In our trust we don’t have paediatric critical care beds. However, in our region we use EMBRACE (a paediatric critical care transport team), who can transfer critically ill children to specialist centers (in or out of region).
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.
Exophthalmos with proptosis – eye pushed forward
Internal ophthalmoplegia – impairment or loss of the pupillary reflex.
Loss of vision – initially colour vision, progressing to local visual loss.
However, this may only be recognised on CT if there is significant facial injury and altered conscious level.
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.
On rare occasions you may receive a pre-alert, where you want blood available for the patient when they arrive (for example in major haemorrhage). This process has been agreed with transfusion so this can be done safely and responsibly. Read more
We often worry about patients developing rhabdomyolysis and consequently developing AKI. However, there is much debate and little consistency in the published data, over how to diagnose and who needs admission to treat. So its important to consider both clinical context along with laboratory values