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Pierre VA, Smith T, Salerno A. Ocular Ultrasound. Emerg Med Clin North Am 2024; 42:891-903. [PMID: 39326993 DOI: 10.1016/j.emc.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Point-of-care ultrasound may be used to assist in the diagnosis of ocular complaints in the emergency department. With the use of a linear probe, the emergency physician can view anterior and posterior chamber structures of the patient's eye and evaluate for signs of pathology.
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Affiliation(s)
- Valerie A Pierre
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA
| | - Tierra Smith
- Department of Emergency Medicine, University of Florida College of Medicine, 1329 Southwest 16th Street, PO Box 100186, Gainesville, FL 32610-0186, USA
| | - Alexis Salerno
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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2
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Shanmugam N, Benard-Seguin E, Arepalli S, Alencastro G, McHenry JG, Rodriguez Duran M, Torres Soto M, Pendley AM, Wright DW, Newman NJ, Biousse V. Remote Diagnosis of Retinal Detachment in an Emergency Department Using Nonmydriatic Hybrid Ocular Imaging. Telemed J E Health 2024. [PMID: 39347598 DOI: 10.1089/tmj.2024.0435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024] Open
Abstract
Background: Ocular emergencies are commonly evaluated in general emergency departments (ED) where ophthalmologists are rarely available. Nonmydriatic ocular imaging combining color fundus photographs and optical coherence tomography (NMFP-OCT) can help with rapid remote triage by ophthalmologists. We evaluated the rate at which retinal detachments (RDs) can be diagnosed with NMFP-OCT in the ED. Methods: Quality improvement project with prospective collection of data on RD patients who had NMFP-OCT obtained by ED staff over 1 year. Photographs were interpreted remotely by ophthalmologists and all patients underwent an in-person ophthalmologic examination in the ED to confirm the presence of a RD. Results: A total of 63 eyes (58 patients) had a RD, among which 53 (84.1%) had strong suggestion of RD on ocular imaging (34 [54%] were seen on both color and OCT nerve/macula; 11 [17.5%] were seen on color but missed on OCT; 8 [12.7%] were missed on color but seen on OCT). Ten RDs (15.9%) were missed on both color and OCT because of peripheral location of the RD (4, 40%), vitreous hemorrhage (4, 40%), or poor image quality (2, 20%). A total of 40 out of 58 patients were not seen by an eye care provider prior to reaching our ED and 10 had an inappropriate stroke workup for acute vision loss of presumed vascular origin. Conclusion: NMFP-OCT of the posterior pole obtained by ED staff revealed the RD in 84.1% of eyes, allowing for rapid remote triage of patients with visual symptoms and avoiding unnecessary testing when the diagnosis of RD is confirmed.
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Affiliation(s)
- Nithya Shanmugam
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Etienne Benard-Seguin
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sruthi Arepalli
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - George Alencastro
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jessica G McHenry
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Mariam Torres Soto
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew M Pendley
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David W Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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3
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Shinde VS, Birru JD. The Use of Point-of-Care Ultrasound for a Rapid Diagnosis of Endophthalmitis: A Case Report. Cureus 2024; 16:e68609. [PMID: 39371754 PMCID: PMC11450510 DOI: 10.7759/cureus.68609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 09/04/2024] [Indexed: 10/08/2024] Open
Abstract
Acute and subacute vision loss often requires specialized evaluation in emergency departments. Endophthalmitis, a serious eye infection, can be challenging to diagnose early but is critical to identify due to its potential severity. This case report illustrates the use of ocular point-of-care ultrasound (POCUS) in diagnosing endophthalmitis in a 72-year-old male initially thought to have orbital cellulitis. Despite swollen and painful eyes hindering direct examination, the ocular POCUS examination revealed intraocular hyperechoic debris, indicating an intraocular infection suggestive of endophthalmitis. This timely diagnosis facilitated quick and appropriate treatment, highlighting the role of ocular POCUS in the emergency department for swift and accurate assessment.
