EM Reflections – January 2015 – Top Tips

Thanks to Dr Joanna Middleton for presenting and preparing this summary.

1)  Orbital cellulitis is a clinical diagnosis and should be considered in a patient with a swollen eyelid and ocular signs/symptoms.  Although both preseptal and orbital cellulitis typically cause eyelid swelling with or without erythema, the presence of ophthalmoplegia, pain with eye movement, and/or proptosis occur only with orbital cellulitis.  Even if the eyelid is swollen shut, it is essential to examine the eye (pupil reactivity, EOM, IOP, etc).  It is important to note that in some cases of orbital cellulitis the CT scan abnormalities may be very subtle.

2)  Before admitting a patient to the hospitalist/family doctor, please consider the appropriateness of the admission.  If a specialty admission would be more appropriate, we should be pushing for this.

3)  Just a reminder that handover is a high-risk part of our job and that errors that occur as a result of handover is a recurrent theme at M and M’s.  The department is looking at developing tools to help standardize the handover process and improve patient safety. 

4)  Spontaneous bacterial peritonitis does not always have a classic presentation.  The signs/symptoms are often very subtle, so think of it in every patient who presents to the ED with ascites secondary to cirrhotic liver disease.  If suspected, paracentesis should be done and antibiotic treatment should be initiated ASAP in patients with >0.25×10 to the 9th WBC in the fluid.

5)  Have a low threshold for CT in elderly patients with headaches, particularly if there is a change in characteristics of their usual headaches.

6)  If your patient arrived by ambulance, have a look at the EMS notes – they often contain valuable information!

Thank you to everyone who attended and participated!  Dr. Desousa will be presenting rounds next month, so please forward any cases to her.  Thanks!



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