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Emergency

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					      Emergency 911



Shane R. Kannarr, OD
 Grene Vision Group
   Define

 Emergency
 Emergent
 Urgent
 Routine
Our Patients
           Key Questions
 When did it start?
 Which eye is impacted?
 Has it happened before?
 What problems are you noticing?
 Do you have loss of vision?
 Do you have flashes or floaters?
       Key Questions cont:
 Are you having discharge? What type?
 Is your eye red?
 Has there been trauma to your eye?
    Key responses to watch for

 Loss of Vision
 Flashes or Floaters
 Severe Pain
 Severe Redness
 Light Sensitivity
 Foreign Body
          Follow up Questions
   Loss of Vision
    – All or part of the vision?
    – Is it transient?
    – Did it happen immediately or was it proceeded
      by flashes and floaters
           What could it be?
   Loss of Vision
    Papilledema, TIA, migraine,CRAO,
    glaucoma, blood pressure change

   Emergency, Emergent, Routine
         Follow Up Questions
   Flashes and Floaters
    – One eye or both?
    – Do they move around?
    – What were you doing when it started?
    – History?
How you ask matters
         What could it be?
Flashes and Floaters:
RD or break, PVD, migraine, posterior
 uveitis, vitreous hemorrhage
Emergency, Emergent, or Routine
           Follow up Questions
   Pain

 History of trauma? Contact lens wear?
 Is it mild or severe?
 Is it in the eyes or around the eyes?
 Does anything relieve the pain?
 Duration?
              What could it be?
   In the eye (Ocular)
    – Dry eye, bleph, FD, episcleritis, or SPK
    – Abrasion, erosion, Anterior Uveitis


    – Around the eye
        Sinusitis, orbital pseudotumor



          Emergency, Emergent, Routine
           Follow Up questios
   Redness:
    – Is there discharge? What type?
    – Is there pain? How severe…?
    – When did it start? Is it getting progressively
      worse?
    – Have you been treating the redness
    – Contact lens history?
           What could it be?
   Redness:
    – CLARE
      Conjunctivitis
    – Dry Eye
    – Sub conjunctival hemorrhage


    – Emergency, Emergent, Routine
        Follow Up Questions:
   Photophobia (Light Sensitivity)
    – Is it mild moderate or severe?
    – Contact lens history?
    – History of trauma?
    – Duration?
            What could it be?
   Corneal issue, uveitis, conjunctivitis,
    migraine

   Less common Meningitis

   Emergency, Emergent, Routine
       Follow Up Questions
 Do you have any idea what it could be?
 What is your pain level?
 Has it impacted your vision?
 When did it happen?
 What steps did you take to help yourself?
           What could it be?
   A foreign body

   Emergency, Emergent or Routine
         Talking to Patients
 Instill confidence
 Know what you are talking about
 Ask pertinent questions
 Instill Confidence
 Provide the patients ways to contact the
  office after hours
               Key points
 Have a plan in place
 Know the office protocol
 It is not wrong to say “let me check with the
  doctor and I will get back to you”
 Put yourself in the patients shoes
     If it is not an emergency
 Remember while it is not an emergency to
  the office, the patient is still very concerned
 If at all possible the patient should be in the
  office if 24-48 hours
 Ask the doctor if any thing can be done to
  make the patient more comfortable until
  they can be seen

				
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