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Affiliation(s)
- Varsha S Shinde
- Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Joshua D Birru
- Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
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Tagle CA, Chen JW, Mistry J, Fernandez D, Neeki CC, Dong F, Neeki MM. A role of point-of-care ultrasound in the emergency department diagnosis of vision loss due to traumatic cataract. Int J Emerg Med 2023; 16:78. [PMID: 37919646 PMCID: PMC10623738 DOI: 10.1186/s12245-023-00558-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Ocular complaints, including acute or subacute vision loss, are commonly encountered in emergency departments (ED). These potentially time-sensitive complaints are difficult to diagnose and evaluate without adequate, specialized equipment and expertise. Additionally, a thorough evaluation often requires a more extensive and specialized physical exam, imaging, and ophthalmologic consultation, all of which may not be readily available in the acute setting. CASE PRESENTATION This case report presented a patient in the emergency department with the chief complaint of vision loss. Point-of-care ultrasound (POCUS) using the 10-MHz-linear-array probe, in the ocular setting, demonstrated calcification of the lens, a finding consistent with cataract in the right eye. CONCLUSIONS The use of POCUS can expedite the accurate identification of vision threatening pathology, such as cataracts, and streamline ED disposition and plan of care.
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Affiliation(s)
- Christian A Tagle
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Joe W Chen
- California University of Science and Medicine, Colton, CA, USA
| | - Jamshid Mistry
- California University of Science and Medicine, Colton, CA, USA
- Department of Emergency Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Ave, Suite # 107, Colton, CA, USA
| | - Danny Fernandez
- Department of Emergency Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Ave, Suite # 107, Colton, CA, USA
| | - Cameron C Neeki
- Department of Emergency Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Ave, Suite # 107, Colton, CA, USA
| | - Fanglong Dong
- Department of Emergency Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Ave, Suite # 107, Colton, CA, USA
| | - Michael M Neeki
- California University of Science and Medicine, Colton, CA, USA.
- Department of Emergency Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Ave, Suite # 107, Colton, CA, USA.
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5
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Humniski N, Ahn JS, Manji R, Kim DJ. Globe Rupture Diagnosed with Point-of-Care Ultrasound. J Emerg Med 2023; 65:e453-e456. [PMID: 37806809 DOI: 10.1016/j.jemermed.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 03/29/2023] [Accepted: 06/13/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Nicholas Humniski
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Emergency Medicine, Richmond Hospital, Richmond, British Columbia, Canada
| | - Justin S Ahn
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Emergency Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Rahim Manji
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Daniel J Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
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6
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Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med 2023; 82:e115-e155. [PMID: 37596025 DOI: 10.1016/j.annemergmed.2023.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 08/20/2023]
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Bukowski J, Nowadly CD, Schauer SG, Koyfman A, Long B. High risk and low prevalence diseases: Blast injuries. Am J Emerg Med 2023; 70:46-56. [PMID: 37207597 DOI: 10.1016/j.ajem.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Blast injury is a unique condition that carries a high rate of morbidity and mortality, often with mixed penetrating and blunt injuries. OBJECTIVE This review highlights the pearls and pitfalls of blast injuries, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Explosions may impact multiple organ systems through several mechanisms. Patients with suspected blast injury and multisystem trauma require a systematic evaluation and resuscitation, as well as investigation for injuries specific to blast injuries. Blast injuries most commonly affect air-filled organs but can also result in severe cardiac and brain injury. Understanding blast injury patterns and presentations is essential to avoid misdiagnosis and balance treatment of competing interests of patients with polytrauma. Management of blast victims can also be further complicated by burns, crush injury, resource limitation, and wound infection. Given the significant morbidity and mortality associated with blast injury, identification of various injury patterns and appropriate management are essential. CONCLUSIONS An understanding of blast injuries can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Josh Bukowski
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Craig D Nowadly
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Steven G Schauer
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Mese I, Taslıcay CA. The Benefits of Ocular Ultrasound in Emergency Settings for the Evaluation of Orbital Compartment Syndrome. AJNR Am J Neuroradiol 2023; 44:E38-E39. [PMID: 37500282 PMCID: PMC10411839 DOI: 10.3174/ajnr.a7904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- I Mese
- Department of RadiologyHealth Sciences UniversityErenkoy Mental Health and Neurology Training and Research HospitalIstanbul, Turkey
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Li J, Yan P, Li Y, Han M, Zeng Q, Li J, Yu Z, Zhang D, Chen X. Harnessing the power of Raman spectroscopic imaging for ophthalmology. Front Chem 2023; 11:1211121. [PMID: 37252371 PMCID: PMC10213270 DOI: 10.3389/fchem.2023.1211121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 05/31/2023] Open
Abstract
Eye diseases can cause great inconvenience to people's daily life; therefore, it is necessary to study the causes of ocular diseases and related physiological processes. Raman spectroscopic imaging (RSI) is a non-destructive, non-contact detection technique with the advantages of label-free, non-invasive and highly specific. Compared with other mature imaging technologies, RSI can provide real-time molecular information and high-resolution imaging at relatively low cost, making it very suitable for quantitative detection of biological molecules. RSI can reflect the overall situation of the sample, revealing the content distribution of the same substance in different areas of the sample. This review focuses on the recent advances in ophthalmology, with particular emphasis on the powerful use of RSI techniques, as well as its combination with other imaging techniques. Finally, we prospect the wider application and future potential of RSI approaches in ophthalmology.
