Emergency Ultrasound (EUS)(20)

Ocular ultrasound.

Focused Bedside Ocular Ultrasound

Acad Emerg Med 2008;15:792

cross-section of the optic nerve complex

Emerg Med J 2009 26: 630-634

Emerg Med J 2009 26: 630-634

Optic nerve sheath diameter

ONSD
3mm behind the globe Adult: 5mm Child
> 1 y/o : 4.5mm < 1 y/o 4.0mm

Br. J. Ophthalmol. 2002;86;1109-1113

Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath

Acad Emerg Med 2003; 10:376381

ONSD measurements correlate with noninvasive and invasive measurements of the ICP, and with head CT findings in brain-injured adults

Intensive Care Med (2007) 33:17041711 Intensive Care Med (2008) 34:20622067 Critical Care 2008, 12:R67

Optic nerve sheath diameter is significantly enlarged (8.11 mm)

Emerg Med J 2009 26: 630-634

EUS ONSD correlates with ICP

* threshold of ONSD > 5 mm to detect ICP > 20 cm H2O

Acad Emerg Med 2008; 15:201204

EUS is sensitive to detect elevated ICP in adult head injury patients

Ann Emerg Med. 2007;49: 508-514

The sensitivity and specificity of bedside sonographic measurement of ONSD is inadequate in children with suspected IICP

Ann Emerg Med. 2009;53:785-791

34M, conscious change with vomiting

44M, severe headache then LOC

Ocular US for retinal detachment

J Emerg Med. 2009 Jul 20

EPs can use ocular US to detect RD

Ophthalmology Findings

RD+
ED ultrasound RD+ 28 RD1 Total 29
Sensitivity 97%(28/29) Specificity 92%(58/63) Positive predictive value 85%(28/33) Negative predictive value 98% (58/59) Accuracy 93%(86/92)

RD5 58 63

Total
33 59 92
J Emerg Med. 2009 Jul 20

US to detect ruptured globe

West J Emerg Med. 2009;10(4):263-266.]

West J Emerg Med. 2009;10(4):263-266.

Incomplete posterior vitreous detachment

Acad Emerg Med 2000; 7:947950

Retrobulbar hematoma

Acad Emerg Med 2000; 7:947950

Traumatic lens dislocation

Acad Emerg Med 2000; 7:947950

Retinal detachment

Acad Emerg Med 2000; 7:947950

US to diagnose traumatic periorbital gas

AJEM 2005;23: 517520

US for acute subretinal hemorrhage in ED

AJEM 2009;27:369.e5369.e7

ULTRASOUND IMAGING OF PENETRATING OCULAR TRAUMA

Journal of Emergency Medicine 2009;36:181182

Ultrasonic evaluation of pupillary light reflex

Crit Ultrasound J (2009) 1:5357

Ultrasonic evaluation of pupillary light reflex

Crit Ultrasound J (2009) 1:5357

Ultrasonic evaluation of pupillary light reflex

Crit Ultrasound J (2009) 1:5357

Transparent dressing for ocular US

J Emerg Med. 2010 Jan 23

Focused Bedside Ocular Ultrasound

Video Clip S1. Normal eye and the measurement of the optic nerve sheath diameter Video Clip S2. Papilledema with increased optic nerve sheath diameter Video Clip S3. Retinal detachment. One edge remains attached at the optic disk Video Clip S4. Vitreous hemorrhage. Hyperechoic blood floats in the posterior chamber Video Clip S5. Globe rupture. Hyperechoic substance with disruption of ocular integrity.
Acad Emerg Med 2008;15:792

Take Home Message

Ocular ultrasound may be useful to detect
IICP (ONSD) Retinal detachment Ocular FB Vitreous hemorrhage Traumatic lens dislocation Pupillary light reflex

Dont apply pressure on eyeball