daily EM pearl, 4/14/12

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    daily EM pearl, 4/14/12

    A young woman is BIBEMS to your trauma bay. She has been assaulted, has multiple signs of trauma with a GCS of 6 and saliva is noted to be pooling in her mouth and onto the bed. After a swift and successful intubation you further assess the patient. Her right eye is proptotic and she has a Marcus Gunn pupil; you check the tonopen to confirm and appreciate an IOP of 42. Her portable CXR and pelvis are negative for PTX or fracture. CT calls to say they are ready for the patient. What to do next? 

     

    Do a lateral canthotomy while someone else is on the phone with ophtho.
    Do not wait for ophtho to come down/in, do not go to CT (yet), as time wasted can cause your patient to lose her sight.
    Save the eye.
    Done correctly, it’s a quick procedure. Usually, you spend more time talking about whether you should do it than actually doing it.
    Get oriented: http://www.google.com/imgres?q=lateral+canthus+anatomy&um=1&hl=en&client=safari&sa=N&rls=en&biw=1267&bih=680&tbm=isch&tbnid=rtHteAk-qufhcM:&imgrefurl=http://www.qmpelearning.com/mm5/merchant.mvc%3FScreen%3DPROD%26Store_Code%3DE%26Product_Code%3D890%26Category_Code%3DHeadandNeck&docid=NbTcdweqahaFfM&imgurl=http://www.qmpelearning.com/mm5/graphics/00000001/Nahai05_0633b_72lab_w.jpg&w=340&h=370&ei=v4KJT5vYA-rv0gHk4JHvCQ&zoom=1&iact=hc&vpx=437&vpy=298&dur=7015&hovh=234&hovw=215&tx=111&ty=136&sig=115537471255410289450&page=1&tbnh=158&tbnw=145&start=0&ndsp=15&ved=1t:429,r:6,s:0,i:82

    Technique: http://emedicine.medscape.com/article/82812-overview#a15

     

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