If Ophthalmology Ran Medicine: The Trauma Bay


(Two ophthalmology interns and a nurse wait for trauma to arrive. The ophthalmology attending walks in wearing dress clothes)

ATTENDING: What do we have coming in?

INTERN 1: Gunshot wound

ATTENDING: To the eye?

INTERN 1: No, roughly 40 eyeball lengths below the head, give or take

(Attending adjusts bow tie as he looks at his interns tightly gripping their ophthalmoscopes)

ATTENDING: You'll be fine. Remember your training! Vision! Pupils! Pressure! Drops!


(Trauma arrives)

INTERN 1: Patient is unconscious. He's wearing glasses

ATTENDING: Ok, we need to expose the eyes

(Intern uses glasses shears to remove glasses from face)

INTERN 1: I don’t see an RAPD, but pupils are unequal. Sir, there appears to be anisocoria

ATTENDING: DON'T PANIC. Nurse, please mark PRRLA in the chart

NURSE: Got it! PERRLA noted.


NURSE: Yes, I have it written as PERRLA

ATTENDING: No it’s P-R-R—You know what, nevermind. I’ll have my trauma scribe do it.

NURSE: Sir, there's no such thing as a tr—

ATTENDING: There's no time. Now, what’s the eye pressure?


ATTENDING: Excellent! Now, we can’t check vision or get him up to the slit lamp, so John, get the portable.

(Intern 2 breaks emergency glass, grabs portable slit lamp)

INTERN 2: Anterior chamber is formed, lens intact, no scleral lacerations, there is a pterygium extending into the visual axis. He may need excision with a conjunctival autograft.

ATTENDING: Good catch, we’ll get him on the surgery schedule for pterygium excision once he recovers from his gunshot wound. Go ahead and check his other body parts.

INTERN 2: Looks like the ophthalmoscope holders and cataract surgery pedal steppers are intact

(Nurse rolls eyes, types “extremities normal”)

INTERN 2: There’s a bullet hole in the wall of the organ container. Also, there’s blood. Oh my God. There’s so much blood.

(Intern 2 rolls up sleeves of dress shirt and applies 2x2 gauze with small forceps)

ATTENDING: We’ll deal with the bleeding in a second. First we need to do an ultrasound to look at the organs inside the organ container.

(Intern 2 grabs ocular ultrasound probe and places it on the patient’s abdomen)

INTERN 2: The patient has subcutaneous tissue. It appears intact.

ATTENDING: That’s reassuring. Call the ICU. Tell them we have an unconscious male of pre-cataract age with anisocoria and a pterygium that is probably visually significant. He also has a bullet hole in the organ container with blood present and intact subcutaneous tissue on ultrasound.

INTERN 2: Got it!

ATTENDING: When you’re done, meet me in the cafeteria for second lunch. It’s deluxe chicken sandwich day.