Plain and Simple Ocular Punctal Plug Removal: Part II
Ocular punctal plug removal is a straightforward procedure easily completed in the emergency department. Serious complications from punctal plug insertions are rare but sometimes seen.Left: A punctal plug in the upper lacrimal duct of the right eye, allowing for moisture balance from tear production. Right: The tiny punctal plug after it was removed. Photos by M. Roberts.Punctal plugs are placed in some or all of the lacrimal ducts by an ophthalmologist to treat chronic dry eye, and can be permanent or dissolvable. Plugs typically stay in place for three months or longer. (Am J Ophthalmol. 2007;144[3]:441.) ...
Source: The Procedural Pause - July 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Slit Lamp Made Simple
The slit lamp is a straightforward and user-friendly machine designed to make ocular exams easy. All the buttons, knobs, and lights, however, can be intimidating. This should not dissuade practitioners from getting cozy, driving the joystick, and evaluating ocular issues.An ED slit lamp with an LED light and magnification power up to 40x. Photo by M. Roberts.ED slit lamps are designed to be a bit more basic in function than those found in an ophthalmologist's office. Many EDs may house more complex machinery, but the vast majority of microscope and light arm combination is set at one length with one lens and one to two ...
Source: The Procedural Pause - February 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Now You See Me, Now You Don’t
A 32-year-old man presented to the emergency department complaining of eye pain and decreased vision. He worked for the city and was removing rust and graffiti from a wall with a power washer when the spray ricocheted off the surface and into his eye. He presented with a bottle of the chemical he used, which contained hydrofluoric acid (HF) and other chemicals. He rinsed his eyes with tap water, but experienced persistent decreased vision and pain in both eyes. His exam was remarkable for bilateral injected conjunctiva and excessive tearing.More than 7,000 ocular exposures were reported to U.S. poison control centers pe...
Source: The Tox Cave - January 2, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Acute Angle Closure: Mastering Tonometry
Identifying and managing disease often requires the delicate and skillful use of temperamental emergency department machinery. The ability to apply these may appropriately help determine a difficult diagnosis.Glaucoma, we all know, can cause blindness, and acute narrow angle glaucoma refers to the angles within the eye that are not as wide and open as normal. People with acute angle glaucoma have abnormal anatomy within the eye where the angle changes as the eye is dilated. This can cause blockages of fluid drainage from the anterior to posterior changes resulting in increased intraocular pressure. It ca lead to acute a...
Source: The Procedural Pause - November 9, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
LITFL Review 334
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Welcome to the 334th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.
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The Most Fair Dinkum Ripper Beauts of the Week
Don’t Forget ...
Source: Life in the Fast Lane - June 4, 2018 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs
Small Hairs Make Big Cuts (and Consequences)
The hair or thread tourniquet syndrome is a relatively rare condition that has evaded me in the emergency department for several decades, until past year when three cases showed up over six months. This condition has been around for as long as there has been hair or thread and body appendages. In fact, this condition may have first been described in the 1600s. (J Pediatr Adolesc Gynecol 2005;18[3]:155.)The etiology of this condition seems almost unbelievable. How in the world does a hair get wrapped repeatedly and tightly around an appendage of the body? Some authors expressed the need to consider nonaccidental etio...
Source: M2E Too! Mellick's Multimedia EduBlog - April 30, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Rare Intervention for an Unusual Exposure
Children like to put things in their mouth, ears, nose, and eyes. A 9-year-old boy superglued his right eye shut and came to our pediatric emergency department. He thought the glue was an over-the-counter eye lubricant and filled his entire eye with the glue.Overdoses and poisonings are a dangerous threat to children. In fact, unintentional poison overdose or ingestion has continued to claim hundreds of children's lives. More than 300 children in the United States ages 0 to 19 are seen at EDs for poisoning and two of them die each year. (CDC. April 28, 2016; http://bit.ly/2kjVmhO.)Not all toxic exposures are i...
Source: The Procedural Pause - March 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Rare Intervention for an Unusual Exposure
Children like to put things in their mouth, ears, nose, and eyes. A 9-year-old boy superglued his right eye shut and came to our pediatric emergency department. He thought the glue was an over-the-counter eye lubricant and filled his entire eye with the glue.Overdoses and poisonings are a dangerous threat to children. In fact, unintentional poison overdose or ingestion has continued to claim hundreds of children's lives. More than 300 children in the United States ages 0 to 19 are seen at EDs for poisoning and two of them die each day. (CDC. April 28, 2016;
http://bit.ly/2kjVmhO.)Not all toxic exposures a...
Source: The Procedural Pause - March 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Solutions for Difficult Problems:Eye Irrigation — Morgan Lens No More! Part 2
We promised you short, sweet, and simple solutions, and we plan to deliver. Many of the tools we want you to use may have merely been forgotten. The steps to complete these simple solutions will require just a few minutes of brushing up on the basics while watching our how-to videos and reading our step-by-step blog posts.One of the lengthiest procedures in the emergency department can be eye irrigation. Some patients may need 5-15 liters of normal saline flush, which can take hours. Alkaline products need ample flushing and constant reevaluation with pH checks to avoid ocular burns. Patients can get frustrated and often t...
Source: The Procedural Pause - October 3, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
No Pea'ce in the Pods
Discussion of Recent Literature. Pediatr Emerg Care 2013;29(6):743.Davis MG, Casavant MJ, et al. Pediatric Exposures to Laundry and Dishwasher Detergents in the United States: 2013-2014. Pediatrics 2016;137(5):e20154529.Russell JL, Wiles DA, et al. Significant Chemical Burns Associated with Dermal Exposure to Laundry Pod Detergent. J Med Toxicol 2014;10(3):292.Tags: detergent pod, laundry detergent, vomiting, poisoning, erythema, decontaminationPublished: 7/2/2016 10:06:00 AM (Source: The Tox Cave)
Source: The Tox Cave - July 2, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Research and Reviews in the Fastlane 120
Welcome to the 120th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check ou...
Source: Life in the Fast Lane - February 3, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Clinical Research Education General Surgery Ophthalmology Pediatrics Pharmacology Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation Trauma critical care emergency Emergency Medicine recommendations resea Source Type: blogs
A Nefarious Character with an Agenda
Every new advanced nurse practitioner, physician assistant, or resident gets his fair share of complex emergency department procedures during training. Seasoned providers, however, are just as excited to place a central line in a septic patient, LP a "rule-out meningitis," or swiftly fix a nursemaid's elbow.This month we hope to remind you of a few sweet and satisfying procedures that take only moments to do. Your skill in completing these procedures is imperative. Not only will you amaze your patient, but you'll shorten your door to dispo-time.The StyeThe stye is a nefarious character with an agenda. It starts o...
Source: The Procedural Pause - February 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
