Thanks For Watching

Its been a rough few weeks. The stories keep piling up on my desk. This one keeps coming to mind, so I figured I’d try to post it from my phone.* An elderly patient came in by ambulance after tripping over a curb. She fell and hit her face, causing a nasal fracture and a periorbital contusion. But she was also having an increasing headache and she had proptosis. That’s a bad sign. We got the CT scan of her brain and it confirmed our fears. She had a retrobulbar hematoma, meaning that there was an expanding blood clot behind her eye which was pushing her eyeball outwards against the eyelid. Because the lids push back to hold the eye in the socket, the expanding blood clot was putting increasing pressure on her eye. Too much pressure and the eyesight is gone permanently. When we checked her vision, she was only able to see shapes out of that eye. We checked her pressure using a tonometer. It was 55. More bad news. Normal should be less than 20. We had to perform a canthotomy, meaning that we had to cut the ligament of the lower eyelid to bring down the pressure in the eyeball. A good article on performing a lateral canthotomy is here, including a drawing of what a retro-orbital hematoma looks like and why it needs to be treated. We called two ophthalmologists to come in and help us, but neither one had ever seen a canthotomy or had done a canthotomy. Both said to send the patient to the trauma center. Great. I did a canthotomy during a trauma rotation in my residenc...
Source: WhiteCoat's Call Room - Category: Emergency Medicine Doctors Authors: Tags: Patient Encounters Source Type: blogs