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Affiliation(s)
- Jing Li
- Shaanxi Eye Hospital, Xi’an People’s Hospital (Xi’an Fourth Hospital), Affiliated People’s Hospital of Northwest University, Xi’an, Shaanxi, China
| | - Peirao Yan
- Center for Biomedical-photonics and Molecular Imaging, Xi’an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Yong Li
- Shaanxi Eye Hospital, Xi’an People’s Hospital (Xi’an Fourth Hospital), Affiliated People’s Hospital of Northwest University, Xi’an, Shaanxi, China
| | - Ming Han
- Center for Biomedical-photonics and Molecular Imaging, Xi’an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Qi Zeng
- Center for Biomedical-photonics and Molecular Imaging, Xi’an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Juan Li
- Shaanxi Eye Hospital, Xi’an People’s Hospital (Xi’an Fourth Hospital), Affiliated People’s Hospital of Northwest University, Xi’an, Shaanxi, China
| | - Zhe Yu
- Shaanxi Eye Hospital, Xi’an People’s Hospital (Xi’an Fourth Hospital), Affiliated People’s Hospital of Northwest University, Xi’an, Shaanxi, China
| | - Dongjie Zhang
- Center for Biomedical-photonics and Molecular Imaging, Xi’an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Xueli Chen
- Center for Biomedical-photonics and Molecular Imaging, Xi’an Key Laboratory of Intelligent Sensing and Regulation of Trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
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10
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Song A, Roh KM, Lusk JB, Valikodath NG, Lad EM, Draelos M, Ortiz P, Theophanous RG, Limkakeng AT, Izatt JA, McNabb RP, Kuo AN. Robotic Optical Coherence Tomography Retinal Imaging for Emergency Department Patients: A Pilot Study for Emergency Physicians' Diagnostic Performance. Ann Emerg Med 2023; 81:501-508. [PMID: 36669908 PMCID: PMC10038849 DOI: 10.1016/j.annemergmed.2022.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVE To evaluate the diagnostic performance of emergency physicians' interpretation of robotically acquired retinal optical coherence tomography images for detecting posterior eye abnormalities in patients seen in the emergency department (ED). METHODS Adult patients presenting to Duke University Hospital emergency department from November 2020 through October 2021 with acute visual changes, headache, or focal neurologic deficit(s) who received an ophthalmology consultation were enrolled in this pilot study. Emergency physicians provided standard clinical care, including direct ophthalmoscopy, at their discretion. Retinal optical coherence tomography images of these patients were obtained with a robotic, semi-autonomous optical coherence tomography system. We compared the detection of abnormalities in optical coherence tomography images by emergency physicians with a reference standard, a combination of ophthalmology consultation diagnosis and retina specialist optical coherence tomography review. RESULTS Nine emergency physicians reviewed the optical coherence tomography images of 72 eyes from 38 patients. Based on the reference standard, 33 (46%) eyes were normal, 16 (22%) had at least 1 urgent/emergency abnormality, and the remaining 23 (32%) had at least 1 nonurgent abnormality. Emergency physicians' optical coherence tomography interpretation had 69% (95% confidence interval [CI], 49% to 89%) sensitivity for any abnormality, 100% (95% CI, 79% to 100%) sensitivity for urgent/emergency abnormalities, 48% (95% CI, 28% to 68%) sensitivity for nonurgent abnormalities, and 64% (95% CI, 44% to 84%) overall specificity. In contrast, emergency physicians providing standard clinical care did not detect any abnormality with direct ophthalmoscopy. CONCLUSION Robotic, semi-autonomous optical coherence tomography enabled ocular imaging of emergency department patients with a broad range of posterior eye abnormalities. In addition, emergency provider optical coherence tomography interpretation was more sensitive than direct ophthalmoscopy for any abnormalities, urgent/emergency abnormalities, and nonurgent abnormalities in this pilot study with a small sample of patients and emergency physicians.
