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Vision Loss

UNFINISHED CASE: COME BACK LATER

Scroll to bottom for case answer and E-meducation 

History: A 44-year-old female with multiple medical problems including pulmonary embolism on Coumadin, renal failure and diabetes comes to the ED for 24 hours of painless gradual loss of vision described as darkness and blurry vision in her left eye.

Exam: Vital signs were normal.  Physical exam was normal except for a questionable APD and finger counting vision in the involved eye.  She also had a dialysis shunt.

Initial Concern(s): CRAO, CRVO, retinal detachment, vitreous hemorrhage…

Testing: See image BELOW or ABOVE

Sorry about the poor image quality

Question(s):

  1. What does the image show? (click then click again to enlarge)
  2. What should you do next?

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ANSWERS:

  1. The case image shows vitreous hemorrhage.  This is actually not a great example.  For better examples go to this webpage: http://www.skinsonography.com/investigations/B-Scan.html  These images are taken with B-mode by ophthalmologists and so the orientation is different than most EP’s use
  2. What you should do next is to read the highlighted area on the page-shot below

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E-meducation for medical topic of this case.  Read the yellow highlighted area of the page-shot below from our #1 title.  The Emergency Medicine 1-Minute Consult Pocketbook

 

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CASE CONCLUSION: She was seen by the ophthalmologist.

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