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| Even an eye doctor can use this. |
I have mentioned before the feast or famine nature of the Children's emergency room - I'm either told way less than the actual truth, or the picture is painted way out of proportion. I'm used to it. But what is even worse is when I am consulted to see a patient with an "eye" problem when there is clearly something else going on. This has happened a couple times in the last couple months - and both times at the VA.
The first was a patient who had an episode of decreased vision in his only good eye, the other being nearly lost secondary to glaucoma. So surely I would want to see the patient right away, right? I walk in the patient's room in the ED to find him attached to a blood pressure cuff with fluids running into him. This was his second liter of fluids, with a systolic blood pressure still barely over one hundred. I already knew the problem - hadn't even stated my name yet or seen an eyeball. After further (proper) questioning of the patient, I come to find out he hadn't been eating or drinking, while on diuretics, and had this episode of decreased vision after he stood up and got dizzy and subsequently fell. Most non-physicians could diagnose this - LOW BLOOD PRESSURE. EYE = FINE.
The second was a patient sent from the vascular surgery clinic because he was having intermittent, brief episodes of dimming of his vision. Medications? Oh yeah, he was recently switched from one beta blocker to another because of excessively low blood pressure. What he was not counseled well on was to actually stop the first. So he went home from the hospital taking both. And his symptoms usually occurred while he was standing on a ladder painting the ceiling. Clearly another case of hypotension-induced vision change. Again, LOW BLOOD PRESSURE. EYE = FINE.
Moral? Check some vitals, ask some good questions, be a doctor, and then consult. Only then. These are two gleaming examples of textbook, board-worthy, EASY scenarios.
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