Nose bleeds are a bloody common problem (bad pun intended) – most originating at the front to the nose where there is a cluster of blood vessels – Little’s Area.
In the young the bleeding often starts after trauma (e.g. picking or punching noses). In the elderly however, it is commonly a manifestation of underlying vascular disease. Read more
Chronic pancreatitis is a low grade inflammatory disease of the pancreas. It can occur after an attack of acute pancreatitis or can present on its own. Some patients are best under the Surgical team and some under Gastro/Medical teams Read more
Bell’s Plays is a lower motor neurone (LMN) lesion of the facial nerve (CN VII), which causes one side of the face to “droop” [1% of cases are bilateral], and patients are often concerned that it is a stroke.
However, unlike in stroke the whole face is affected, in stroke and other upper motor neurone (UMN) lesions the upper portion of the face is unaffected due to input from both sides of the brain. Read more
Nausea and vomiting in pregnancy is common and at best an unpleasant experience for the patient, and at worst can be life threatening. It normal starts @ 4-7/40, peaks @ 9/40, and finishes @ 20/40.
We need to conduct a thorough history and examination looking for causes other than a high βHCG. these include:
Like tension pneumothorax the biggest step is deciding to do it – Remember it it sight saving and they heal well
Retrobulbar Haematoma secondary to blunt eye injury is a a rare but potentially sight threatening injury.
Blood collects in the retrobulbar space
Pushing the eye forward to accommodate the extra volume.
The Orbital Septum (made up of the eyelids and ligaments that attach them to the orbital rim) restricts this forward movement, creating a compartment syndrome for the eye. Thus threatening the patients sight if not treated quickly.
Recognition
Severe pain
Red/Congested conjunctiva
Exophthalmos with proptosis – eye pushed forward
Internal ophthalmoplegia – impairment or loss of the pupillary reflex.
Visual flashes
Loss of vision – initially colour vision (esp. red), progressing to local visual loss.
However, this may only be recognised on CT if there is significant facial injury and altered conscious level.
Treatment
Call Ophthalmology immediately to attend. If there is going to be any significant delay, it may be necessary for ED to preform a Lateral Canthotomy, to allow the eye to move forward, reduce the orbital pressure & preserve the patients sight.