Ophthalmologic Procedures in the Emergency Department

Ophthalmologic emergencies account for up to 3% of visits to emergency departments in the United States Visual acuity testing A simple but vital part of the ophthalmologic examination is a test of visual acuity. This is essential for all patients who have ocular or visual complaints. The affected and non-affected eyes should be tested individually, and then together, using a Snellen chart or equivalent. If the patient wears corrective lenses during the examination (or is not wearing lenses that are usually used), this should be noted. A critical part of the visual acuity examination is that decreased visual acuity should be rechecked using a pinhole card. A pinhole corrects for most refractive errors, by ensuring that only light striking the lens perpendicularly reaches the retina. Initially abnormal visual acuity that corrects with a pinhole indicates a problem with the lens, and is less concerning to an emergency physician. If this does not correct the visual problems, it indicates pathology that is more likely located within the retina or central nervous system

Acute Pancreatitis in the Emergency Department

Introduction: Acute pancreatitis (AP) is a common emergency department (ED) presentation with a variety of outcomes. Stratifying AP severity with scoring systems can allow physicians to effectively manage patient disposition. Objective: To identify ED pancreatitis patients who will likely be admitted to the ICU or be discharged within 48 hours, and to validate existing pancreatitis severity scores. Methods: Patients with a final ED diagnosis of AP and/or lipase ≥ 3 times the upper limit of normal were enrolled in a prospective, observational chart review study. Parametric and non-parametric descriptive statistics were used to describe the patient population. Area under receiver operating curve (AUC) was used to determine the predictive accuracy of existing pancreatitis scores. Results: Ranson criteria, Glasgow-Imrie (GI) criteria, Bedside Index of Severity in Acute Pancreatitis (BISAP), and Harmless Acute Pancreatitis Score (HAPS) were assessed. GI criteria (AUC = 0.77) had the highest predictive accuracy for ICU admission, while Ranson criteria (AUC = 0.62) had the highest predictive accuracy for early discharge. Mean scores of ICU patients were significantly (p \u3c 0.05) higher than those of non-ICU patients in all four scoring systems; however, mean scores in ICU patients failed to meet the severe case threshold for all four scoring systems. Discussion: Existing pancreatitis scoring systems cannot consistently predict AP severity in ED patients. The small difference in mean ICU and non-ICU patient scores illustrates the difficulty of using scoring systems to stratify AP severity in the ED. Further efforts to develop an ED-specific scoring system could allow physicians to more efficiently admit patients