Monday, May 23, 2011

Sorry, Not Going to Happen

Another textbook gem from Ellis Clinical Anatomy (i.e. my current favorite anatomy resource):

"A carotico- cavernous arteriovenous fistula results with pulsating exophthalmos, a loud bruit easily heard over the eye and, again, ophthalmoplegia and marked orbital and conjunctival oedema due to the venous pressure within the sinus being raised to arterial level."

Sorry Ellis, if someone comes into my A & E dept with a penetrating injury to the skull, I am probably not going to put my stethoscope on their eye to determine if they have an EYE BRUIT.

How the hell would you be able to hear that anyway? And really if they've knackered their cavernous sinus I am pretty sure there will be other, less subtle clinical signs. Thanks though, for that tip.


Grumpy, M.D. said...

Cranial bruits are masturbation, and of no value- if you're suspicious of one, you're going to get an MRI, anyway, regardless of what you hear.

In my experience, the only doctors who still ascribe value to listening for intracranial bruits are those who trained before the development of CT. Fortunately, they grow fewer every year.

OMDG said...

An EYE bruit. Huh. New one for me. Remember ABB, drs are divided into 2 camps: doers and thinkers. Neurologists (bless their hearts) are thinkers. Trauma surgeons (like you) are doers.

Red Stethoscope said...

If they have a pulsating exophthalmos, won't you SEE that something is clearly wrong before you decide to put your steth on their EYE? LOL! This is too funny.

Anonymous said...

I remember one guy came in to the ED with wicked anemia (Hb of like 40 or something), and the opthalmologists were tripping over themselves getting as many residents in as possible to hear their retinal bruits.