ophthalmologist: visual acuity, pupils, and pressure.
If you can't get a visual acuity, have them count fingers, then identify hand movement, and if all else fails, ask about light perception.
- If the patient has a detached retina - whether mac on or off - call the ophthalmologist.
- If you are going to dilate, use a shorter acting agent, such as 2.5% phenylephrine and 1% tropicamide,
- There are few, if any, conditions you will diagnose in the ED that require acute topical steroids when it comes to eye complaints. You don’t need to prescribe them in the ED for the most part, and if you need to, you should at least talk with an ophthalmologist
- When it comes to retrobulbar hematoma - know the pressure. Just because they have one does not mean it is causing elevated pressure, which is why you do the lateral canthotomy.
- Dilute proparicaine is probably not ready for primetime. Make sure you are talking to your local ophthalmologist about stuff like this before jumping on a small amount of data.
- When it comes to ocular exposure to alkali or acid, anything you can flush with is better than acid or alkali. Normal saline is fine. So is tap water.