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About Laryssa Patti, MD

Assistant Professor
Emergency Medicine Clerkship Director
Department of Emergency Medicine
Rutgers - Robert Wood Johnson Medical School

SAEM Clinical Images Series: Ocular Trauma Following Ground Level Fall

eye

The patient is an 82-year-old female who presents to the Emergency Department after an unwitnessed fall from standing approximately 2 hours prior to arrival. The patient states that she thinks she lost her balance and fell, striking her face. She denies loss of consciousness or any antecedent dizziness or presyncopal symptoms, but has limited recollection of the event. At presentation, she reports pain to the left side of the face, a laceration to the left side of her face, and decreased vision in her left eye. She has no other complaints at this time and denies any other injuries.

Vitals: BP 184/86 HR 83 R 17 T 98.4 O2sat 85% room air

General: Awake, alert, conversational, and in mild distress from pain.

HEENT: 2cm laceration over the left temple. Eye exam physical findings as shown in the image provided. Visual acuity 20/30 OD, 20/100 OS. Visual fields intact. Extraocular movement intact. Right pupil reactive to light. Left pupil non-reactive to light. Tympanic membranes clear. Examination otherwise unremarkable.

This patient has a hyphema, uveal prolapse, iridodialysis, teardrop pupil, and subconjunctival hemorrhage.

This patient has a ruptured globe.

This patient has a ruptured globe with multiple significant traumatic eye findings on examination. The clinical image shows a globe rupture with the iris prolapsing through a corneal defect at the 2 o’clock position, an irregularly shaped (teardrop) pupil, a hyphema, iridodialysis (separation of the iris from the ciliary body), and a subconjunctival hemorrhage. CT is specific for diagnosing a globe rupture, but a negative CT scan does not definitively rule out a globe rupture. Management of globe rupture includes emergent ophthalmologic consultation, firm ocular shield, antibiotics, and tetanus prophylaxis if indicated. The initial ED management of a globe rupture should focus on preventing further expulsion of additional intraocular material. Anti-emetics should be given to prevent vomiting, which may cause a sudden rise in intraocular pressures and expulsion of intraocular contents.

Take-Home Points

  • Do not put any pressure on the eye in cases of suspected globe injury. Commercial firm ocular shields are available, but the bottom of a Styrofoam or Dixie cup can be used if such a shield is unavailable.
  • Emergency Department treatment is aimed at expediting emergent ophthalmology consultation and definitive management while minimizing further damage to the eye.

  • Romaniuk VM. Ocular trauma and other catastrophes. Emerg Med Clin North Am. 2013; 31(2): 399-411. PMID: 23601479. DOI: 10.1016/j.emc.2013.02.003.
  • Mohseni M, Blair K, Gurnani B, Bragg BN. Blunt eye trauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. PMID: 29261988.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2025 SAEM Annual Meeting | Copyrighted by SAEM 2025 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.

By |2025-12-12T14:01:11-08:00Dec 15, 2025|Emergency Medicine, Ophthalmology, SAEM Clinical Images|
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How I Work Smarter: Laryssa Patti, MD

One word that best describes how you work?

Organized chaos (that’s 2 words)

Current mobile device

iPhone XS

Computer

2020 13″ Macbook Air + iPad with keyboard as a second monitort

What is something you are working on now?

Incorporating FOAM into our EM clerkship

How did you come up with this Idea/Project?

COVID decided for me — we’re working on a way to keep students engaged even though we’re still semi-distance learning. Additionally, I want to send my students into residency knowing that FOAM exists but needs to be assessed in the same way we think about peer reviewed literature.

What’s your office workspace setup like?

I have an office at our medical school that is a big flat surface in a square room with an internet connection. All of the art on the walls is of landscapes, no diplomas! It is off the beaten path (and also around the corner from the hospital Starbucks), which makes it a great place to get work done.

Since COVID, I’ve been doing the majority of my non-clinical work at home with essentially the same set up, but including a cat.

What’s your best time-saving tip in the office or home?

Everything goes into my Google calendar. If I need 30 minutes to read articles for our department journal club or food shopping, it goes in my calendar. It keeps me honest and on top of my to-do list. I try to protect a certain morning/afternoon a week (this year it’s Tuesday afternoon) for my own projects and writing and will defend that time from other obligations. I am still learning that I probably need 1.25-1.5x more time than I think to achieve any goal, though.

What’s your best time-saving tip regarding email management?

I am an inbox zero person. The 5 digit unread email number of one of my good friends gives me palpitations. My Gmail automatically sorts emails into buckets (e.g., advertisements, bills) so that my actual inbox is only emails that need immediate attention. If I can give a response immediately, I will. If I need more time to research an answer, I’ll reply as much, and stick it on my calendar to come back to. I’ve also really leaned into “snoozing” emails in both Gmail and Outlook. Things like the didactic conference schedule for this week or the agenda for a meeting later this week will get snoozed until 30 minutes before that time. Similarly, I schedule a lot of emails to be sent (like the medical student schedule that we send out weekly) so that I can put in a little bit of effort upfront and then trust Outlook to send that to faculty at a certain time.

What apps do you use to keep yourself organized?

Gmail, Tasks, and Google Calendar primarily. And also the notes app on my phone for random things that I don’t want to forget that come to me while driving or in the middle of the night.

How do you stay up to date with resources?

I subscribe to a few journal aggregators that send me weekly summaries of new articles and, of course, the EM:RAP and Twitter FOAM universe that sends me back to primary sources.

