Penetrating orbital trauma Jerome R. Hoffman, Russell W. Neuhaus, Henry I. Baylis
DOI: http://dx.doi.org/10.1016/0735-6757(83)90033-5
The American Journal of Emergency Medicine , Vol. 1 , Issue 1 ,
Published in issue: July 1983
x A small number of patients suffer penetrating injury to the orbit in the absence of trauma to the globe. Hospital records from the Jules Stein Eye Institute and affiliated hospitals were reviewed to obtain such cases. Five cases of penetrating orbital trauma, in which the globe was spared, are discussed. Many of the injuries initially appeared trivial but subsequent complications were severe. A review of these cases suggests that the shape and speed of the penetrating object, the anatomical location of the entry wound, and the physical characteristics of intraorbital structures determine the character and severity of orbital injuries.
Air bag-related ocular trauma Ali Ghafouri, Stuart K Burgess, Zuzana K Hrdlicka, Bruce M Zagelbaum
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90135-2
The American Journal of Emergency Medicine , Vol. 15 , Issue 4 ,
Published in issue: July 1997
x Automobile air bags have recently gained acceptance as an effective measure to reduce the morbidity and mortality associated with motor vehicle accidents. This report describes 11 cases of air bag-related ocular trauma and reviews cases previously reported in the literature, for a total of 32 patients and 39 eyes. This is the first comprehensive report on various types of ocular trauma related directly to air bag deployment. The most common type of ocular injuries seen are to the eyelids (23 patients, 28 eyes), conjunctiva (21 patients, 25 eyes), and cornea (23 patients, 28 eyes).
Occult penetrating orbital trauma Paul Coogan, Daniel Debehnke
DOI: http://dx.doi.org/10.1016/0735-6757(93)90175-B
The American Journal of Emergency Medicine , Vol. 11 , Issue 4 ,
Published in issue: July 1993
x The case of a 25-year-old male college student who presented to the emergency department with uniocular blindness is described. Initially, the injury was thought to be secondary to blunt orbital trauma. Further investigation showed an occult gunshot wound to the orbit. The diagnosis and management of penetrating orbital trauma are discussed.
Prevalence of significant intraocular sequelae in blunt orbital trauma Ken O Kreidl, Dennis Y Kim, Sam E Mansour
DOI: http://dx.doi.org/10.1016/j.ajem.2003.08.009
The American Journal of Emergency Medicine , Vol. 21 , Issue 7 ,
Published in issue: November 2003
x The purpose of this study was to describe the prevalence of significant intraocular sequelae (SIOS) and its correlation with the severity of blunt orbital trauma. Four hundred ten consecutive patients presenting to the ED who had sustained blunt orbital trauma were studied. The severity of orbital trauma was graded and SIOS was determined by the presence of an intraocular injury as listed in Table 2. The presence of SIOS was noted in 14 (41.2%) mild, 22 (59.5%) moderate, and 20 (29.4%) severe orbital trauma.
A case of Purtscher's retinopathy Keizo Shibata, Isao Furuki, Yugo Saitoh, Kiyofumi Mochizuki, Joji Tanabe
DOI: http://dx.doi.org/10.1016/0735-6757(94)90034-5
The American Journal of Emergency Medicine , Vol. 12 , Issue 6 ,
Published in issue: November 1994
x This article describes a case of Purtscher's retinopathy, a syndrome believed to be caused by microembolic infarction of the retina, in a 20-year-old man after remote extraocular trauma. The patient jumped from a 20-meter high building. He suffered multiple crush injuries, but a computed tomographic scan of the brain and orbit was normal. More than 1 month after injury, his visual acuity diminished to light perception in the right eye and counting fingers in the left. The ophthalmoscopic picture was characteristic of Purtscher's retinopathy with cotton-wool exudates and retinal hemorrhages localized to the posterior pole.
The sky is a limit: Errors in prehospital diagnosis by flight physicians Shai Linn, Nachshon Knoller, Christopher G Giligan, Uri Dreifus
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90025-5
The American Journal of Emergency Medicine , Vol. 15 , Issue 3 ,
Published in issue: May 1997
x The medical records and air evacuation reports of 186 trauma patients were examined to determine the type and characteristics of missed diagnoses. More than 35% of all cases of hypovolemic shock were not identified, nor were two cases of respiratory distress. Although unconsciousness was always identified correctly, almost 7% of all cases with partial unconsciousness were not recorded. Of 443 diagnoses, 337 were correctly recorded by the flight physician, slightly more than 76%. The flight physicians missed 10 critical diagnoses, all of which were feasible, 56 important diagnoses, 42 of which were feasible, and 40 relatively marginal diagnoses, 27 of which were feasible.
