I.
Introduction to the Emergency Department
A.
1.
Lid avulsion
2.
Was an optometrist helpful?
B.
History of the ED
C.
Current role of the ED
D.
Triage systems
E.
F.
G.
II.
Typical case scenario for an ED consultation
1.
What is triage?
2.
Why are triage systems important?
3.
Emergency Severity Index
Key players & common scenarios
1.
Emergency care of a trauma patient
2.
Roles and responsibilities: who does what
Consultation protocol
1.
Phone consultation
2.
Clinical pearls: when you arrive on the scene
Environment of care
1.
Familiarize yourself with the equipment: know what is available
2.
Be aware of on-site diagnostics and therapeutics
Standardized Ocular Trauma Terminology
A.
Why standardize the terminology?
B.
Birmingham Eye Trauma Terminology System (BETTS)
1.
Ocular injury flow chart
2.
Terms and definitions
a.
b.
Open globe injuries
(1)
Rupture vs. laceration
(2)
Penetration, perforation, IOFB
Closed globe injuries
III.
(1)
Contusion
(2)
Lamellar laceration
Review of Emergency Department Ocular Epidemiological Data
A.
Eye cases commonly presenting to the ED
1.
Common conditions with minor severity
2.
US hospitalization for ocular conditions
3.
B.
C.
D.
a.
Incidence 13.4 to 71 per 100,000
b.
Top three trauma admissions
Anecdotal experience & collected data
True eye emergencies
1.
Chemical burn
2.
Orbital compartment syndrome
3.
Other potentially urgent vs. emergent conditions
4.
What about central retinal artery occlusion?
Ocular injuries
1.
A public health issue
2.
Where do patients access emergency eye care?
3.
United States Eye Injury Registry (USEIR)
a.
Selective reporting
b.
Database results: trends in ocular injury
(1)
Type of injury
(2)
Initial vision
Ocular Trauma Score (OTS)
1. Evidence based methodology to predict visual prognosis
2. Six variables
a.
Initial vision
b.
Rupture
c.
Endophthalmitis
IV.
d.
Perforating injury
e.
Retinal detachment
f.
Afferent papillary defect
Emergency Department Case Presentations
A.
B.
C.
Facial trauma
1.
Life-Eye-Orbit:Traumatic Optic Neuropathy
2.
Facial trauma without ocular complication
3.
Facial trauma with orbital fractures
Domestic violence
1.
Commonly encountered in ED
2.
How to stay focused and perform your role
Ocular trauma
1.
Open globe injuries
a.
b.
2.
(1)
Post-op Seidel
(2)
Ocular Trauma as a disease
Penetrating injury
(1)
Rooster peck
(2)
Are toy guns harmless?
(3)
Late complications
Closed globe injuries
a.
b.
3.
Ruptured globe
Contusions
(1)
Miscellaneous contusions
(2)
Lens trauma
(3)
Choroidal rupture
(4)
Retinal contusions
Lamellar laceration
Ocular and adnexal surface injuries
4.
5.
C.
2.
3.
V.
Corneal foreign body
b.
Thermal burns
(1).
Fireworks
(2)
Curling iron burn
Eyebrow and eyelid injuries
a.
Brow laceration
b.
Lid avulsion
Orbital fractures and foreign bodies
a.
CT imaging in ocular and orbital trauma
b.
Orbital floor fracture
c.
Ethmoid fracture
e.
Intraorbital foreign body
Acute eye pain and redness
1.
D.
a.
Ocular surface conditions
a.
Conjunctivitis potpourri
b.
Keratitis potpourri
Preseptal cellulitis
a.
MRSA
b.
R/O orbital cellulitis
Uveitis
Blurry vision or sudden vision loss
1.
Diabetic eye disease
2.
Vascular occlusions
3.
Neuro-ophthalmic disease
Role of the Optometrist
A.
Review of a prospective study on the diagnostic accuracy of the OD in the ED
B.
Emergency department bloopers
1.
Impetigo?
C.
2.
Conjunctivitis?
3.
Orbital cellulitis?
Need for “on-call” eye care services
1.
2.
D.
a.
The effect of the ambulatory surgery center (ASC)
b.
Changes to EMTALA law: amended in 2003
Survey results from hospital CEOs: the “on-call” crisis
How to get involved
1.
2.
VI.
Issues with supply and demand
Credentialing & privileges
a)
Formalized relationship: become active medical staff
b)
Hospital administrators need to be on board
(1)
Chief of staff
(2)
Clinical director or chief medical officer
Physician networking
The OD is in the ED
VII.
A.
Final case presentation: Multiple facial and skull fractures
B.
Closing statements
1.
Improving access to eye care
2.
Integrating optometry into the hospital medical community
3.
Becoming a better provider
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