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Affiliation(s)
- Ailin Song
- Duke University School of Medicine, Durham, NC
| | - Kyung-Min Roh
- Department of Ophthalmology, Duke University, Durham, NC
| | - Jay B Lusk
- Duke University School of Medicine, Durham, NC
| | | | - Eleonora M Lad
- Department of Ophthalmology, Duke University, Durham, NC
| | - Mark Draelos
- Department of Biomedical Engineering, Duke University, Durham, NC
| | - Pablo Ortiz
- Department of Biomedical Engineering, Duke University, Durham, NC
| | | | | | - Joseph A Izatt
- Department of Biomedical Engineering, Duke University, Durham, NC
| | - Ryan P McNabb
- Department of Ophthalmology, Duke University, Durham, NC
| | - Anthony N Kuo
- Department of Ophthalmology, Duke University, Durham, NC; Department of Biomedical Engineering, Duke University, Durham, NC.
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11
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Galust H, Banks S, Riscinti M. Point-of-care ultrasound in the detection of central retinal artery occlusion in a patient with recent COVID-19. J Am Coll Emerg Physicians Open 2022; 3:e12842. [PMID: 36381482 PMCID: PMC9660847 DOI: 10.1002/emp2.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Ocular emergencies are a frequent occurrence in the emergency setting. Fortunately, point-of-care ultrasound (POCUS) lends itself exceptionally well to ocular evaluation. Here, we present a unique case of central retinal artery occlusion rapidly diagnosed with POCUS in a patient with a recent COVID-19 diagnosis.
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Affiliation(s)
- Henrik Galust
- Denver Health Residency in Emergency MedicineDenverColoradoUSA
| | - Sarah Banks
- Denver Health Residency in Emergency MedicineDenverColoradoUSA
| | - Mathew Riscinti
- Denver Health Residency in Emergency MedicineDenverColoradoUSA
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12
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Marks A, Patel D, Chottiner M, Kayarian F, Peksa GD, Gottlieb M. Covered or uncovered: A randomized control trial of Tegaderm versus no Tegaderm for ocular ultrasound. Am J Emerg Med 2022; 61:87-89. [PMID: 36057214 DOI: 10.1016/j.ajem.2022.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Studies on ocular point-of-care ultrasound vary on whether gel should be directly applied to the eye or on top of an adhesive membrane (i.e., Tegaderm™). However, there are currently no data regarding which approach has better image quality and the impact of patient preference. In this study, we sought to address this gap by assessing the difference in image quality and patient preference between Tegaderm™ versus no Tegaderm™ for ocular ultrasound in the emergency department. METHODS Patients were randomized to have a Tegaderm™ placed on either their right or left eye. The other eye served as a comparator with no Tegaderm™. Ultrasound was performed on the right eye followed by the left eye in all instances. After performing each ultrasound, the sonographer asked the patient to rate their maximal discomfort from the ultrasound of that eye using a Likert scale (0 = no discomfort; 10 = severe discomfort). The sonographer then asked the patient which side (Tegaderm™ vs no Tegaderm™) they preferred. Finally, images were reviewed by an experienced ultrasound fellowship-trained sonographer blinded to allocation and rated from 1 to 5. Continuous data were analyzed using descriptive statistics with mean and standard deviation. A paired samples t-test was performed to assess for differences between groups. Categorical data were presented as frequency and percentage. RESULTS The mean image score was significantly worse with Tegaderm™ compared with no Tegaderm™ (mean difference: 0.94/5.00; 95% CI 0.79-1.08; p < 0.001). This was consistent in both the transverse and the sagittal plane subgroups. The percentage of acceptable images was also higher in the no Tegaderm™ group compared with the Tegaderm™ group (97.8% versus 82.8%). There was no statistically significant difference in patient discomfort with the Tegaderm™ versus no Tegaderm™ group. When asked to compare the two approaches, 54.4% of patients preferred Tegaderm™, 30.0% preferred no Tegaderm™, and 15.6% had no preference. CONCLUSIONS Tegaderm™ was associated with reduced image quality and no significant difference in patient discomfort when utilized for ocular ultrasound. This study suggests that ocular ultrasound may be better performed without the use of Tegaderm™. Future research should evaluate the impact of Tegaderm™ vs. no Tegaderm™ among more novice users.