Infection control for health care workers caring for critically injured patients: A national survey William A. Berk, Keir Todd
DOI: http://dx.doi.org/10.1016/0735-6757(94)90201-1
The American Journal of Emergency Medicine , Vol. 12 , Issue 1 ,
Published in issue: January 1994
x Prevention of transmission of bloodborne pathogens to health care workers (HCWs) involved in resuscitation of critically injured patients presents special challenges. As a step toward creation of a standard, a telephone survey of the infection control practices in this setting of the 100 busiest EDs in the United States (US) was performed. Departmental staff who were knowledgeable about ED infection prevention protocols were questioned about general policy, barrier protection measures, sharps management, and educational programs directed to HCWs.
Infant seizures not so infantile: First-time seizures in children under six months of age presenting to the ED Thuy T. Bui, Carlos A. Delgado, Harold K. Simon
DOI: http://dx.doi.org/10.1053/ajem.2002.34796
The American Journal of Emergency Medicine , Vol. 20 , Issue 6 ,
Published in issue: October 2002
x Data regarding first-time seizures in children ≤6 months of age is limited. This retrospective study, therefore, reviews the presentation, management, and outcome of children ≤6 months of age presenting to a pediatric tertiary care facility with a first-time seizure. Charts for 31 patients were identified and reviewed. Nineteen patients (61%) received sepsis work-ups. Two of the 31 (7%) had infectious etiologies. One of these infants, a 3-month-old who presented with only a history of fever and eyes rolling back but otherwise appeared well on initial presentation, had pneumococcal meningitis.
Anterior chamber depth measurement using ultrasound to assess elevated intraocular pressure Getaw Worku Hassen, Brett Sweeney, Tania Portillo, Dinah Ali, Omer Nazeer, Rania Habal, Miguel Arbulu, Roger Chirurgi, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.042
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: December 1 2014
x Increased anterior chamber pressure also known as intraocular pressure can result from conditions such as glaucoma and trauma. The pressure in the anterior chamber is measured using tonometer. Measurement of the intraocular pressure is essential, as it requires immediate medical attention to alleviate pain and to avoid temporary or permanent damage to intraocular structures. Bedside ocular ultrasound (US) has gained popularity in recent years. It has been used to assess intracranial pressure via optic nerve sheath diameter (ONSD) and evaluate retinal detachment, vitreous hemorrhage, or pupillary reflex in a trauma patient.
A simple tool for exposure of the eye in patients with periorbital edema Luc H.E. Karssemakers, Tymour Forouzanfar, Engelbert A.J.M Schulten, K. Hakki Karagozoglu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.038
The American Journal of Emergency Medicine , Vol. 31 , Issue 9 ,
Published online: July 29 2013
x The reported incidence of ocular injuries in patients with orbital fractures varies widely, ranging from 2.7% to 90% [1]. Ocular injuries vary from corneal abrasion, displacement of the globe, entrapment of extraocular muscles, and loss of vision due to optic nerve injury. The risk of reduced visual acuity or even blindness can be minimized by prompt diagnosis and immediate treatment. Every facial trauma patient in whom the orbit is involved should receive ophthalmic examination preferably within 1 hour after trauma.
Journal club: The use of the trauma score as a triage tool Ronald B. Taylor, Howard A. Werman, Douglas A. Rund
DOI: http://dx.doi.org/10.1016/0735-6757(87)90373-1
The American Journal of Emergency Medicine , Vol. 5 , Issue 4 ,
Published in issue: July 1987
Ophthalmic mass casualty Josef Pikkel, Izchak Beiran, Irena Krasnitz, Benjamin Miller
DOI: http://dx.doi.org/10.1016/0735-6757(95)90149-3
The American Journal of Emergency Medicine , Vol. 13 , Issue 4 ,
Published in issue: July 1995
Prognostic indicators of open globe injuries in children Ching-Hsing Lee, Lan Lee, Ling-Yuh Kao, Ken-Kuo Lin, Meng-Ling Yang
DOI: http://dx.doi.org/10.1016/j.ajem.2008.04.004
The American Journal of Emergency Medicine , Vol. 27 , Issue 5 ,
Published in issue: June 2009
x To determine the prognostic indicators of visual outcome in children with open globe injuries.
