EM Quick Hits 24 Lateral Canthotomy, Cannabis Poisoning, Hyperthermia, Malignant Otitis Externa, BBB in Occlusion MI, Prone CPR

Topics in this EM Quick Hits podcast Anand Swaminathan on lateral canthotomy (0:54) Emily Austin on pediatric cannabis poisoning  (7:38) Reuben Strayer on an approach to hyperthermia  (13:22) Brit Long on diagnosis and management of malignant otitis externa  (20:28) Jesse McLaren on ECG diagnosis of occlusion MI in patients with BBB (25:42) Peter Brindley on prone CPR (32:15) Podcast production, editing and sound design by Anton Helman. Voice Editing by Raymond Cho. Podcast content, written summary & blog post by Anton Helman, Emily Austin, Brit Long and Reuben Strayer Cite this podcast as: Helman, A. Swaminathan, A. Austin, E. Strayer, R. Long, B, McLaren, J. Brindley, P. EM Quick Hits 24 - Lateral Canthotomy, Cannabis Poisoning, Hyperthermia, Malignant Otitis Externa, BBB in Occlusion MI, Prone CPR. Emergency Medicine Cases. December, 2020. https://emergencymedicinecases.com/em-quick-hits-december-2020/. Accessed [date]. Lateral canthotomy - cantholysis * Time is eye; a lateral canthotomy is indicated for trauma patients with orbital compartment syndrome within 60-120 minutes of onset of ischemic features (decreased visual acuity and RAPD) as a temporizing measure to definitive surgical evacuation of the retrobulbar hematoma. * Clinical clues to orbital compartment syndrome include mechanical consequences (proptosis from the retrobulbar hematoma - most easily seen from the head of the bed with the patient lying supine - IOP>40mmHg and impaired extraocular movements), and ischemic consequences (decreased visual acuity, RAPD and a blown pupil) * Do not wait for a CT to confirm a retrobulbar hematoma; the clinical diagnosis is all you need to go ahead with the procedure * Gear: 2% Lidocaine with Epinephrine, 25g needle, straight clamp, iris scissors, toothed forceps * The lateral canthotomy procedure * * Ensure adequate sedation and local anesthesia * Crush and clamp the lateral canthus for 1-2 minutes with the straight clamp * Make a 1-1.5cm cut to the lateral canthus with the iris scissors while an assistant is pulling the lower lid out of the way with toothed forceps * Palpate the lateral canthal ligament (because the surgical field is usually very bloody, finding the lateral canthus ligament becomes a tactile procedure and has been likened to the feel of a guitar string) and cut the inferior branch of the lateral canthal ligament * Recheck the IOP; if still elevated cut the superior  branch of the lateral canthal ligament * Medical treatment for OCS is similar to that of acute angle closure glaucoma with mannitol, acetazolamide, pilocarpine and timolol. Traumatic retrobulbar hemorrhage: Emergent decompression by lateral canthotomy and cantholysis paper https://www.youtube.com/watch?v=tgQaKVGynFA Expand to view reference list * Vassallo, S., Hartstein, M., Howard, D., & Stetz, J. (2002).