October 26, 2020

Orbital compartment syndrome (OCS) is a rare, vision-threatening diagnosis that requires rapid identification and immediate treatment for preservation of vision.1-4 As with other compartment syndromes, rapidly increasing and sustained high intraocular pressures (IOP) can result in devastating consequences. OCS causes retinal and optic nerve ischemia due to increased pressure on those structures. Due to the time-sensitive nature of this condition, the emergency physician (EP) plays a critical role in the diagnosis and management of OCS.5 The definitive therapy for this condition is lateral canthotomy and inferior cantholysis (LCIC).

October 14, 2020

Take Home Points
  • Trauma resulting in a retrobulbar hemorrhage can lead to orbital compartment syndrome which is a vision threatening injury
  • Diagnosis is made clinically based on the presence of an afferent pupillary defect, vision loss and an intraocular pressure > 40 mm Hg
  • Treatment is with a lateral canthotomy - a simple but mentally daunting procedure

June 22, 2020

Ear, nose, and throat (ENT) complaints are commonly seen in the emergency department. When you hear “ENT emergencies,” you probably think about epistaxis, sinusitis, and possibly foreign body removal (either from the ear or nose). While not as common, auricular hematomas are equally important to both understand and know how to manage. As a former wrestler, I can attest to the importance of 1) knowing how to accurately diagnose and 2) how to treat this injury to prevent future development of “cauliflower ear”. An auricular hematoma is a collection of blood underneath the perichondrium of the ear that typically occurs secondary to trauma. Common mechanisms of injury include an ear-piercing gone wrong or blunt trauma in contact sports (wrestling, boxing, and martial arts). Inadequate treatment of an auricular hematoma can lead to the development of an auricular deformity commonly known as “cauliflower ear,” which develops from permanent cartilage destruction.

October 9, 2019

Take Home Points 
  • Acute closed angle glaucoma is an ophthalmologic emergency that usually presents with sudden, painful, monocular vision loss.
  • Physical exam will reveal conjunctival redness, corneal haziness or cloudiness due to edema and a pupil that is mid sized and minimally reactive to light, a rock hard globe and IOP >/= 21.
  • These patients require emergent ophthalmology evaluation but treatment should be started empirically while waiting for the evaluation. Initial treatment to decrease IOP usually includes a topical BB such as timolol and topical AB such as apraclonidine and either IV or PO acetazolamide.  
 

May 24, 2018

Background: Sore throat is among the most common complaints in the emergency department (ED). Sometimes, the etiology is bacterial, and in those cases antibiotics may shorten the duration of disease and provide symptomatic relief. The majority of cases are viral and though most are appropriately treated with symptom management in the forms of NSAIDS and acetaminophen, some are prescribed antibiotics before cultures result in the hopes of alleviating pain. Corticosteroids are another treatment modality with prior studies suggesting their effectiveness. That said, steroids remain an uncommon therapy for a common disease.

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