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Ocular Triage

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Jeremy Baumfalk

on 21 September 2012

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Transcript of Ocular Triage



QUALITY OF CARE Chemical splash (Acute)

1. Obtain patient’s name, DOB, and number where they can currently be reached.

2. Instruct patient to hang up phone, flush eyes with warm water for 10 minutes and present to clinic.

3. Consult with doctor immediately

4. Upon arrival, patient is immediately escorted to eyewash station to begin lavage.

5. Alert doctor that patient has arrived

*A chemical splash is a true ocular emergency where every second counts. Delay in proper treatment can result in permanent vision loss. In order to expedite evaluation, Ocular Triage form is not completed for these patients, and preliminaries (history, acuities, etc.) are not completed prior to evaluation LVC Red Eye Protocol
Ocular Triage Form completed for all red eyes and ocular urgencies/emergencies.*

If slot is available same day, fill slot.

Place completed Ocular Triage Form in red plastic sleeve, place in chart holder for rooms #1 or #8 to alert doctor and technician on that side that red eye has been added. After review, doctor will return Ocular Triage Form to receptionist.

If slot is not available same day, place patient on hold, consult with doctor (have triage form completed prior to consulting with doctor)

Assume all red eye patients are infectious until proven otherwise.

After check-in, patients are immediately escorted to exam room #4 or #5 with Ocular Triage form attached to chart.

Technician to obtain expanded history (to include contact lens information if applicable), visual acuity (OD, OS).*

If doctor determines that condition is infectious, will place a red C discretely on front of chart to alert technician, back desk personnel.

Assuming infectious condition, exam room will be temporarily closed with door shut and all flags out.

Clean all surfaces in exam room including countertop, occluder, exam chair arm rests, phone, sterile saline bottle, slit lamp table, slit lamp joystick, light switches and door handles to exam room. Clean countertop at back desk and front desk. Clean inner and outer handles of clinic doors.

Remember to wash your hands after patient encounter! Contact lens wearers
Non-compliant contact lens wearers
Young males
Extended wear contact lens
Swimming, hot tubs, lake water, tap water
Diabetics Risk factors for corneal ulcers Giant Cell Arteritis

Polymyalgia Rheumatica

Symptoms: Scalp pain, jaw claudication, Acute vision loss

Treatment: IV methlyprednisolone

*Fellow eye can become involved within 24 hours Anterior Arteritic Ischemic Optic Neuropathy Central Retinal Artery Occlusion

Acute Angle Closure Glaucoma

Anterior Ischemic Optic Neuropathy

Chemical Splash

Open Globe

Retinal Detachment???

Infectious Keratitis Ocular Emergencies Acute
Orbit and or Adnexa
Permanent vision loss eminent
Possible loss of life or limb Ocular Emergency Triage

Patient flow

Public health issues

Universal precautions Red Eye Protocol Where to find

When to use

Office tracking

When not to use Triage form Efficiently identify patients who need urgent care
Maximize patient flow
Minimize schedule disruption
Meet standard of care Ocular Triage Form 1. Understand what constitutes an ocular emergency
2. Understand what constitutes an ocular urgency
3. Introduce and implement ocular triage form
4. Establish a red eye office protocol
5. Establish a chemical splash protocol OBJECTIVES Ocular Urgencies and Emergencies
The Art of Triage Pain (Severe)
Vision loss
Acute onset
Unilateral Infectious Keratitis Symptoms: Flashes, Floaters, veil or curtain over vision.
Painless loss of vision
50% asymptomatic Retinal Detachment? Triage= “sorting”

-maximize patient flow
-miss true emergencies

-impedes patient flow
-emergency refractions Triage 1. Die

2. Go blind

3. Go to the emergency room, LincCare, or the PCP office for eye care We don’t want our patients to: Trauma
High velocity projectile
Hammering, sharpening Open Globe Symptoms:
pH 1-14
Acid vs Base
Saponification Chemical Splash Symptoms: Eye Pain, Nausea, Vomiting, Headache, Blur, Haloes

Causes: Iatrogenic, Dark environment, race, anatomy, hyperopia

Treatment: In office lowering of IOP, anterior chamber paracentesis, referral for Lateral Peripheral Iridotomy (LPI), Acute Angle Closure Glaucoma Symptoms: Acute, persistent, loss of vision
Count Fingers – Light Perception

Causes: Hypertension, Diabetes, Cardiac Disease, Acute angle closure glaucoma

Treatment: Indention gonioscopy, Anterior chamber paracentesis, Paper bag, Hyperbaric Oxygen Chamber Central Retinal Artery Occlusion Acute= Of abrupt onset, in reference to a disease. Acute often also connotes an illness that is of short duration, rapidly progressive, and in need of urgent care.

Chronic= Persisting over a long period of time. Acute vs Chronic
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