Patient in Your Chair...
64yo gentleman, your 1st px of the day, called your answering service overnight. Left a message describing intense pain around his left eye, blurred vision, and difficulty opening that eye.
You have him come in immediately. Slight ptosis OS with limited adduction + diplopia on right gaze. You didn't even need to look at his pupils and you knew what to do within 30 seconds.
The day before, he had already been to both urgent care & the local ED. Was told normal CT and cleared, both urgent care and ED told him sinusitis. Clindamycin PO. He has history of HTN + DVT.
What was your top differential in those 30 seconds? More importantly, what did you tell him are the many possibilities as to WHY? What did you tell him to expect going forward? What did you do with him and what did YOU order to be done? How did YOU fill the void in care?
Did anyone fail him as he begins his journey?
HINT: You're thinking aneurysmal? What if it's not?...
- John R. Martinelli, MD, OD, FAAO
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