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- Jan 7, 2004
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14yoF comes in w blurry vision to right eye since yesterday, wears soft contacts and one minute she was ok then the next minute she thought her right contact fell out because her vision had become so blurry so quickly. She went to the bathroom at school and checked only to note that her contact was still in place.
She sees me in the ER the next day w/ mom. No pain, no redness, counting fingers at right and 20/70 at left (both w/o correction), no afferent pupillary defect, neg SLE, normal tonopressures. Fundoscopic exam shows maybe a pale retina in right, but no bleed and sharp vessels.
I call our transfer center because we have no ophthalmologist at our ER, I speak to the pediatric ophthalmologist on the other line and I gave her the schpiel.... she thought I was the ophthalmologist because maybe I gave a pretty good "physical exam" over the phone (I had rotated in optho in 1 of my electives as a resident).... and she starts questioning why I didn't do stereo optic exams and if I thought this was a functional defect.. I was like... WTF???
And so I tell her I'm just the ER doc and that I had no idea what she was talking about.... she apologized and asked me to send the patient home because she thought it can't be a CRAO or CRVO or PVD given the story and my exam w/o APD... I tell her that I cannot do that because we need optho to clear her before I can do that... this is a 14yo girl for gosh sakes. She first resists the transfer.... "This is a functional defect, she'll be ok..." she says.
I say, we need to transfer for optho to clear, I cannot in good conscience send a patient home w/o specialist clearance and given such a valuable sensory organ affected, we cannot take this chance. So I transferred and she accepted.
But yeah.... I think I did the right thing. Right?
And what in the world is a functional visual defect??
She sees me in the ER the next day w/ mom. No pain, no redness, counting fingers at right and 20/70 at left (both w/o correction), no afferent pupillary defect, neg SLE, normal tonopressures. Fundoscopic exam shows maybe a pale retina in right, but no bleed and sharp vessels.
I call our transfer center because we have no ophthalmologist at our ER, I speak to the pediatric ophthalmologist on the other line and I gave her the schpiel.... she thought I was the ophthalmologist because maybe I gave a pretty good "physical exam" over the phone (I had rotated in optho in 1 of my electives as a resident).... and she starts questioning why I didn't do stereo optic exams and if I thought this was a functional defect.. I was like... WTF???
And so I tell her I'm just the ER doc and that I had no idea what she was talking about.... she apologized and asked me to send the patient home because she thought it can't be a CRAO or CRVO or PVD given the story and my exam w/o APD... I tell her that I cannot do that because we need optho to clear her before I can do that... this is a 14yo girl for gosh sakes. She first resists the transfer.... "This is a functional defect, she'll be ok..." she says.
I say, we need to transfer for optho to clear, I cannot in good conscience send a patient home w/o specialist clearance and given such a valuable sensory organ affected, we cannot take this chance. So I transferred and she accepted.
But yeah.... I think I did the right thing. Right?
And what in the world is a functional visual defect??