History of Present Illness
The coronary care unit has consulted ophthalmology regarding a 46-year-old male inpatient who complains of decreased vision in his right eye (OD). He has had a protracted course in the hospital. He presented 2 weeks ago with ST-elevation myocardial infarction complicated by cardiogenic shock. He underwent emergent coronary artery stenting of the left anterior descending artery. He has been on multiple vasopressors and had an aortic balloon pump placed. He was on mechanical ventilation earlier in his course, but was extubated a few days ago. He was also febrile last week and has been treated for ventilator-associated pneumonia.
He notes that he started to see floating spots in his OD about 3 or 4 days ago. These have gradually been increasing, and he says his vision is now blurry in that eye. He denies pain or any problems with his left eye (OS). His only past ocular history is mild myopia.
Questions to Ask the Primary Team
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What clinical data are available regarding the patient’s infection (e.g., culture results and sensitivities)?
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What antimicrobials was he or is he on?
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Is his clinical course improving?
The following information is gathered from a review of the patient’s chart and discussion with the intensive care unit (ICU) team. The patient had a ventilator-associated pneumonia from which he is recovering. Blood cultures have all been negative. 1,3-β-D-glucan was positive. The patient is no longer febrile, is hemodynamically stable, and his oxygen requirement is decreasing. He was started on broad-spectrum antimicrobials last week, specifically vancomycin, piperacillin–tazobactam, and voriconazole.
| OD | OS | |
|---|---|---|
| Vision | J12 | J3 |
| (20/125 distance equivalent) (20/30 distance equivalent) | ||
| Intraocular pressure (IOP) | 14 | 15 |
| OD | OS | |
|---|---|---|
| Lids and lashes: | Normal | Normal |
| Sclera/conjunctiva: | White and quiet | White and quiet |
| Cornea: | Clear | Clear |
| Anterior chamber (AC): | Deep and quiet | Deep and quiet |
| Iris: | Flat | Flat |
| Lens: | Clear | Clear |
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