January 28, 2021

Background: Anyone who has had a corneal abrasion knows how painful it can be.   Unfortunately, traditional analgesic agents (ibuprofen, acetaminophen, opiates etc) are ineffective in relieving pain. Topical anesthetic drops can be diagnostic of superficial eye pathology and are routinely used prior to slit-lamp examination.  They provide immediate relief in the emergency department and have been shown to be effective and safe (Limited evidence has not shown significant adverse events) as short-term outpatient therapy (REBEL EM).  The biggest concern with the use of topical anesthetic agents as outpatient therapy is delayed healing, which is what most evidence has focused on.  This may occur with long-term use, but not been seen in studies of short-term use of topical anesthetics (REBEL EM). Use of short-term topical anesthetics further has the potential to reduce the use of opioids for analgesia for this indication. Recent published literature on topical anesthetic for this indication have focused on harms. There is scant literature detailing their benefit.

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.