A 75 year-old female with a past medical history of hypertension, hyperlipidemia, SVT, chronic kidney disease, diabetes, lung cancer status post partial right lung resection, and remote history of breast cancer status post resection presented with chest pain. She awoke in the middle of the night after hearing a loud crash and found her husband lying on the ground unresponsive. She thought he was dead and felt an overwhelming sensation of fear, followed immediately by the onset of substernal chest pain radiating to the back associated with some shortness of breath. She denied fever, diaphoresis, nausea, vomiting, or palpitations. She denied any history of angina. Upon arrival to the emergency department she was given nitroglycerin with a subsequent improvement in her chest pain…
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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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