The assessment of extraocular movement (EOM) and pupillary light reflex can be used to evaluate for ocular injury post-trauma. However, many patients with ocular trauma can present with significant orbital edema or pain that limits assessment due to the physician being unable to retract the eyelids. Ocular ultrasound provides a unique way to assess the eyes in the event of a trauma without causing significant pain or harm to the patient. This blog post provides techniques on how to perform ocular ultrasound to assess EOM and pupillary light reflex…
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By: Russell Prichard MD and Melanie Lippman MD
CASE
The patient is a 52 year-old female with a past medical history of hypertension, hyperlipidemia, hypothyroidism, and a 2 pack a day smoking history who presented to the emergency department in respiratory distress.
When EMS arrived to the patient’s home, she was hypoxemic with a pulse oximetry reading of 70s on room air and hypotensive with systolic blood pressures in the 80s. She was placed on nasal cannula with improvement in her saturations and she was given aspirin, fentanyl, and nitroglycerin without relief.
Upon arrival her vitals were significant for respiratory rate of 34, pulse oximetry of 98% on 6L NC. She was noted to be in acute distress.
The patient was placed on positive pressure ventilation via BiPAP and broad blood work, chest X-ray and electrocardiogram (ECG) were obtained.
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By Hoi See Tsao, MD, and Alicia Genisca, MD
CASE
A 2-year-old previously healthy boy presented to the emergency department with a foreign body in his right nostril.
The patient was staying at his father’s house and the father became concerned about a foreign body when the patient suddenly began complaining of right nostril pain and dark brown nasal discharge. The father did not know what foreign body may have been inserted. On the patient’s return to his mother’s house the next day, he was found to also have right nostril swelling. His mother brought him to the emergency department for evaluation. The mother denied the patient having fever, coughing, gagging, vomiting, diarrhea, or abdominal pain.
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A 74 year-old Portuguese speaking man with history of hypertension, hyperlipidemia, depression, non-insulin-dependent diabetes, presented to the emergency department with one week of left flank pain. The pain was gradual in onset and cramping in quality. The pain was constant and worse since beginning last week, approaching 10/10 in severity. It was located over the left flank and radiated toward the left abdomen and groin. The patient stated his symptoms began while cooking dinner. He had been working in his home vineyard and vegetable garden all day…
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