(Ignore the needle in the picture – direct the needle tip away from the globe.). 0000004616 00000 n 0000003251 00000 n 0000062598 00000 n 0000005605 00000 n %%EOF 0000031528 00000 n Should we use a bougie routinely for our first attempt at intubation? 0000056647 00000 n The opthamologist is covering at another hospital and is at least an hour away, but suggests you go ahead with the lateral canthotomy… Most experts recommend starting with the inferior crus. 0000032664 00000 n 0000004891 00000 n S = superior canthal ten-don. 0000005844 00000 n 0000062699 00000 n lateral angle are anesthetized with 2% lidocaine with epinephrine. 0000064036 00000 n 4a: Expose the inferiolateral canthal tendon. Lateral canthotomy and inferior cantholysis is a potentially eyesight saving procedure, which is performed to relieve orbital compartment syndrome. 0000006278 00000 n 0 %PDF-1.7 %���� 0000003621 00000 n On exam, you note proptosis and an afferent pupillary defect. 0000014240 00000 n 0000062546 00000 n MInnes G and Howes D. Lateral canthotomy and cantholysis: a simple, vision-saving procedure. 0000005289 00000 n Cite this article as: Justin Morgenstern, "Lateral Canthotomy – procedure guide", First10EM blog, April 1, 2015. An orbital compartment syndrome, or OCS, results from a buildup of pressure behind the eye - most commonly caused by retrobulbar hematoma. 0000006004 00000 n 0000003950 00000 n 0000013547 00000 n xref 282 104 0000005368 00000 n FOAM enthusiast. 0000062406 00000 n 2002;4(1):49-52. 0000019777 00000 n At: http://www.cjem-online.ca/v4/n1/p49. First10EM – 0000011998 00000 n <]>> 0000062445 00000 n 0000006084 00000 n A 21 year old man was minding his own business on a street corner, when out of nowhere two dudes just jumped him. 0000003215 00000 n 0000005924 00000 n 0000031922 00000 n His primary injury appears to be to his right eye. 0000011280 00000 n (The tendon is just inferior and posterior to the lateral canthal fold.). Lift the inferior portion of the lateral eyelid. 0000006972 00000 n 0000005209 00000 n 0000013059 00000 n 0000003173 00000 n 0000062757 00000 n Available at: Emergency doctor working in the community. His primary injury appears to be to his right eye. 0000063361 00000 n He is complaining of a lot of eye pain and blurred vision. Use half diluted betadine if potential for it to go into the eye, © 2020 )))[t@AP���@< ��,$ʤl�P� 0000040241 00000 n 0000006491 00000 n 0000007402 00000 n On exam, you note proptosis and an afferent pupillary defect. 0000006734 00000 n 0000008370 00000 n In […], Massive GI bleeds can be very scary (for both the patient and the clinician), and it makes sense that we want to […], A conclusion to the stress test evidence series, A few extra tips and resources are available here: http://adelaideemergencyphysicians.com/2014/01/a-nasty-black-eye-2/, Chlorhexidine shouldn’t be use next to the eye. 0000005682 00000 n 0000006164 00000 n Use iris scissors to cut from the lateral canthus to the rim of the orbit, about 1 to 2 cm (canthotomy). website which shows how it’s done. I = inferior canthal tendon. 0000008089 00000 n 0000006312 00000 n The opthamologist is covering at another hospital and is at least an hour away, but suggests you go ahead with the lateral canthotomy…, Inject local anesthetic from the lateral canthus to the orbital rim. 0000005527 00000 n 0000009611 00000 n 0000000016 00000 n x�b``�c`��a`g`��ef@ a6�(�4 �I�(��] �';�/��n���@$�aU���퓓WT���vu�A\�M�u�%��>�!��61iӳc�^޺c���0�P�ӳ�����Xw�g��֖�ӳ�~/�.ܜX�ik�ىR?��2 Toronto: McGraw-Hill; 2013. Grasp the lower eyelid with forceps and retract it to reveal the lateral canthal tendon. 0000063510 00000 n 0000004387 00000 n 0000027786 00000 n 0000005763 00000 n 0000063808 00000 n 0000011445 00000 n The the whole process in a series of excellent, short cadaver videos: Lateral Canthotomy and Cantholysis at wikemerg.ca, Bashed, Blind and Bulging aka Ophthalmology Befuddler 033 at LITFL, The Procedures Course: Orbital decompression – lateral canthotomy & cantholysis. 