Painless Loss Of Monocular Vision

In Patients with retinal detachments may present with “flashes,” “floaters,” or a
“curtain” over the visual field. Funduscopic findings may include a pale,
billowing parachute-like fundus, and a retina that appears partially out of focus.

In Patients with vitreous detachments often complain of “flashes” or “floaters.”
Visual loss may not be noted unless there is a retinal tear, vitreous hemorrhage,
or retinal detachment.

In Monocular maculopathy may prompt a loss of central vision, but peripheral
vision often is spared.

In Central retinal artery occlusion can be indicated by a pale retina with cherry-red
macula. These patients require emergent ophthalmologic evaluations and should
be assessed for embolic complications.
In A “blood and thunder” fundus is indicative of central venous artery occlusion,
which warrants urgent outpatient treatment.

In The most concerning etiology of amaurosis fugax is ischemia to the retinal
vessels or optic nerve from giant cell arteritis. These patients may or may not
present with classic temporal cephalalgia; ESR and CRP measurements should
be ordered in any elderly patient with a new headache.

Acetaminophen Toxicity

TABLE 1. Clinical Features at Various Stages of Acetaminophen Toxicity
Stage Clinical Features
Stage I — Preclinical
(0 to 24 hours)
• Minimal to no signs and symptoms
• Nausea, vomiting, general malaise
• Normal liver function tests (possibly)
Stage II — Hepatotoxicity
(24 to 72 hours)
• RUQ pain
• Elevations in AST, ALT
• Possible elevation in bilirubin and coagulation
studies (PT, PTT, INR)
Stage III — Hepatic failure
and encephalopathy
(72 to 96 hours)
• Liver function tests peak
• Jaundice
• Coagulopathy
• Encephalopathy
• Metabolic acidosis
• Pancreatitis (possibly)
• Acute renal failure (possibly)
Stage IV — Survival
or death (>96 hours)
• Full resolution or normalization of liver function
tests, or
• Fulminant liver failure, multiorgan dysfunction
and death
Adapted from Farcy DA, Chiu WC, Flaxman A, et al. Critical Care Emergency Medicine. 1st ed. New York, NY: