Answer VizD 1.5

Case 1.5

VizD Winners

Brian Kern                      Chris Guyer                Rob Klever

Scott Ottolini                  Devon Moore             David Mishkin

Kevin MacWilliams          Marjan Siadat             Allison Loynd

A 53-year-old woman presents to your ED after tripping down a flight of steps. On exam, you note marked swelling of her right orbit with proptosis of the right eye. You ask the patient to look to the side but she cannot move her eye.

Questions:
1. What is the procedure being performed?
2. What is the most common reason to perform the procedure?
3. What complication are you trying to prevent in performing this procedure?

Answer:

This week, Dr Susi Vassallo, author of the seminal work on emergency canthotomy, and previous EM resident at Detroit Receiving Hospital, will discuss the answer to this weeks VizD

Receiving: When indicated, why is it so important to perform a lateral canthotomy?
Dr Vassallo: Performance of lateral canthotomy is critical to decompression of the orbit and relief of pressure on the optic nerve. Otherwise, there is risk for ischemia to the optic nerve resulting in blindness.
Receiving: In your opinion, what is the most important technical aspect in performing this procedure?
Dr Vassallo: The most important technical aspect in performing the procedure is palpating the lateral canthal tendon and cutting it. It is more easily palpated than visualized.
Receiving: How often do you see this procedure performed? (no pun intended)
Dr Vassallo: This procedure is performed more often than one would think. When I first wrote this article, Dr. Peter Rosen, then editor of the Journal of Emergency Medicine did not think it was an emergency medicine procedure. We happened to be talking years later when Dr. Rosen was practicing in Jackson Hole Wyoming. He told me that one of his former residents had to perform the procedure without ophthalmology assistance; this is when he realized it was important for emergency physicians to understand the indications for the procedure and to know how to do it.
Receiving: How does it feel that Roberts and Hedges Procedure book uses your article and images for their chapter on lateral canthotomy?
Dr Vassallo: I am happy to see the pictures from our article in the book by Roberts and Hedges. Jim Roberts is one of my hero clinicians.
Receiving: Thank you for your time!
Dr Vassallo: Of course, you are very welcome!

Check out Dr Vassallo’s article

Here is video of the actual procedure

Thank you to everyone who submitted their answer.  Stay tuned for next week’s VizD

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

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