« 2007年9月 | トップページ | 2007年11月 »

2007年10月22日 (月)




Hi my friends, Below is some info for ophthalmoscope technique. Applicable to panoptic as well.


From my stand point, common mistakes for using a direct ophthalmoscope are below...

Mistake 1) Choosing a bright light.

It is very important that a pt can tolerate the brightness of this exam. I will chose the least bright and smallest light so that he or she can tolerate longer.

Mistake 2) Have a pt look straight.

It is important to get your patient to fixate on a precise area (for example, the corner of the room or curtain rail). If you are too vague about this they will move their eyes. Instruct the patient to look at this spot no matter what-even if you get in the way. This spot should be located so that they are looking slightly away from you when they are examined-that is, to the left when you examine the right eye and vice versa.

Mistake 3) Do not pay attention to your and his or her refractive errors.

Often the examiner try to take his or her glasses off. Also pt's glasses might be off. If you can examine both glasses on, probably that is the best way because you don't have to correct refractive errors. If you need get pt's glasses off, I will recommend you to estimate their diopters by using cheating sheet below from his or her visual acuity. That way you can have good estimation about how many diopter dial you will move.

Often time examiner will get close to the pt's face, and dial 4-5 diopters. Looking at the cheating sheet below, you will see how far you will go if you dial 4-5 diopters. If you are using your glasses on, I will recommend keep them on. If you need to take that off. You need make sure that you will adjust diopter prior to looking at pt.

-The dial is green for +, red for - for your reference.-

Refractive Error Myopia in Diopters Approximage Unaided Visual Acuity

-.50 D 20/50

-1.00 D 20/100

-2.00 D 20/200

-3.00 D 20/300

-4.00 D 20/400

-5.00 D 20/500

-6.00 D 20/600

-7.00 D 20/700

-8.00 D 20/800

-9.00 D 20/900

-10.00 D 20/1000

These approximations apply to nearsighted (myopia) patients wearing glasses. Obviously I am not good at ophthalmoscop technique and the info above could contain errors, feel free to give me any inputs. Thank you very much!


*参考 ウェブで見つけた説明のコピーです。

※なお分母の視標の番号は小数視力1.0の人がその視標をかろうじて判別できる距離になっています。20/40 の場合は小数視力1.0の人は40フィートの距離からその視標を判別できる事になります。

2007年10月17日 (水)







2007年10月14日 (日)




Practical Implementation of the Guidelines for Unstable Angina/Non ST-Segment Elevation Myocardial Infarction in
the Emergency Department

A Scientific Statement From the American Heart Association Council on Clinical Cardiology (Subcommittee on Acute
Cardiac Care), Council on Cardiovascular Nursing, and Quality of Care and Outcomes Research Interdisciplinary
Working Group, in Collaboration With the Society of Chest Pain Centers

Circulation. 2005;111:2699-2710.

Prospective Validation of the San Francisco Syncope Rule to Predict Patients With Serious Outcomes.
Ann Emerg Med. 2006; 47:448 - 454.

Do Emergency Department Blood Cultures Change Practice in Patients with Pneumonia?
Annals EM 2005; 46: 393-400.

Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial.
JAMA. 2004 May 19;291(19):2328-34.

Wait and See Prescription for the Treatment of Acute Otitis Media. JAMA. 2006; 296,(10):1235-1241.

Fever without Source in Children 0 to 36 Months of Age. Pediatric Clinics of North America. 2006; 53: 167-194.

Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic S
2001 Volume 345:1368-1377
Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock. Crit Care Med. 2004;32
Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired
pneumonia. N Engl J Med 1997; 336:243-250.

Prediction of pulmonary embolism in the emergency department : The revised geneva criteria
Ann Intern Med 2006;144:165-171

2007年10月 2日 (火)







« 2007年9月 | トップページ | 2007年11月 »