“Wavy Vision” … Case Conclusion June 7, 2010
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The Diagnosis is…
The small “gray dot” in the sclera and “jiggling” eyeball suggested globe rupture despite the young man’s near normal visual acuity and the absence of pain. The physical examination was stopped immediately, and a plastic shield was placed over the eye to protect it from possible iatrogenic injury. The patient was sent for CT scan, which revealed a BB pellet located next to the right optic nerve on the medial side of the retrobulbar space. Ophthalmology was contacted, and the patient was taken to the OR, where the BB was successfully removed. At 6-month follow-up, his vision was normal.
Congratulations to Axel, James, Kahled, Luis, & Rhona — this week’s winners of Emergency Medicine Practice’s “An Evidence-Based Approach To Traumatic Ocular Emergencies”! For an up-to-date review of the appropriate evaluation of adults with blunt and penetrating ocular and periorbital injuries and evidenced-based management recommendations, read the May 2010 issue of Emergency Medicine Practice, “An Evidence-Based Approach To Traumatic Ocular Emergencies.”
Wavy vision… June 1, 2010
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A 21-year-old male presents to the ED complaining that his vision seems “wavy,” as if something is jiggling inside his eye. One hour earlier, he was standing on the street when he heard what sounded like a gun firing. He felt “something funny” in his eye, but there was no blood and no real pain. On examination, there is no periorbital swelling and no obvious trauma to the eye itself. His visual acuity is 20/40 in the right eye and 20/30 in the left. Further examination of the right eye reveals a small gray mark in the sclera just lateral to the iris.
What’s Your Diagnosis?
(Enter to win the latest issue of Emergency Medicine Practice, including CME, by submitting your diagnosis. To submit your diagnosis, simply click “comments” above and type your answer. The deadline to enter is June 7th. [Note: A valid email address is required to be eligible to win. Your email will only be used to contact you in the event you win and will not be publicly displayed.”])
“Abdominal Pain”…Case Conclusion May 7, 2010
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The Diagnosis Is…
Your 40-year-old male patient on isoniazid has developed acute liver failure (ALF) from an idiosyncratic reaction to the drug — a diagnosis confirmed by his INR of 2.0 and elevated AST, ALT, and bilirubin. He has grade 1 encephalopathy. After moving him to a high-visibility bed in the ED, starting IV fluids via peripheral IV, and evaluating his glucose and electrolyte levels, you contact the transplant center located an hour away and arrange for an advanced life support ambulance to transport the patient.
For an evidence-based review of the management of management of ALF and the acutely symptomatic cirrhotic patient, read the April 2010 issue of Emergency Medicine Practice: Hepatic Failure: An Evidence-Based Approach In The Emergency Department.
“Abdominal pain”… May 1, 2010
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A 40-year-old male presents with a chief complaint of “abdominal pain,” and his nurse tells you he “does not look very good.” He states that he has had gradually worsening abdominal pain for over a week, and that today he felt so fatigued he was unable to go to work. Before this, he was otherwise healthy, and no one around him has been sick. On further history, he reveals that 6 weeks ago he was started on isoniazid for a positive PPD (tuberculosis) test in the absence of active chest disease. Other than mild tachycardia (to 112 beats per minute), his vital signs are normal. Physical examination reveals that his sclerae are yellow and detects marked tenderness of the right upper quadrant with mild hepatomegaly. His wife tells you she is concerned because he seems confused.
What’s Your Diagnosis?
(Enter to win the latest issue of Emergency Medicine Practice, including CME, by submitting your diagnosis. To submit your diagnosis, simply click “comments” above and type your answer. The deadline to enter is May 7th. [Note: A valid email address is required to be eligible to win. Your email will only be used to contact you in the event you win and will not be publicly displayed.”])
Welcome to “What’s Your Diagnosis?” April 1, 2010
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Welcome to EB Medicine’s blog! “What’s Your Diagnosis?” was created by EB Medicine to be a fun way for emergency clinicians to test their knowledge of challenging clinical cases. One ED patient presentation will be posted each month, with the case conclusion posted one week later including a link to a full text article on the topic. Post your guess to the diagnosis before we share the conclusion, and then see if you got it right!
