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Emergency Medicine > Acute coronary syndrome > Flashcards

Acute coronary syndrome Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Eye assessment should include?

A

(a) measurement of visual acuity,
(b) pupillary examination,
(c) visual field testing,
(d) slit lamp or penlight examination of the anterior segment of the eye,
(e) direct funduscopic examination

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2
Q

What are most retinal detachments preceded by?

A

posterior vitreous detachment, which causes traction on the retina

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3
Q

Are we able to visualize the posterior chamber?

A

No

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4
Q

What is a mechanical globe injury

A

full-thickness rupture or laceration through the cornea and/or sclera

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5
Q

Signs of retinal detachment?

A

Floaters, flashes, curtain closing

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6
Q

How are mechanical globe injuries caused?

A

Blunt trauma - rupture

Penetrating trauma - laceration

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7
Q

Tx for mechanical globe injuries?

A
  • Eye shield

* Avoid putting anything in eye

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8
Q

Drugs for mechanical globe injuries?

A
  • Zofran

* Ertapenem

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9
Q

Dispo for mechanical globe?

A

MEDEVAC

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10
Q

Chemical eye injury severity depends on?

A

pH of chemical and duration

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11
Q

Which type of chemical typically causes more damage?

A

Alkalis

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12
Q

Tx for chemical eye burn?

A
  • Irrigate eye with NS or LR with 2L min
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13
Q

Drugs for mild burns?

A

Erythromycin Ophthalmic

Trimethoprim/polymyxin B

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14
Q

Drugs for severe burns? (III or IV)

A

Ciprofloxacin (Ciloxan) or Ofloxacin (Ocuflox)

Doxycycline

Prednisone

Ascorbate (vitamin c)

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15
Q

Acute angle glaucoma?

A

elevated intraocular pressure (IOP) is due to an obstruction of the outflow from the anterior chamber.

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16
Q

Symptoms of acute angle glaucoma?

A

(a) sudden onset of severe ocular pain,
(b) headache,
(c) nausea and vomiting,
(d) blurred vision with halos around lights,
(e) loss of vision.

  • NONREACTIVE pupil
  • Mild dilation
  • Corneal steamy appearance
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17
Q

Signs of acute angle glaucoma?

A

(a) conjunctival injection,
(b) corneal edema (light reflex irregular or steamy appearance),
(c) mid-dilated and nonreactive pupil – key finding
(d) evidence of shallow anterior chamber,
(e) increased IOP

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18
Q

What is tx for acute angle glaucoma?

A

IOP reduction
Inflammation management
Reverse angle closure

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19
Q

Tx for acute angle glaucoma?

A
  • Acetazolamide (Diamox) PO
  • Timolol Eye Solution
  • Prednisolone Topical drops
  • Piocarpine topical
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20
Q

Dispo acute angle closure?

A

MEDEVAC

21
Q

Sx of orbital floor fracture?

A

a) findings include subconjunctival hemorrhage,
b) enophthalmos,
c) hypoesthesia of the cheek and upper gum,
d) subcutaneous emphysema,
e) a palpable step-off of the orbital rim.
f) Soft tissue structures may herniate into the maxillary sinus, leading to entrapment and vertical diplopia.
g) The classic “blowout fracture” is the result of a blow to the anterior orbit, which increases retro-globar pressures thus breaking the weakest portion of the bony orbit, the medial floor.

** Entrapment

** Vertical diplopia

22
Q

Tx for orbital floor fracture?

A
  • Tylenol
  • NSAIDS
  • Ice
  • Consult
23
Q

So what is a orbital floor fracture?

A

facial trauma with periorbital edema and ecchymosis associated with tenderness to palpation along the inferior orbital rim.

24
Q

What requires immediate surgical decompression?

A

retrobulbar hematoma is associated with visual loss or increased IOP

25
Q

What is orbital cellulitis?

A

Typically presents with fever and an erythematous, swollen, tender eyelid with a recent history of sinusitis or upper respiratory tract infection

26
Q

How is orbital cellulitis different from periorbital cellulitis?

A

(a) Proptosis,
(b) tenderness,
(c) pain with extraocular muscle movement,
(d) chemosis,
(e) resistance to retropulsion of the globe,
(f) visual changes such as double vision or decreased acuity each suggest orbital cellulitis.

27
Q

Do either orbital or periorbicalt cellulitis involve the globe?

A

No

28
Q

What is imaging required for suspected orbital cellulitis?

A

CT

29
Q

What is mandatory for orbital cellulitis?

A

CT

30
Q

Tx for orbital cellulitis?

A
  • Ertapenem IV immediately

* MEDEVAC

31
Q

What is central retinal artery occlusion?

A

sudden, painless loss of vision, usually from emboli, atherosclerosis, vasculitis, vasospasm, or coagulopathy

32
Q

What is usually present with retinal artery occlusion?

A

Afferent puppillary defect

** Effected eye is more sluggish than the good eye

33
Q

What does fundoscopic exam show for retinal artery occlusion

A
  • Classic cherry-red spot on the fovea

* Cloudy swelling and whitening due to ischemia

34
Q

Non-ishcemic retinal artery occlusion?

A

may be asymptomatic or present with gradual vision loss that is more pronounced in the morning.

35
Q

Ischemic retinal artery occlusion presentation?”

A

marked decrease in vision usually discovered upon awakening.

36
Q

Is the vision loss painful in retinal, artery occlusion?

A

No, presents as painless

37
Q

What does fundoscopic exam reveal?

A

retinal hemorrhages extending outward from the optic disk and may cover the whole fundus, giving a “blood and thunder appearance”.

38
Q

Tx for retinal artery occlusion?

A
  • dilation of the central retinal artery by rebreathing expired carbon dioxide
  • sublingual nitroglycerin
  • gentle massage through a closed lid may dislodge the embolus distally
39
Q

Another name for flash burn?

A

Photokeratitis

40
Q

When do sx appear for flash burns?

A

6-12 hours later

41
Q

Hallmarks of flash burns?

A
  • Latency

* bilateral eye pain, injection, photophobia, and inability to open the eyes.

42
Q

How does the patient present with flash burns?

A

patient is typically distraught and pacing or rocking, due to severe pain.

43
Q

Complaints from patient with flash burns?

A

photophobia and foreign body sensation, symptoms that are characteristic of a keratitis.

44
Q

Exam findings for flash burns?

A

(2) Visual acuity is typically mildly to moderately reduced but may be difficult to obtain without administration of topical anesthetic.
(3) Penlight examination reveals tearing, and generalized injection and edema (chemosis) of the bulbar conjunctiva.
(4) There is no discharge or involvement of the tarsal conjunctiva, which distinguishes photokeratitis from conjunctivitis.
(5) The cornea may appear mildly hazy.
(6) Instillation of fluorescein reveals superficial punctuate staining of the cornea in the interpalpebral fissure.
(7) The pupils may be miotic.

45
Q

Tx for flash burns?

A

Analgesics

Carboxymethylcellulose ophthalmic (lubricant eye drops)

Erythromycin Ophthalmic

re-examined in one to two day

46
Q

What drug can continued use lead to dependency, corneal toxicity, persistent corneal epithelial defects, corneal ulceration, and loss of the eye?

A

Topical anesthetics

47
Q

Are topical anesthetics used for flash burns?

A

No

48
Q

Dispo for flash burns?

A

MEDADVICE

may need to use narcotics

Emergency Medicine (13 decks)

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