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The Certifying Exam asks you to perform a procedure out loud: why it is indicated, what you ask for, your landmarks and steps, and what you do afterward. Work through a complete case free, then compare your answers against the suggested ones.
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Case 1
Case Parameters
- This is a 10-minute case.
- An 81-year-old woman taking apixaban is brought in after falling down four steps and striking her face. She reports severe right eye pain and says the vision in that eye has gone dark.
- Vital signs: BP 158/86, HR 92, RR 18, SpO2 97% on room air, T 36.8 C.
Physical Examination
General
Awake, oriented, holding a cold pack against the right side of her face
Right eye
Globe pushed forward, firm to gentle palpation, lids tight and hard to retract, bruising and swelling of the lids
Vision
Light perception only on the right, 20/40 on the left
Pupils
Right pupil sluggish with an afferent defect, left pupil reactive
Eye movements
Severely limited in all directions on the right, full on the left
Eye pressure
52 mmHg right, 16 mmHg left
Neuro
No focal weakness, no anticoagulant reversal given yet
Task Statement
- Describe how you would perform a lateral canthotomy and cantholysis.
- Answer the examiner questions.
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