Morning Report: 11/16/2012

Today’s Morning Report comes from Dr. Fan!

The Case:

60 yo M rolled out of bed and hit corner of eye on dresser. On exam, there is swelling with hemorrhagic chemosis.

Globe Rupture

Mechanism of injury: blunt or penetrating trauma, projectiles, metal grinders, be concerned for globe rupture with puncture or laceration to eyelid or periorbital area. Blunt trauma causes ruptures at thinnest parts of globe: limbus or insertion sites of extraocular muscles.

Generally occur in younger men, and men in general who more likely present with penetrating injuries.

Pt generally have pain and decreased visual acuity. Assess associated injuries (SDH secondary to fall?), possibility of foreign body. AMPLE.

Exam goal: identify globe rupture while protecting globe, use eyelid retractors

–       visual acuity and EOMI

–       orbits: bony deformity, foreign body, globe displacement

–       eyelid and lacrimal injuries

–       conjunctival injuries or hemorrhage

–       cornea and sclera: lacerations, prolapse of iris, scleral buckling, do not measure IOP, fluorescein Seidel test (clear stream of fluid through dye)

–       pupil: shape (irregular or teardrop), size, light reflex, APD

–       anterior chamber/slit lamp: hyphema, lens dislocation/injuries, corneal lacerations, shallow or deep anterior chambers

Imaging: CT orbits w/o contrast, do not ultrasound if suspicion high

Care:

–       protect with rigid shield, paper cup

–       elevate head of bed

–       avoid eye manipulation, leave lid laceration repair for ophtho

–       antiemetics to prevent Valsalva

–       sedation and analgesics

–       antibiotics: prophylactically treat endophthalmitis (strep, staph, pseudomonas) cephalosporins, cipro, vanc, augmentin for dog/cat bites

–       tetanus

–       npo

–       ophthalmology consult

–       RSI: succ increases IOP 5-10 mm Hg through contracture of EOM or cycloplegic effect on ciliary muscle, goal smooth intubation without cough

Thanks Dr. Fan!

The following two tabs change content below.

• Bio
• Latest Posts

Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

Latest posts by Jay Khadpe MD (see all)

• Save of the Month! December 2015 - December 23, 2015
• Morning Report: Unprovoked First Seizure in Adults - September 11, 2015
• Morning Report: Extramural Deliveries in the Emergency Room - September 10, 2015