Ep 107 Blunt Ocular Trauma Live from The EM Cases Course

In this live podcast on Blunt Ocular Trauma from The EM Cases Course 2018 with Anna MacDonald we discuss the most important diagnoses to consider, describe how physical exam in queen while CT can misguide you, explain a simple approach to orbital compartment syndrome with retrobulbar hematoma, give you tips on lateral canthotomy, how to pick up subtle hyphemas, why sickle cell patients are high risk, describe the key clinical clues to subtle globe rupture, the role of tranexamic acid in eye bleeds and much more... We include special guest appearances by POCUS gurus Jordan Chenkin and Rob Simard to give us tips on using POCUS in a patient who presents with their eye swollen shut as well as a bonus excerpt from the Expert Panel Discussion at The EM Cases Course on how to deal with obstructive consultants with Walter Himmel. Podcast production, sound design & editing by Anton Helman Written Summary and blog post by Anton Helman February 2018 Cite this podcast as: Helman, A, MacDonald, A, Chenkin, J, Simard, R, Himmel, W. Blunt Ocular Trauma Live from The EM Cases Course. Emergency Medicine Cases. February, 2018. https://emergencymedicinecases.com/ocular-trauma/. Accessed [date]. Important diagnoses to consider in blunt ocular trauma  While our minds seem to go first to orbital fractures in patients with blunt ocular trauma, our primary considerations should be the truly vision threatening emergency diagnoses: * Retrobulbar hematoma with orbital compartment syndrome * Hyphema * Retinal detachment and * Globe rupture Physical exam is queen in blunt ocular trauma There are few presentations in EM in which physical exam so crucial to clinching the diagnosis and guiding management as it is in blunt ocular trauma. The most common reason we miss these 4 vision threatening diagnoses are failing to do a thorough physical exam of the eye. The first challenge often is getting a good view of the globe in a patient who presents with their eye swollen shut. There are two options. First, after adequate analgesia, apply a small piece of gauze to your fingertips and gently pry open the lid making sure not to apply any pressure to the globe. If that fails, point of care ultrasound (POCUS) may be helpful in identifying not only retinal detachment, but also globe rupture and pupillary response. POCUS tips for globe assessment in blunt ocular trauma [9,10,11,12,13] First, gently place a Tegaderm over the patient's closed eyelid and then place a lot of ultrasound gel over the Tegaderm so that the ultrasound probe floats over the eye rather than pressing against the eyelid. This is to prevent pressure being placed on the globe from the high frequency linear array ultrasound probe or from having to wipe the ultrasound gel off the naked eyelid. For pupillary response, simply shine light in the non-affected eye and look on ultrasound for pupillary dilation. Then shine the light through the eyelid of the affected eye and again, look on ultrasound for pupillary dilation. Ask yourself the following questions: Is the anterior chamber present or not? The absence of an anterior chamber on POCUS could be a clue that there is an anterior chamber perforation. Is the posterior area of the globe black, round and smooth? If you see anechoic material in the posterior segment, you are probably dealing with a globe rupture associated with blood in the posterior chamber, and if the globe is not round and smooth you should suspect...