1. Emergency 911 Shane R. Kannarr, OD Grene Vision Group

2. Define Emergency Emergent Urgent Routine

3. Our Patients

4. Key Questions When did it start? Which eye is impacted? Has it happened before? What problems are you noticing? Do you have loss of vision? Do you have flashes or floaters?

5. Key Questions cont: Are you having discharge? What type? Is your eye red? Has there been trauma to your eye?

6. Key responses to watch for Loss of Vision Flashes or Floaters Severe Pain Severe Redness Light Sensitivity Foreign Body

7. Follow up Questions Loss of Vision – All or part of the vision? – Is it transient? – Did it happen immediately or was it proceeded by flashes and floaters

8. What could it be? Loss of Vision Papilledema, TIA, migraine,CRAO, glaucoma, blood pressure change Emergency, Emergent, Routine

9. Follow Up Questions Flashes and Floaters – One eye or both? – Do they move around? – What were you doing when it started? – History?

10. How you ask matters

11. What could it be? Flashes and Floaters: RD or break, PVD, migraine, posterior uveitis, vitreous hemorrhage Emergency, Emergent, or Routine

12. Follow up Questions Pain History of trauma? Contact lens wear? Is it mild or severe? Is it in the eyes or around the eyes? Does anything relieve the pain? Duration?

13. What could it be? In the eye (Ocular) – Dry eye, bleph, FD, episcleritis, or SPK – Abrasion, erosion, Anterior Uveitis – Around the eye Sinusitis, orbital pseudotumor Emergency, Emergent, Routine

14. Follow Up questios Redness: – Is there discharge? What type? – Is there pain? How severe…? – When did it start? Is it getting progressively worse? – Have you been treating the redness – Contact lens history?

15. What could it be? Redness: – CLARE Conjunctivitis – Dry Eye – Sub conjunctival hemorrhage – Emergency, Emergent, Routine

16. Follow Up Questions: Photophobia (Light Sensitivity) – Is it mild moderate or severe? – Contact lens history? – History of trauma? – Duration?

17. What could it be? Corneal issue, uveitis, conjunctivitis, migraine Less common Meningitis Emergency, Emergent, Routine

18. Follow Up Questions Do you have any idea what it could be? What is your pain level? Has it impacted your vision? When did it happen? What steps did you take to help yourself?

19. What could it be? A foreign body Emergency, Emergent or Routine

20. Talking to Patients Instill confidence Know what you are talking about Ask pertinent questions Instill Confidence Provide the patients ways to contact the office after hours

21. Key points Have a plan in place Know the office protocol It is not wrong to say “let me check with the doctor and I will get back to you” Put yourself in the patients shoes

22. If it is not an emergency Remember while it is not an emergency to the office, the patient is still very concerned If at all possible the patient should be in the office if 24-48 hours Ask the doctor if any thing can be done to make the patient more comfortable until they can be seen