0000007574 00000 n 0000016538 00000 n 0000002376 00000 n 0000062497 00000 n Vision loss can be permanent after 60-100 min of ischemia- do not delay procedure for imaging 0000063146 00000 n trailer 0000026927 00000 n 3. […], […] First10EM outlines simple approach to Retrobulbar Hematoma and Lateral Canthotomy […], […] First 10 EM – Procedure: Lateral Canthotomy […], […] First10EM outlines simple approach to Retrobulbar Hematoma and Lateral Canthotomy […], […] in the Fast Lane: Bashed, Blind and BulgingFirst 10 EM: Lateral CanthotomyNUEM: CanthotomyEM3 Resus Drills: Lateral Canthotomy – There…, […] found this cool and non gory (it’s all drawings!) 0000003727 00000 n 0000011782 00000 n 0000010313 00000 n ��h4?�ANi �)`%` )0(�0x0��,q�bT R��.L��1laz�� �t�0} � ������Hf�bo�/�eTg�`:�����W��A}���2D�39u�gp%�3�2�p �t��-#�t�aK�b y��XL��X��}K��V�, �,���9|��60�0 p8(��>c)çM�h ��$�>� �� b5 �� �� H[00�_ endstream endobj 283 0 obj <> endobj 284 0 obj <> endobj 285 0 obj <> endobj 286 0 obj <> endobj 287 0 obj <> endobj 288 0 obj <. 0000009533 00000 n So far this week, I have covered 2 large trials looking at airway management strategies in out of hospital cardiac arrest. 0000063041 00000 n 0000057173 00000 n Evidence based medicine junkie. 0000008776 00000 n procedure: use about 1 cc of 1% lidocaine with epineph-rine to infiltrate; use the hemostats for about 1 min to devitalize the skin at the lateral canthus before making a 1-cm incision (the lateral canthotomy) to expose the one structure you want to incise first, again with a 1-cm Figure 7. 0000017665 00000 n Identify the lateral canthus (see arrow). Lateral Canthotomy and Cantholysis or Acute Orbital Compartment Syndrome Management. L = lateral canthal tendon. 0000015945 00000 n 0000004731 00000 n 0000013603 00000 n 0000006445 00000 n A 21 year old man was minding his own business on a street corner, when out of nowhere two dudes just jumped him. Slide a straight mosquito hemostat along the lateral canthus, with one prong against the orbit and the other superficial to the skin. 0000002945 00000 n 0000013749 00000 n 0000063675 00000 n 0 Emergency Medicine Procedures, 2e. 0000005050 00000 n 0000011081 00000 n Figure 3: Clamp a small hemostat horizontally across the lateral canthus from the angle of the eyelid to the margin of Then, cut through the crushed tissue with tenotomy scissors to perform the canthotomy. Along this same path, cut all layers of tissue with the iris scissors. Cut the inferior and sometimes both crus of the lateral canthal ligament (cantholysis). 0000016145 00000 n 0000005130 00000 n 0000014925 00000 n “One special advantage of the skeptical attitude of mind is that a man is never vexed to find that after all he has been in the wrong.” - William Osler. 0000063924 00000 n He is complaining of a lot of eye pain and blurred vision. All rights reserved. 0000010608 00000 n 0000004279 00000 n 0000016335 00000 n 0000020522 00000 n Fig. 0000036015 00000 n 4b: … 0000004501 00000 n 0000063247 00000 n 0000006525 00000 n startxref �2�Xl����Ճ� �*� 1��@� =�� In: Reichman EF (ed). Cleanse the area with antiseptic and anaesthetise with 1 ml of 1% Lidocaine. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on Reddit (Opens in new window), Click to share on Pocket (Opens in new window), Click to email this to a friend (Opens in new window), Click to share on WhatsApp (Opens in new window), Click to share on Tumblr (Opens in new window), […] https://first10em.com/2015/04/01/procedure-lateral-canthotomy/ And http://webeye.ophth.uiowa.edu/eyeforum/tutorials/lateral-canthotomy-cantholysis.htm For videos explaining it!

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