Central Retinal Artery Occlusion

An 82 year-old man with a history of dyslipidemia, hypertension, and CAD s/p stenting was driving home from the grocery store when he experienced sudden vision loss in his right eye around 2:30 pm. He has no previous history of vision problems and is puzzled but eventually concerned. By the time he presents to the ED he has light perception only in his right eye. He cannot not recognize motion. Central retinal artery occlusion (CRAO) is first in the differential.

The Anticoagulated Patient with Head Trauma: What’s the Disposition?

EMS wheels in a 74 year-old male with a chief complaint of headache after tripping over the stairs in his home and hitting his head on the railing. He did not lose consciousness and has had no nausea/vomiting, weakness, or confusion. His INR returns at 2.5, and studies including CT (computed tomography) of the head and C spine are normal.

With his INR and clinical status, what is his risk of delayed intracerebral hemorrhage (ICH)? Should he be reversed? What about other anticoagulant medications? Does he warrant admission, observation, or discharge?

Occult-Fractures

EM Cases: Occult Fractures and Dislocations

Missed occult fractures and dislocations, in general, may result in significant morbidity for the patient and law suites for you. Six cases are presented in this episode, ranging from common scaphoid fractures to rarer dislocations. Dr. Sayal & Dr. Mamen answer questions such as: Which fractures can mimic ankle sprains and how do you avoid missing them? What are the most reliable signs of scaphoid fracture? In which occult orthopaedic injuries should we anticipate limb threatening ischemia? Which is better to diagnose occult fractures – MRI or CT? Which calcaneus fractures require surgery and which ones can be managed conservatively? and many more……

Emergency Medicine Education