Clinical Practice and Cases in Emergency Medicine

Introduction: Physician-in-triage (PIT) models have become increasingly common in emergency medicine. The goal is to facilitate rapid patient evaluation and improve key operational emergency department (ED) metrics. However, there is limited time for the PIT encounter, which often involves an abbreviated patient evaluation. Point-of-care ultrasound (POCUS) has been shown to improve patient care and speed diagnosis in a variety of scenarios. Although physicians working within a PIT model must remain mindful of time constraints, POCUS can help identify time-sensitive diagnoses and guide appropriate initial testing during certain encounters. Ocular POCUS can be particularly impactful on timely diagnosis and appropriate deployment of ED resources.

Case Series: We present three cases of acute monocular vision loss wherein the PIT physician used ocular POCUS to arrive at the correct initial diagnosis. This led to the appropriate deployment of ED stroke and neurology resources in the case of acute central retinal artery occlusion, while avoiding this unnecessary use of these resources in two cases where it was not indicated.

Conclusion: Use of point-of-care ultrasound in PIT models should be thoughtfully employed in cases where immediate diagnosis is required, as well as when POCUS results will likely alter subsequent diagnostic testing pathways. Ocular POCUS in PIT can rapidly differentiate neurologic causes of monocular vision loss from primary ophthalmic conditions.