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Minding My Own Business

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History of Present Illness:

A 22-year-old male is brought to the ED for facial trauma due to assault after minding his own business at a night club.  He thinks he was knocked out but isn’t sure.  He denies any vomiting, change in vision or other complaints, but is not the best historian

Vital Signs & Physical Exam:

Vital signs are normal.   Physical exam is otherwise normal except for “drunk talk” and multiple facial contusions and lacerations with the most severe swelling around the left eye.

Initial Differential Diagnosis:

  • Epidural hematoma
  • Blowout fracture
  • Globe rupture
  • Orbital compartment syndrome

Initial Diagnostic Testing:

  • Imaging: See Head CT below

 

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows a retrobulbar hematoma and multiple facial fracture.  A dedicated orbital CT is shown below.
  2. What should you do next?  Check IOP, EOM and acuity.  Perform an emergent canthotomy.  Consult Ophtho.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Department Quick Reference Guide

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CASE CONCLUSION: IOP was measured at 55.  A lateral canthotomy was done.  Repeat IOP was 29

CASE LESSONS:

  1. Always rule out globe rupture before using a tono-pen
  2. Never mind your own business.  It is extremely dangerous.  Ask any police officer, paramedic or ER staff
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