title: Iatrogenic oculocardiac reflex in a patient with head injury.
abstract: A 16-year-old girl with a history of a recent fall from the third floor was transferred to the emergency room. On presentation, the patient, who had sustained multiple facial fractures, was in clinical shock with a blood pressure 80/40 mm Hg, heart rate 130/min, tachypnea (>30/min), Po2 50 mm Hg, and So2 82%, and she was intubated for airway protection. Severe nasal hemorrhage was detected (hematocrit: 22%), therefore a bilateral anteroposterior balloon nasal catheter was inserted and inflated with air. Bleeding was controlled. A few minutes later, her heart rate dropped to 40/min. Atropine was administered intravenously and the rate increased to 60/min. Computed tomography of the head revealed brain and subarachnoid hemorrhage, multiple fractures of the facial skeleton, and a round foreign body, full of air, compressing the left eye. The medial wall and the floor of the ipsilateral orbit were also fractured, establishing a naso-orbital communication. The left catheter was immediately removed. Heart rate was restored to normal. Facial fractures were addressed surgically. Patient's vision is intact.
authors.affiliation: Department of Oral and Maxillofacial Surgery, General Hospital of Attica "K.A.T.," Kifissia, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Stathopoulos
authors.forename: Michael
authors.initials: M
authors.lastname: Mezitis
authors.forename: George
authors.initials: G
authors.lastname: Kostakis
authors.forename: George
authors.initials: G
authors.lastname: Rallis
keywords: balloon nasal catheter; oculocardiac reflex; orbital wall fractures