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Affiliation(s)
- Amy Marks
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Daven Patel
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Mark Chottiner
- Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | - Fae Kayarian
- Rush Medical College, Chicago, IL, United States of America
| | - Gary D Peksa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
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Johnson S, Ryan T, Omari A, Schneider S, Bahl A. Valsalva Retinopathy Masking as a Retinal Detachment on
Point-of-care Ocular Ultrasound: A Case Report. Clin Pract Cases Emerg Med 2022; 6:125-128. [PMID: 35701352 PMCID: PMC9197736 DOI: 10.5811/cpcem.2022.1.55173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/04/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: Approximately two million people present to the emergency department (ED) with eye-related complaints each year in the United States. Differentiating pathologies that need urgent consultation from those that do not is imperative. For some physicians, ocular ultrasound has eclipsed the dilated fundoscopic exam as the standard posterior segment evaluation in the ED.
Case report: A 60-year-old female presented with sudden onset visual disturbance in her right eye. Point-of-care ultrasound showed a hyperechoic band in the posterior segment concerning for a retinal detachment. Ophthalmology was consulted and diagnosed the patient with a condition known as Valsalva retinopathy. The patient was discharged from the ED with expectant management.
Conclusion: This case highlights an important differential diagnosis that should be considered when ocular ultrasound demonstrates a hyperechoic band in the posterior segment. While previous literature has demonstrated that emergency physicians are able to accurately identify posterior segment pathology using ultrasound, there is limited information regarding their ability to differentiate between
pathologies, some of which may not require urgent consultation. We highlight the important differentials that should be considered when identifying posterior segment pathology on point-of-care ultrasound and their appropriate dispositions.
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Affiliation(s)
- Steven Johnson
- Beaumont Hospital, Department of Emergency Medicine, Royal Oak, Michigan
| | - Thomas Ryan
- Beaumont Hospital, Department of Emergency Medicine, Royal Oak, Michigan
| | - Amro Omari
- Beaumont Hospital, Department of Ophthalmology, Royal Oak, Michigan
| | | | - Amit Bahl
- Beaumont Hospital, Department of Emergency Medicine, Royal Oak, Michigan
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Assessing Choroidal Nevi, Melanomas and Indeterminate Melanocytic Lesions Using Multimodal Imaging—A Retrospective Chart Review. Curr Oncol 2022; 29:1018-1028. [PMID: 35200586 PMCID: PMC8870916 DOI: 10.3390/curroncol29020087] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 12/13/2022] Open
Abstract
Using multimodal imaging, the literature proposed the following risk factors for choroidal nevus growth into melanoma: increased tumor thickness, subretinal fluid, decreased visual acuity, presence of orange pigment, ultrasound acoustic hollowness, and increased tumor diameter. This study investigated the presence of the mentioned risk factors in choroidal nevi, choroidal melanomas, and indeterminate choroidal melanocytic lesions. This retrospective, single-center chart review assessed choroidal melanocytic tumors with multimodal imaging. We defined our primary outcome as the cumulative presence of mentioned risk factors. Further, we evaluated various optical coherence tomography (OCT), ultrasound, and autofluorescence findings. We analyzed 51 tumors from 49 patients during the period from April 2008 to June 2021. The median (IQR) age was 64.0 (56.0 to 70.5) years, with 23 of 49 (46.9%) patients being female. The follow-up time for all tumors was median (IQR) 25.0 (12.0 to 39.0) months. The choroidal nevi had a median (range) risk score of 0.0 (0.0 to 3.0), and the choroidal melanoma of 5.0 (3.0 to 6.0), with statistically significant different ratings (p < 0.001). Multimodal imaging creates a score that may help to distinguish choroidal nevi from choroidal melanomas objectively.
