>EM Reflections – January 2019

Thanks to Dr. Paul Page for leading the discussions this month

Edited by Dr David Lewis 


Top tips from this month’s rounds:

  1. Conversion disorder – remember = diagnosis of exclusion.  Consider admission for urgent workup for patients with neurological findings and no definitive diagnosis.  Or good documentation if thought to be functional disorder.
  2. CT reports – important to document details of Diagnostic Imaging report (verbal, system or dictated).  Be aware of old reports on dictation system and make sure report is the appropriate one.
  3. Vision loss – acute vision loss needs to be seen ASAP for assessment.  Don’t need room 27 (eye room) for all eye cases. Emergent ophthalmology cases can be initially assessed in any room.
  4. Supracondylar Fractures – remove ice packs etc to have a good look at all Ortho injuries during triage assessment, even when brought in by EMS.  Assess for limb deformity, skin tenting and especially neuro-vascular compromise. These patients should be urgently assessed and appropriately managed including analgesia, splinting and emergent reduction if indicated. Don’t need to wait for room 10 ( Fracture Procedure Room) for emergent Ortho cases.

Learning Points:

Scanning Dysarthria

Scanning dysarthria (scanning speech, explosive speech) is a stuttering dysarthria found in cerebellar disorders. Spoken words are broken up into separate syllables, often separated by a noticeable pause, and spoken with varying force. The sentence “Walking is good exercise”, for example, might be pronounced as “Walk (pause) ing is good ex (pause) er (pause) cise”. Additionally, stress may be placed on unusual syllables. Charcot’s neurological triad suggestive of multiple sclerosis has it has one of the three classic symptoms.

https://library.med.utah.edu/neurologicexam/cases/html_case03/feedback/FB_dysarthria.html


Corneal Hydrops

Corneal hydrops is the acute onset of corneal edema due to a break in Descemet membrane. This condition may be seen in individuals with advanced keratoconus or other forms of corneal ectasia. More here

Keratoconus is a disorder in which the cornea assumes an irregular conical shape. Acute hydrops is a well-known complication, occurring in approximately 3% of patients with keratoconus. Hydrops occurs after rupture of the posterior cornea leads to an influx of aqueous humor into the cornea, resulting in edema. Corneal edema typically resolves in 6 to 10 weeks; therefore, hydrops is usually not an indication for emergency corneal transplantation. Infectious causes of corneal opacification and visual loss, such as bacterial, viral, or fungal keratitis, must be ruled out as the cause of acute visual loss.


Seidel Test

The test used to reveal ocular leaks from the cornea, sclera or conjunctiva following injury or surgery and sometimes disease is called Seidel test.

http://eyewiki.aao.org/Seidel_Test

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