EMCrit.org

Ocular

brace your hand on patient's nose. Fan through eye in transverse and sag

can see vitreous bleed

retinal detachment

icp-optic nerve sheath

lens dislocation

retro-orbital bleed

Key question, does the ocular anatomy look normal

More and more, it looks like 5.7 is the magic cutoff (Crit Care 2008;12:150)

If the optic nerve sheath is >5mm at a point 3 mm behind the globe, then there is increased icp (ACAD EMERG MED d April 2003, Vol. 10, No. 4)

(2nd study Tayal VS Ann Emerg Med 2006)

Another study (Emerg Med J 2007;24:251)

Third Study (Annals of Emergency Medicine 2007;49(4):508-514)The sensitivity for the ultrasonography in detecting elevated intracranial pressure was 100% (95% confidence interval [CI] 68% to 100%) and specificity was 63% (95% CI 50% to 76%).

another ONSD uts study

case control methods and weird endpoint make this one less compelling, but it bore out the technique

they used a 5.77 mm cutpoint

(Inten Care Med 2007;33:1704)

Confirmation with real ICP measurements ((2008) Academic Emergency Medicine 15 (2) , 201–204)

another real time showed nerve sheath but not nerve reflected ICP (Inten Care Med 2008;34:2062)

Retinal Detachment

(Acad Emerg Med 2002;9:791 and Annals Emerg Med 2005;45(1):97)