Here are the 5 questions for this week. How did you go?

1 Your department is very busy, with over 20 people waiting to be seen. one of the patients that has been waiting for 3 hours is a category 5. His triage is 'headache for one week and a red eye'. what do you do?
​click on the answer you think is correct

(a) You pick up the patient out of turn as he will exceed his 4 hour waiting time and your NEAT targets are suffering

No. As much as the bean counters will embrace-you longing for this, it's a good thing to do, but not the right answer.

(b) You pick up the next patient to be seen

Well done! You did the wrong thing for the right reasons. You are a reasonable person, that follows the rules. The reasonable person abides by the rules of the world and then there can never be progress. It is the unreasonable person that makes the world bend to there will and forces change. This is an old Twain quote.

(c) Headache and eye signs should be seen earlier

CORRECT! This is a potential case of glaucoma that can be missed with dire consequences. All patients with headache and eye signs should be given a higher triage score or at least be discussed with the team leader. 

He had a ciliary flush and a cloudy cornea.
Visual acuity is decreased.
Pupil was not reactive.
On fluorescein staining, there was nothing to see.
He had ‘compartment syndrome of the eye’ – angle closure glaucoma.
The definitive diagnosis is made by taking pressures. This also differentiates it from keratitis.
We used a  ‘tono-pen’, for pressures, but it kept reading error.  Then the penny dropped. I measured the pressure in the good eye and it was 11. The pen wasn’t measuring pressure as it was too high.
Next to treatment – acetazolamide 500mg IV, Timolol eye drops and alphagan eye drops, then transfer for definitive treatment under ophthalmology.

(d) This could be an example of bietti's crystalline dystrophy, which you remember reading at medical school. it is sometimes also known as usher syndrome. it is a medical emergency

 Sorry, tis the wrong answer. The conditions are real, but don't relate to each other, nor to this patient.