Occult Pneumothorax on Chest X-ray Karin Amrein, Harald Sourij, Julia Mader, Steven Amrein, Tanja Robl
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.025
The American Journal of Emergency Medicine , Vol. 29 , Issue 8 ,
Published online: October 28 2010
x We report the case of an adult woman who presented to the medical emergency department because of a swollen neck, eye lid, and chest pain. Vital signs were normal except for tachycardia; a trauma was denied. Clinical examination was remarkable for crepitation on the neck and thoracic wall indicating subcutaneous emphysema. The chest radiograph confirmed extensive emphysema; and a computed tomography scan diagnosed pneumothorax on both sides invisible on conventional radiography with gas in the soft tissue of the neck, chest, and abdominal wall.
Ultrasound assessment of extraocular movements and pupillary light reflex in ocular trauma Aaron Harries, Sachita Shah, Nathan Teismann, Daniel Price, Arun Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2009.06.026
The American Journal of Emergency Medicine , Vol. 28 , Issue 8 ,
Published online: September 18 2009
x We present the case of a 26-year-old man with significant periorbital trauma after blunt head trauma. Ultrasound techniques for evaluation of extraocular movements and pupillary light reflex are described as a proposed adjunct to physical examination and manual retraction of the eyelids.
Diagnosis of periorbital gas on ocular ultrasound after facial trauma S. Timothy McIlrath, Michael Blaivas, Matthew Lyon
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.001
The American Journal of Emergency Medicine , Vol. 23 , Issue 4 ,
Published in issue: July 2005
x Ocular trauma can occur from isolated facial trauma or in major blunt trauma such as motor vehicle accidents or falls. Despite the etiology of the injury, a thorough evaluation is important but may often be difficult if severe swelling is present. Recently, emergency ultrasound has seen the use of ocular ultrasound to evaluate visual changes and trauma. Literature suggests that unsuspected and difficult to diagnose pathology may be easily detected on ultrasound of the orbit. We present 3 cases of isolated facial trauma in which routine evaluation with ocular ultrasound led to the discovery of periorbital air with one patient having air insufflating the upper lid of the affected side.
Purtscher's retinopathy: a case report and review Stuart M. Caplen, Steven A. Madreperla
DOI: http://dx.doi.org/10.1016/j.ajem.2007.12.015
The American Journal of Emergency Medicine , Vol. 26 , Issue 7 ,
Published in issue: September 2008
x A case of posttraumatic loss of vision was seen in the emergency department that was diagnosed as Purtscher's retinopathy or traumatic retinal angiopathy. Purtscher's retinopathy presents as an acute loss of vision after a traumatic event or as a sequelae of another disease process. The case is presented with a discussion of the pathophysiology, diagnosis, prognosis, and treatment options for this entity.
The motor component does not convey all the mortality prediction capacity of the Glasgow Coma Scale in trauma patients Benoît Vivien, Jean-Michel Yeguiayan, Yannick Le Manach, Claire Bonithon-Kopp, Sébastien Mirek, Delphine Garrigue, Marc Freysz, Bruno Riou
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.022
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: October 31 2011
x We tested the hypothesis that the motor component of the Glasgow Coma Scale (GCS) conveys most of the predictive information of triage scores (Triage Revised Trauma Score [T-RTS] and the Mechanism, GCS, Age, arterial Pressure score [MGAP]) in trauma patients.
Ultraviolet dye masquerading as corneal abrasion Rajiv M. Rugwani, Preston H. Blomquist
DOI: http://dx.doi.org/10.1053/ajem.2002.33954
The American Journal of Emergency Medicine , Vol. 20 , Issue 4 ,
Published in issue: July 2002
x —Pepper spray containing oleoresin capiscum is used as a nonlethal deterrent and is associated with corneal abrasions in 7% to 9% of ED patients with ocular exposure.1,2 Fluorescein staining and Wood's lamp or slit lamp biomicroscopic examination has been recommended for patients with ocular exposure to pepper spray.2 We recently encountered an individual without corneal epithelial defects with fluorescence on examination caused by the ultraviolet marking dye in the pepper spray product.
Anterior chamber depth measurement using ultrasound to assess elevated intraocular pressure Getaw Worku Hassen, Hossein Kalantari
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.047
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: December 30 2014
x We read the letter to the editor with interest, and we thank the author(s) for the information on the different causes of anterior chamber diameter (ACD) size variations and different causes of increased intraocular pressure (IOP). We agree that increased IOP results from several causes including trauma and traumatic or spontaneous hemorrhage within the anterior chamber and glaucoma. As it was stated in the letter, IOP can be elevated without change in the ACD. In cases of trauma to the eye, where it is not possible to measure the IOP, ultrasound can be used for detection of retinal detachment, globe rupture (IOP measurement contraindicated in this case), lens dislocation, hyphema, and optic nerve sheath diameter (ONSD) to indirectly assess the intracranial pressure (ICP).
