(Click the link to comment and to vote – voting not working through email, sorry!)
You are seeing a 10-year-old girl who was hit in the eye with a softball, causing her to fall to the ground. She has periorbital ecchymosis and orbital rim tenderness. There was no loss of consciousness, and she is awake and alert and has no other signs of trauma. You are monitoring her while waiting for the CT scanner to be available. Her vitals are: HR 46, RR 20, BP 98/50, O2 sat 99% on room air.
Loading ...
October 20, 2024 at 12:34 pm
D) Orbital blow-out fracture
The oculocardiac reflex can be triggered by pressure on the globe of the eye (e.g. pressing on the eyeballs), but also by traction on the extraocular muscles as can occur in an orbital blow-out fracture. In patients with eye trauma, obtain a baseline HR, then have them stare superiorly for a minute. A drop in HR of 10 bpm is concerning for EOM entrapment-caused oculocardiac reflex. Without LOC and given a completely normal mental status exam and no head hematoma, epidural hematoma is very unlikely. Commotio cordis is from a direct blow to the heart, and results in a ventricular dysrhythmia and cardiac arrest. Although bradycardic heart rates are seen in athletic teens and young adults, this level of bradycardia would not be normal for a 10-year-old girl, particularly one experiencing the stress and pain of traumatic injury.