September 2, 2010

Extraordinary Cries

vocal cords

A 13 year-old boy with a history of allergic rhinitis is sent in to the emergency department by his family doctor. Three days previously he was exposed to smoke from a bushfire and has been having difficult breathing since. He has been having sudden exacerbations where his chest and throat feels tight and he feels as though he can’t get any air in. There has been no improvement despite treatment with prednisolone and ventolin over the past 2 days.
Can you diagnose and manage this case?

Blunt Trauma to the Eye

Eye

Your Emergency Department Director decided that a team-building exercise at the local boxing gym would be a good idea. You are left to hold the fort at work. An hour later the Director is en route to the ED – it seems that someone has given him a good whack in the eye… Hopefully you know your stuff when it comes to blunt trauma to the eye.

Crime Scene Echocardiography

sono2

In this special episode of ‘Crime Scene Echocardiography: Vienna’, the 123sonography team show how echocardiography can be used for good as they put their skills to the test and try to solve a mysterious case of dyspnea in a 39 year-old man.

Half an 8 ball

Hyphaema

A 26 year-old man sustained an injury of uncertain mechanism to his left eye while at the bottom of a ruck during a game of rugby. Fortunately, his team went on to win the game of rugby 24-16. However he still has a problem. Can you sort it out for him?

Bump and blur

A 71 year-old man tripped at home and bumped his forehead on the wall as he went to ground. He did not lose consciousness and apart from a minor bruise on his forehead and a major bruise on his ego, his only complaint is markedly blurred vision in his right eye. He has had previous cataract surgery on both eyes. How are you going to manage this case in the emergency department?

Out of Sight

Eiffel tower

We’re coming to the end of an absolutely eyeful Ophthalmology August here at LitFL. Over the month we’ve considered many different causes of loss of vision. Today’s Q&A’s will bring together all the different ways the ‘lights can go out’. Are you ready for the ‘loss of vision challenge’?

A Woman of Singular Vision

central retinal vein occluson

A 56 year-old female presents with sudden onset loss of vision in her right eye. She has a past medical history of hypertension, hyperlipidema and medication-controlled diabetes mellitus type 2. Her medications include aspirin, ramipril, atorvastation and metformin. On examination she has 6/60 vision in her right eye. Can you make the diagnosis and help to preserve her eyesight?

A Man of Singular Vision

central rtinal artery occlusion

A 52 year-old man presents with sudden onset loss of vision in his right eye. He has no other symptoms. His past medical history is notable for hypertension, hyperlipidemia and angina. His medications include aspirin, atenolol, and atorvastatin. Can you make the diagnosis and save this man’s vision?

More Befuddling Pupillary Asymmetry

cavernosus sinus

A man presents with a persistent cough… but you notice something wrong with his eyes. What is the ocular finding and what is your approach to determining the cause?

I can see clearly now

A man presents with transient monocular loss of vision. Can you make the diagnosis and manage this patient in the emergency department?

The Goggle-eyed Fisherman

orbital cellulitis

A fisherman presents with headache, fevers, left eye pain and swelling and visual disturbance. What is your diagnosis and how will you manage the case?

You’re blind and your hair is a mess

AION

A 65 year-old man presents with sudden onset painless loss of vision affecting the lower half his right eye’s visual field. He says he skipped breakfast because it hurt to chew, and his hair is mess because it was too painful to comb. Can you diagnose and manage this condition in the emergency department?

Stressed and branching out

HSV dendritic ulcer

A 24 year-old medical student presents to the emergency department with 2 days of superficial left eye pain, mild redness, tearing and mild photophobia. She has a history of cold sores and has been stressed out by exams recently. The slit lamp reveals a distinctive corneal lesion…

A gritty sticky red eye

Conjunctival injection

A patient presents with sticky, gritty, red eyes. A common and easy emergency department problem, right? Can you diagnose and treat all the different types of this condition?

The Eye in Chemical

A 45 year-old is rushed into the emergency department by the triage nurse. He was working at a building site and got cement into his eyes. How will you assess and manage this case?

Blinded by the Light

A 22 year-old male had a session on the sunbed in the morning, went for a surf around lunchtime, and helped his mate with some welding in the afternoon. Fortunately there were no mountains nearby. It’s late evening now had he has presented to the emergency department with intense bilateral eye pain and is refusing to open his eyes. What’s the likely diagnosis? How will you manage this condition?

A Ward Round with the Professor of Surgery

The guiding light of Modern Surgery was Theodor Billroth in Vienna, he passed the torch on to Halsted at John Hopkins...

The Professor of Surgery leads his Professorial train on a ward round the night before surgery.
“Look, Mr. Arbuckle. I’m the Professor. You’re no good the way you are. So tomorrow, I’m going to fix you. There are some risks, but you don’t need to worry about them. OK? See you tomorrow.”

Pupils and Prostitutes

On examining a patient’s eyes you note that the pupils are small, irregular, non-reactive to light and constrict when focussed on a near object. What is the significance of this abnormality?

The aching red photophobic eye

hypopyon

A man has an aching red eye and both direct and consensual photophobia. Can you diagnose and manage this condition in the emergency department?

Ultrasound Village

Ret Detat

At last! Ultrasound Village, the awesome emergency medicine ultrasound educational website, is finally welcoming prospective villagers – find out all about it!