Archive for the ‘Ophthamology’ Category

Stop with the Weird Crap at Night

Monday, April 4th, 2011

Normally, I prefer interesting, sick cases over the routine stuff. Not between the hours of 11pm and 4am though.  Not when they come in all at once. Not when I am by myself on the overnight shift.  I’ll take some regular ‘ole CHF any day over:

1. Sigmoid sinsus thrombosis in someone who randomly fell and hit their head.

2. Severe hypocalcaemia from an overenthusiastic thyroidectomy with carpoedal spasm, seizures, and strabismus.

3. A baby with intussusception

4. A young man with likely toxic shock syndrome from God-know’s where.

5. A woman with a big ball of half chewed spagetti and Italian bread lodged in her esophagus.

6. A guy with a recurrent head bleed that no one can figure out what the cause is – despite massive MRI and angiographical workups.

7. A guy with a giant thrombosed haemorrhoid – well, that one was cool. I incised it and got the mother of all clots out.

Sometimes it is just Staring at you

Thursday, January 21st, 2010


ER docs are often disparaged for not really knowing much about certain diseases and or fields that do not really interest them – most notably GYN, Haematology, Ophtho, Pysch, etc. We tend to just boil it down to a few things we worry about and turf the rest to the specialists. However, there are times the diagnosis is right there in front of you, even if it is not one of the fields that really interest you.

Personally, I like Ophtho – not enough to do it as a career (obviously) but I like ocular emergencies more than most other ER docs that I talk to. I did a two month ophtho elective as an intern and actually know how to use the applanation tonometer (although I admit, it is easier usually to just use the Tonopen)! Anyway, the other day I had a guy with “blurred vision” – which is usually a nonspecific and unexciting complaint. In this case, though, he said that the blurring was really just the lower portion of his visual field on one eye.

I ordered some drops to dilate the pupils to be able to see the back of the eye (fundus) because it is usually very hard to examine it in the ER with the bright lights and everything. However, I went over just to quickly take a look and Wow! you could see the abnormality from a foot away.

His eye had the most dramatic partial retinal detachment I have ever seen. This is one of these diagnoses that can be subtle and hard to see unless you are REALLY good at using the equipment, have the patient dilated, and you really know what to look for. But man, this one just jumped out. Of course I have to give it up to the retinal surgeon on call who took the guy in his office right away for surgery with no insurance, no questions asked. Good guy.

Good Shift

Sunday, August 30th, 2009


Some define a good shift as one where you sit around on your ass. And while there are times that is nice, I honestly like shifts where I am not overwhelmed but where the majority of patients I see actually have an urgency or emergency!

The other day I had (in a row no less!):

a. a 40 year old lady with acute iritis (not a serious emergency but much better then the typical bogus conjunctivitis!)

b. Elderly lady with acute left femoral artery occlusion and a nearly dead foot.
c. 30 year old man with epidural bleed and mid-line shift.
d. 29 year old man with unknown type of OD and hyponatraemia-induced seizures who needed to be intubated for airway protection.
e. 38 year old lady with 3 months of SOB and cough who wound up having numerous b/l PE’s with right sided heart failure, probable previously undiagnosed thalassaemia with platelets of 70, and guiac + stool!