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Visual Diagnoses in the ED


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Visual Diagnoses in the ED

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Visual Diagnoses in the ED

  1. 1. 23/02/17 Visual Stimuli In Emergency Medicine CME Teaching
  2. 2. A 50 year old man is BIBA following an MVA - the driver of a car travelling 80km/hr that was hit head on by a car travelling roughly the same speed
  3. 3. Basilar skull fracture ✤ Bleeding from the fracture site into the surrounding structures ✤ Clinical manifestations of basilar skull fracture may take hours to fully develop ✤ Needs urgent CT to evaluate and identify any underlying brain injuries
  4. 4. Seatbelt sign ✤ Increased risk of underlying visceral injuries ✤ Low threshold for CT
  5. 5. Septal haematoma ✤ Risk of avascular necrosis or secondary infection/abscess formation ✤ Can cause permanent deformity if left untreated ✤ Needs ENT input for urgent aspiration/drainage
  6. 6. Hyphaema ✤ Collection of red blood cells within the anterior chamber ✤ Usually managed conservatively with close ophthalmology follow up ✤ Can be complicated by obstruction of the trabecular meshwork leading to raised intraoccular pressure
  7. 7. A 26 year old man presents to ED with a 2 day history of a red, painful eye with blurred vision
  8. 8. Hypopyon ✤ Visible accumulation of white cells in the anterior chamber ✤ Indicates severe anterior uveitis ✤ Needs urgent ophthalmology referral ✤ Can be sight threatening
  9. 9. A 38 year old lady presents to hospital with a one day history of pain and irritation in her right eye
  10. 10. Dendritic ulcer ✤ Herpes simplex keratitis ✤ Treated with topical anti-virals and needs urgent ophthalmology referral ✤ Can be sight threatening
  11. 11. A 78 year old lady with a background of hypertension and type 2 diabetes presents with painless visual loss in her right eye
  12. 12. Central retinal vein occlusion ✤ Predisposing factors include age, HTN and Diabetes ✤ Visual acuity varies depending on the severity of the bleed ✤ Needs urgent ophthalmology referral
  13. 13. A 63 year old man presents with sudden loss of vision in his left eye
  14. 14. Central retinal artery occlusion ✤ Visual acuity always reduced <6/60 ✤ Need to rule out Giant Cell Arteritis ✤ Needs urgent ophthalmology referral
  15. 15. A 32 year old lady presents with severe headaches and blurred vision
  16. 16. Papilloedema ✤ Assess with full neurological and ophthalmological examinations ✤ Needs urgent neurological imaging ✤ Neurology/opthalmology input depending on cause
  17. 17. A 56 year old man presents with loss of vision in one after complaining of flashes and floaters over the last couple of days
  18. 18. Retinal detachment ✤ Direct fundoscopy can’t always rule out a detachment ✤ Ultrasound is a useful tool for diagnosis ✤ Needs urgent ophthalmology referral
  19. 19. A 68 year old man in brought into ED following a collapse at home. He is GCS 6/15
  20. 20. Unequal pupils ✤ Injury or compression of the third cranial nerve and upper brainstem ✤ Suggests severe inter cranial pathology ✤ Needs urgent CT head to assess
  21. 21. A 45 year old smoker presents to ED complaining that her left eye is ‘droopy’
  22. 22. Horner’s Syndrome ✤ Ptosis, miosis and anhidrosis ✤ Interruption of the sympathetic nerve supply to the eye ✤ Painful Horner’s - need to consider dissection
  23. 23. A 70 year old man presents to hospital with a painful rash and redness in his right eye
  24. 24. Hutchinson’s sign ✤ Supplied by the nasocilliary branch of the trigeminal nerve ✤ Highly predictive of eye involvement ✤ Needs urgent ophthalmology referral - can be sight threatening
  25. 25. A 72 year old man with a background of lung cancer presents to hospital complaining of increasing shortness of breath
  26. 26. SVC obstruction ✤ Pemberton’s sign ✤ Most common cause is lung cancer ✤ Treated with chemotherapy/radiotherapy or stenting
  27. 27. A 54 year old man presenting to hospital with abdominal pain and distention
  28. 28. Distended abdominal veins ✤ IVC obstruction vs caput medusa ✤ Caput medusa signifies severe portal hypertension
  29. 29. Spider Naevi ✤ Dilation of arterioles caused by increased oestrogen levels ✤ Multiple spider naevi is a common sign in liver disease ✤ Also common in pregnancy
  30. 30. A 46 year old alcoholic man presents to hospital with severe abdominal pain and vomiting
  31. 31. Retroperitoneal bleed ✤ Trauma, ectopic pregnancy rupture or pancreatitis ✤ Signifies necrotizing pancreatitis ✤ Associated with very high mortality
  32. 32. A 78 year old lady with a history of COPD presents to hospital with respiratory distress
  33. 33. Peripheral cyanosis ✤ Caused by excessive deoxyhaemoglobin in the blood ✤ Inadequate or obstructed circulation ✤ Anaemic patients may be hypoxic without cyanosis
  34. 34. A 42 year old IVDU presents to hospital feeling generally unwell with high fevers
  35. 35. Infective endocarditis ✤ Vascular and immunologic phenomena ✤ Most commonly caused by Staph aureus ✤ Modified Dukes criteria for diagnosis
  36. 36. A 72 year old man presents to ED with SOB which has been getting worse over the last few months
  37. 37. Clubbing ✤ Many associated diseases ✤ Schamroth’s test used to identify subtle clubbing ✤ Needs further investigation if not known to have a causative disease
  38. 38. A 38 year old man presents to hospital with a painful rash on his chest
  39. 39. HSV ✤ Cause by the varicella zoster virus ✤ Never crosses the midline ✤ Infective until lesions have crusted ✤ Often complicated by post-herpetic neuralgia
  40. 40. Any Questions?