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A Man With Vision Loss. Ann Emerg Med 2021; 77:649-656. [PMID: 34030778 DOI: 10.1016/j.annemergmed.2020.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Indexed: 11/23/2022]
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Just the facts: point-of-care ultrasound for painless loss of vision. CAN J EMERG MED 2021; 23:590-592. [PMID: 34185306 DOI: 10.1007/s43678-021-00169-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
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De Arrigunaga S, Aziz K, Lorch AC, Friedman DS, Armstrong GW. A Review of Ophthalmic Telemedicine for Emergency Department Settings. Semin Ophthalmol 2021; 37:83-90. [PMID: 34027803 DOI: 10.1080/08820538.2021.1922712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients presenting to emergency departments for ophthalmic emergencies benefit from prompt evaluation. However, Few emergency departments (EDs) have ophthalmologists on call, and eye care provided in EDs without ophthalmic services can be inaccurate. METHODS We review the current state of ophthalmic telemedical care in EDs and highlight important considerations when implementing telemedicine in this setting. RESULTS Telemedicine allows ophthalmologists to work with on-site emergency care providers to interview and examine patients remotely in EDs, enabling proper assessment of patient history, visual acuity, pupils, intraocular pressure, as well as the anterior and posterior segment. To date, patients' perceptions of this new model of care have been largely positive. DISCUSSION The use of telemedical consultations for remote evaluation of patients with ophthalmic complaints stands to improve the quality of care provided to patients and extend the reach of remote ophthalmologists. The onset of the COVID-19 pandemic and the risk of in-person care further highlights the potential for telemedicine to augment existing models of emergency care.
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Affiliation(s)
| | - Kanza Aziz
- Department of Ophthalmology, Wilmer Eye Institute, Baltimore, MD, USA
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
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18
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Glickman A, Szczucki B, Kalivoda EJ, Furiato A, Cabrera G. Bedside Ocular Ultrasound Diagnosis of a Traumatic Lens Dislocation. Cureus 2021; 13:e14666. [PMID: 33927958 PMCID: PMC8075821 DOI: 10.7759/cureus.14666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rapid identification of ophthalmologic emergencies can be challenging in the ED, and a missed or delayed diagnosis may have vision-threatening consequences. The application of ocular point-of-care ultrasound (POCUS) by the emergency physician (EP) can facilitate the timely recognition of a myriad of emergent eye conditions. This report describes a case in which EP-performed POCUS established the prompt diagnosis of a traumatic lens dislocation in a patient with chronic vision changes.
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Affiliation(s)
- Andrew Glickman
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
| | - Brian Szczucki
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
| | - Eric J Kalivoda
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
| | - Anthony Furiato
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
| | - Gabriel Cabrera
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
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Murali S, Davis C, McCrea MJ, Plewa MC. Orbital compartment syndrome: Pearls and pitfalls for the emergency physician. J Am Coll Emerg Physicians Open 2021; 2:e12372. [PMID: 33733246 PMCID: PMC7936795 DOI: 10.1002/emp2.12372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
Orbital compartment syndrome (OCS) is a rare, vision-threatening diagnosis that requires rapid identification and immediate treatment for preservation of vision. Because of the time-sensitive nature of this condition, the emergency physician plays a critical role in the diagnosis and management of OCS, which is often caused by traumatic retrobulbar hemorrhage. In this review, we outline pearls and pitfalls for the identification and treatment of OCS, highlighting lateral canthotomy and inferior cantholysis (LCIC), a crucial skill for the emergency physician. We recommend adequate preparation for the diagnosis and procedure, early consultation to ophthalmology, clear and thorough documentation of the physical examination, avoidance of iatrogenic injury during LCIC, and complete division of the inferior canthal tendon. Emergency physicians should avoid failing to make the diagnosis of OCS, delaying definitive surgical treatment, overrelying on imaging, failing to decrease intraocular pressure, and failing to exclude globe rupture. The emergency physician should be appropriately trained to identify signs and symptoms of OCS and perform LCIC in a timely manner.
