VFlutter
Flight Nurse
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I thought I would write about an interesting case I had this week. Patient came up to our floor from the cath lab s/p peripheral stent placement x2 in the Superficial Femoral Artery due to PVD. The cath lab first went in via the right Brachial Artery but could not reach the blockage so they pulled out and used the right Femoral Artery. There were no reported complications. Patient received Fentnyl and Versed during procedure.
Upon returning to floor patient compained of blurry vision. It was originally attributed to a side effect of the medications and patient was started on fluids and told to rest. (He also wore glasses and had poor vision) Pt then proceeded to sleep and woke up 2 hours later still complaining of vision problems but how complaining of double vision. A Neuro exam was performed and mostly unremarkable. He was A&Ox4, strong grips x4, no drift, no dizziness, pupils were equal and reactive to light. Patient did have double vision and could see two clocks on the wall (Patient's left) but correctly identified the number of fingers when presented on the patient's right. No other complaints other. So the PA was called to assess the patient. The PA at first was not overly concerend and still thought it might be a side effect of the fentnyl but then went though a more detailed Neuro exam which included an accomidation assessment. Patient's right eye could not accommodate/track past midline. So when tracking from right to left the right eye would stop at center (no movment medially) while the left eye continued to track all the way laterally. The patients right eye would track all the way laterally like normal.
The patient was sent down for a CT scan which came back normal. The plan was to consult with Opthamology in the morning since it appeared to be some type of abducens nerve palsy but they also consulted Neuro just to cover all the bases. Neuro came down and assessed the patient and ordered an MRI.
Anyone want to guess what the final diagnoses was? And why or how it happened?
Upon returning to floor patient compained of blurry vision. It was originally attributed to a side effect of the medications and patient was started on fluids and told to rest. (He also wore glasses and had poor vision) Pt then proceeded to sleep and woke up 2 hours later still complaining of vision problems but how complaining of double vision. A Neuro exam was performed and mostly unremarkable. He was A&Ox4, strong grips x4, no drift, no dizziness, pupils were equal and reactive to light. Patient did have double vision and could see two clocks on the wall (Patient's left) but correctly identified the number of fingers when presented on the patient's right. No other complaints other. So the PA was called to assess the patient. The PA at first was not overly concerend and still thought it might be a side effect of the fentnyl but then went though a more detailed Neuro exam which included an accomidation assessment. Patient's right eye could not accommodate/track past midline. So when tracking from right to left the right eye would stop at center (no movment medially) while the left eye continued to track all the way laterally. The patients right eye would track all the way laterally like normal.
The patient was sent down for a CT scan which came back normal. The plan was to consult with Opthamology in the morning since it appeared to be some type of abducens nerve palsy but they also consulted Neuro just to cover all the bases. Neuro came down and assessed the patient and ordered an MRI.
Anyone want to guess what the final diagnoses was? And why or how it happened?
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