excellent case. thank you. one also need to be concerned ,I think, of retrobulbar hemorrhage. altho that's a bit tricky. (if one is absolutely sure there's a globe rupture , in that case a retrobulbar hemorrhage puts no strain on the optic nerve (I think). and, with a suspected globe rupture you shouldn't attempt ocular tonometry! all very challenging with a continuously intoxicated patient, severe periorbital swelling, no CT.
Thanks for writing in! I was definitely concerned about retrobulbar hemorrhage- in fact I was concerned about all of the scary things! Either way he had to leave my department and needed a CT scan, which he did eventually get.
Vanessa, do you have POCUS in any of your remote shops? the retrobulbar hemorrhage as well as globe rupture, lens dislocation, pupillary responses, FBs can be seen with an US and the linear transducer. you can put a cm of gel and not need to put any pressure on the eye, just image through a thick layer of gel. Just a thought. thanks again for the wonderful case. Sean
We do indeed have POCUS and I considered it but given that he was definitely leaving the department and was uncooperative at times I decided not to risk it. I was worried he would lurch about and then pressure would get transmitted to the eye by him inadvertently sitting up and smacking his eye right into my probe. And given I was worried about a globe rupture and potentially introduce an infection I didn't want to put U/S gel into the mix and I didn't feel comfortable smacking a tegaderm over the eye before putting on the gel. So he got the coffee cup on the eye and a stretcher :)
tom f. - May 2, 2022 11:46 PM
excellent case. thank you.
one also need to be concerned ,I think, of retrobulbar hemorrhage. altho that's a bit tricky. (if one is absolutely sure there's a globe rupture , in that case a retrobulbar hemorrhage puts no strain on the optic nerve (I think). and, with a suspected globe rupture you shouldn't attempt ocular tonometry! all very challenging with a continuously intoxicated patient, severe periorbital swelling, no CT.
thank you for sharing this case
Vanessa C. - May 13, 2022 5:57 AM
Thanks for writing in! I was definitely concerned about retrobulbar hemorrhage- in fact I was concerned about all of the scary things! Either way he had to leave my department and needed a CT scan, which he did eventually get.
Vanessa C. - May 13, 2022 5:57 AM
Thanks for listening!
Sean R. - May 12, 2022 5:06 AM
Vanessa, do you have POCUS in any of your remote shops? the retrobulbar hemorrhage as well as globe rupture, lens dislocation, pupillary responses, FBs can be seen with an US and the linear transducer. you can put a cm of gel and not need to put any pressure on the eye, just image through a thick layer of gel. Just a thought. thanks again for the wonderful case. Sean
Vanessa C. - May 13, 2022 6:08 AM
We do indeed have POCUS and I considered it but given that he was definitely leaving the department and was uncooperative at times I decided not to risk it. I was worried he would lurch about and then pressure would get transmitted to the eye by him inadvertently sitting up and smacking his eye right into my probe. And given I was worried about a globe rupture and potentially introduce an infection I didn't want to put U/S gel into the mix and I didn't feel comfortable smacking a tegaderm over the eye before putting on the gel. So he got the coffee cup on the eye and a stretcher :)
Thanks for writing in and for listening
Mitchell F. - May 23, 2022 10:13 PM
Any reference for the 90% sensitivity of CT scan for orbital rupture? Everything I can find says the sensitivity is much lower.
Kate M. - June 22, 2022 10:57 PM
I used a denture cup in a similar situation in our rural/remote hospital…
Vanessa C. - June 24, 2022 12:34 PM
Oh I like it! Thanks for the tip, and thanks for listening!