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Affiliation(s)
- Shyam Murali
- Mercy Health St. Vincent Medical CenterToledoOhioUSA
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20
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Castilla-Guerra L, Gómez-Escobar A, Carmona-González E. Usefulness of point-of-care ultrasound for the evaluation of non-traumatic eye emergencies. Med Clin (Barc) 2021; 156:503-508. [PMID: 33478811 DOI: 10.1016/j.medcli.2020.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Abstract
The role of clinical ultrasound or Point-of-Care Ultrasound (POCUS) in patients with urgent pathology has expanded exponentially in recent years. With clinical ultrasound, physicians can make a quick assessment and decide how to act in time critical situations. Ocular ultrasound is one of the most recently developed applications. In patients with severe non-traumatic ocular pathology it has numerous clinically relevant uses: retinal detachment, occlusion of the central retinal artery or optic nerve pathologies, among others. The technique is widely available, easy to perform, and can provide information even when fundoscopy is impossible. In this review, we describe the bases of clinical ocular ultrasound, focusing on the management of the main non-traumatic urgent ophthalmological pathologies that the physician may face in their clinical practice.
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Affiliation(s)
- Luis Castilla-Guerra
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España.
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21
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Schmitz G, Long B, April MD. Are Emergency Practitioners Able to Diagnose Posterior Chamber Abnormalities With Point-of-Care Ocular Ultrasonography? Ann Emerg Med 2020; 76:767-769. [DOI: 10.1016/j.annemergmed.2020.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Indexed: 11/30/2022]
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22
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Skidmore C, Saurey T, Ferre RM, Rodriguez-Brizuela R, Spaulding J, Lundgreen Mason N. A Narrative Review of Common Uses of Ophthalmic Ultrasound in Emergency Medicine. J Emerg Med 2020; 60:80-89. [PMID: 32919837 DOI: 10.1016/j.jemermed.2020.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/24/2020] [Accepted: 08/02/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The timely evaluation of ocular conditions in the emergency department (ED) can be difficult due to a general lack of specialized equipment, trained personnel, and the time-sensitive nature of emergent ocular conditions. Recently, the use of ocular point-of-care ultrasound (POCUS) has been shown to be particularly useful in the ED. POCUS can be used to promptly diagnose various ocular pathologies, which include ocular trauma, vitreous hemorrhage, central retinal artery occlusion, and retinal detachment. OBJECTIVES This narrative review seeks to inform the reader of current literature regarding the use of POCUS for the assessment of various ocular emergencies in the ED. The goal of this review is to provide the emergency physician with succinct and up-to-date information and instruction regarding the current uses of POCUS for patients presenting with particular ocular emergencies. Ocular pathologies that are common (ocular trauma) or for which ultrasound is particularly useful (such as retinal detachment) are discussed. Other ocular pathologies are also briefly discussed, such as central retinal artery occlusion, which is a promising new application for ultrasound evaluation. DISCUSSION There have been many studies that provide evidence for the utility of POCUS in the evaluation of trauma and other ocular pathologies, including vitreous hemorrhage, retinal detachment, and central retinal artery occlusion. CONCLUSIONS Ocular POCUS is a useful modality in the evaluation of acute ocular complaints in the ED. Emergency physicians should be aware of these findings and feel confident in the utility of ocular POCUS in the ED.
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Affiliation(s)
- Chad Skidmore
- Rocky Vista University College of Osteopathic Medicine - Southern Utah, Ivins, Utah
| | - Tate Saurey
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | | | - Nena Lundgreen Mason
- Rocky Vista University College of Osteopathic Medicine - Southern Utah, Ivins, Utah
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