Ophtho/Environmental Flashcards
A patient comes in with pain, foreign body sensation, photophobia, tearing. They note relief of pain with topic anesthetics. What’s the dx, how would you dx, and tx?
Corneal abrasion
Slit lamp exam w/ flourescin stain: ““ice rink”” or linear abrasians
+ seidel test
corneal laceration
To dx this:
Tonometry: increased IOP
Fundoscopy :optic blurring or cloudy “steamy” cornea”
Acute angle-closure glaucoma
Progressive, painful vision loss over hours to days
Loss of color vision (desaturation)
Deep ocular pain worse with movement, often relieved at rest
Afferent pupillary defect, papilledema, ↓ visual acuity, normal IOP, red desaturation test (red dot appears lighter)
Often unilateral
Optic neuritis
Marcus-Gunn Pupil (relative afferent pupillary defect): swinging flashlight test from unaffected to affected eye = pupils appear to dialte
Tx?
optic neuritis
IV methylpredinsolone
What must you not do with a global rupture?
Don’t measure IOP
Instead: "Emergent ophtho consult = OR -Eye shield, elevate HOB -IV abx (ceftazidime, gentamycin, vancomycin) -Tetanus prophylaxis -Analgesia, antiemetics, NPO"
“-Sudden, profound, painless, monocular vision loss & APD
-Often preceding episodes of amaurosis fugax”
Central retinal artery occlusion
-Fundoscopy: Pale retina with “cherry red” macula showing retinal ischemia
Central retinal artery occlusion
Fundoscopy: “Blood-and-thunder fundus” showing extensive retinal hemorrhage
Central retinal venous occlusion
“-Photopsa (flashing lights) followed by floaters, visual field cuts, +/- reduced visual acuity
-Progressive unilateral peripheral vision loss ““curtain coming down”””
Retinal detachment
-Keep pt supine w/ head turn to affected side
Heat edema- swelling of hands and feet. Tx?
Nothing
Leg elevation, tight support hose
“-Maculopapular, pruritic, erythematous rash occurs in clothed areas
-Predominate symptom is pruritis”
Name and tx
Prickly heat
Antihistamines/topical cream
“-Exercise associated muscle cramps
- Intermittent, painful, and involuntary spasmodic contractions of skeletal muscles
- Relieved by stretching and massage, resolve spontaneously “
Name and tx
Population mostly affected
Heat cramps
Electrolytes
“-Typically unacclimated individuals or athletes with extended periods of exercise
-Commonly seen in roofers, firefighter, military personnel, athletes, steel workers, and field workers. “
“-Headache, vertigo, ataxia, impaired judgement, dizziness, nausea, and muscle cramps
-Patients can develop heat stroke after removal from heat-stress environment”
Name and tx
Population mostly affected
Heat Exhaustion
“-Aggressive cooling of nonresponders is indicated to a core temp of 39℃ (102.2℉)
-Laborers, athletes, elderly individuals exerting themselves in hot environments, without adequate fluid intake
“-Total loss of thermoregulatory function
-Prognosis worsens if initial core temperature exceeds 42℃ (107.6℉), acute renal failure, massively elevated liver enzymes, significant hyperkalemia “
Heat stroke
-Triad: Exposure to heat stress, CNS dysfunction, core temperature > 40.5 ℃
Heat stroke
ong periods of high ambient temperature and humidity (heat waves)
–Skin feels hot and dry to the touch
Classic heat stroke
often young and previously health individuals (i.e athletes, laborers, military recruits)
–d/t strenuous exercise skin may feel dry and moist
Exertional heat stroke
“EKG
- Bradycardia- Osborn (J) wave
- Artial or ventricular dysrhythmias
TSH and Cortisol may be elevated
-Consider a toxicology screen
-Esophageal probe: device of choice to monitor core body temp”
Name and tx
Hypothermia
“Essential that resuscitative efforts be continued until patient is rewarmed: Unless severe injuries incompatible with life, changes present in prolonged death
Airway:
- Orotracheal intubation unless patient able to manage airway
- Orogastric tube
Breathing:
-Mechanical ventilation with warmth
Circulation:
- Crystalloids should be warmed and infused
- Serially assess volume status
Rewarming
- Remove any wet clothing
- Passive warming (with a blanket)
- Rewarm at rate of 0.5 - 2℃ /H in mild cases without significant hemodynamic instability
- Active rewarming if cardiac instability, temp below 32℃, peripheral vasodilation, endocrine insufficiency “
“-Clumsiness of extremity (“chunk of wood”) sensation
- Numbness/paresthesias
- Sensory deficit: Hands, feet, nose, ears, face especially susceptible
- appears waxy, mottled, yellow, or violaceous-white
- Advanced cases/delayed presentation: bullous and Eschar formation, Tissue necrosis “
Frostbite
“-Potential for limb-threatening local reactions
- Coagulopathy, bleeding
- Rhabdomyolysis
- Capillary leak with intravascular volume depletion and shock
- Metallic taste, nerve paralysis and respiratory failure”
Crotalidae
“-Crotalus (Rattlesnakes)
- Agkistrodon (Copperheads)
- Cottonmouths”
-Treat systemic changes
“-Minor local reactions
- N/V, headache, paresthesia, numbness
- Neurotoxicity
- Paralysis
- Respiratory depression”
Elapide
Coral snakes
-Limited antivenom: if presence of systemic signs
-Vomiting, tachycardia, hypertension, local pain, paresthesias, muscle jerking, rhabdomyolysis, respiratory failure
Scorption Stings
“-Supportive management: Analgesia, Benzos, IV Fluids
-Severe systemic symptoms: Administration of antivenom, immune F(ab’)2 (equine) injection, with readministration at 30-minute serial evaluations if symptoms persist”
Electric Shock tx
- Advance cardiac and mechanical respiratory support
- Surgical consultation and management: Deep tissue injury, compartment syndrome, bone fracture, osteonecrosis, spinal injury
- Adequate volume infusions: Rhabdomyolysis, AKI
- Burn management center”
“-Cardiopulmonary arrest, cardiac arrythmias, seizures, deafness, confusion, amnesia, blindness, paralysis
- TM ruptures in >50% of victims
- Burns may result from vaporization of sweat or moist clothing, heating of clothing or metal objects (belt buckles, bra wiring), direct effects of strike
- Secondary blunt trauma: Myocardial contusion”
Lightening Injury
ABCs
