Open AccessBlurring of Vision with Malaise
Author(s) -
Mansoor Zafar,
Ratan Randhawa,
Barnaby PeacockYoung,
Reem Eldebri,
Umesh Dashora
Publication year - 2021
Publication title -
journal of the royal college of physicians of edinburgh/the journal of the royal college of physicians of edinburgh
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.275
H-Index - 26
eISSN - 2042-8189
pISSN - 1478-2715
DOI - 10.4997/jrcpe.2021.112
Subject(s) - malaise , thrombolysis , medicine , crew , medical emergency , emergency department , infective endocarditis , blurred vision , intensive care medicine , optometry , surgery , nursing , psychiatry , aeronautics , myocardial infarction , engineering
We present the case of a 56-year-old female brought to the Emergency Department via routine ambulance transport with complaints of blurred vision and malaise. She was screened by ambulance crew using the facial arm speech time (FAST) tool and a basic top-to-toe assessment as per current routine. The examining practitioner performed a thorough assessment of the patient, revisiting the initial examination findings, and establishing new clinical features of visual field deficit and pan-systolic murmur. The likely diagnosis of septic emboli or stroke with infective endocarditis was identified through the power of rigorous history taking and examination. These were then supported by investigation with blood tests and imaging. This prompted discussion with a tertiary centre and subsequent transfer for further investigation and management. The patient’s journey shows that there may indeed be a role for a more comprehensive (but not exhaustive) initial screening from ambulance services in order to help appropriately stream specific patients to hospital in a timelier manner (to meet the thrombolysis window). This case supports the addition of V (visual fields) to the FAST screening tool.