What’s your best time-saving tip in the ED?

Enter orders and write/dictate at least HPI/PMH after every patient. Every time I try to stack a bunch of patients (even low acuity ones) I end up getting interrupted and realize that I’m more behind than I thought.

ED charting: Macros or no macros?

Macros, with cautions. I have some standard physical exam and discharge instructions, but only use them for specific patients.

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

    Say no to things after your first year out. Once you know what you like, ask yourself: is the time/effort required to participate in [admissions committee/ interdepartmental project / extracurricular project] worth what you get out of it? If the answer is no, don’t do it. If the thing that you get out of it is rest/relaxation that is a valid reason.

  • What advice would you give other doctors who want to get started, or who are just starting out?

Say yes to things your first year out. This helps you meet people and learn about different niches that you can fill. But you can’t do this forever (see answer above).

  • Is there anything else you’d like to add that might be interesting to readers?

Accept that things will not go according to plan and forgive yourself. One of the best things that I did in the last month was blow off a long meeting in that I had nothing much to add besides being a member of the quorum in order to go on a walk and watch a movie with my husband. I came back to work re-energized and was much more productive the next day. Totally worth it.

In the same vein, I’m a new mom and still struggling to find a balance between being home and present, clinical work, and non-clinical work, and am continuing to remind myself that as much as my son is growing, I am growing too! (Some days work out better than others).

Who would you love for us to track down to answer these same questions?

  • Eric Blazar (@eblazar)
  • Sugeet Jagpal (@ysugeety)

Read other How I Work Smarter posts, sharing efficiency tips and life advice.

By |2021-05-17T06:44:59-07:00May 19, 2021|How I Work Smarter, Medical Education|
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Banishing Busy: Part 3

banishing busy

Medical professionals are busy people and exist in a constant state of “being busy.” How do we resolve chronic “busy-ness”? How do we manage our time effectively? In her recent talk at the CORD Academic Assembly 2020, Dr. Christina Shenvi, EM Physician and Associate Residency Director at UNC, provided 5 key actions to help us be productive, complete our work effectively, and strive for work-life balance. Dr. Shenvi recorded her lecture again to be shared with the ALiEM Faculty Incubator. This series of posts breaks down her talk into 3 sections in order to summarize her key points and to help us “Banish Busy” from our lives. This third post will address how to take control of our time.

(more…)

By |2020-07-10T10:48:16-07:00Jul 17, 2020|Life, Professional Development|
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Introducing: GroundED in EM a 4 week asynchronous curriculum for 3rd year students

A group of educators from our ALiEM Faculty Incubator 2020 class has created a 4-week virtual introduction to Emergency Medicine curriculum for 3rd-year medical students called Grounded in EM!

Think back, back to March 2020: you were a medical student, happily rotating through core specialties, considering Emergency Medicine, and then WHAM! The coronavirus pandemic pulled the rug out of your regularly scheduled 3rd year. Or, you were a program looking forward to a “business as usual” approach to your 3rd-year EM clerkship. Now, you’ll have limited face to face time, and are wondering “How do we provide the same general em content?”

Are you still considering emergency medicine? Are you worried that your fragmented clinical experience is leaving you unprepared for your rotations in an Emergency Department near you? Are you a program looking for an answer to provide a great EM learning experience? This is the curriculum for you!

Target Audience: Third-year medical students who haven’t committed to Emergency Medicine, but are interested in being introduced to the field AND programs looking to have a comprehensive and ready-made EM related content for MS3’s rotating this academic year.

What: A 4-week completely asynchronous and virtual curriculum containing FOAM resources, including blog posts, podcasts, webpages, and interactive modules, based on the ACGME core competencies. Each module includes a short quiz to test immediate knowledge retention, and the end of the week choose your own adventure case.

Where: Hosted on ALiEM.com

When: Curriculum release on July 1st

Benefits: Walk into your EM rotations feeling confident that you will know how to approach the undifferentiated patient, make a differential, talk to people about it, and write it down, in a compassionate and patient-centered way! Programs can have their students do this curriculum in parallel with their clinical shifts during their 4-week rotation.

Over four weeks, we will cover:

  1. How to approach undifferentiated and acutely ill adult and pediatric patients (Patient Care and Clinical Reasoning)
  2. An introduction to the flow and system of the Emergency Department (System Based Practice)
  3. Communication strategies in Emergency Medicine, both with written and verbal and with EM physicians, consultants, and patients (Interpersonal and Communication Skills)
  4. Professionalism, medical ethics, and patient-centered issues that arise in the Emergency Department (Professionalism)
  5. Creating a differential diagnosis for both common and life-threatening patient presentations (Medical Knowledge)
  6. Exposure to key Emergency Medicine content areas such as resuscitation, evaluation, diagnostics interpretation, and management of common ED presentations (Medical Knowledge, Practice-Based Learning and Improvement)
  7. Development of procedural skills, including suturing, vascular access, as well as EM tricks of the trade. (Medical Knowledge, Practice-Based Learning and Improvement)

We can’t wait to have you join us on GroundED In EM!

By |2020-06-30T14:48:03-07:00Jul 4, 2020|Academic, Medical Student|
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Banishing Busy: Part 2

banishing busy

Medical professionals are busy people and exist in a constant state of “being busy.” How do we resolve chronic “busy-ness”? How do we manage our time effectively? In her recent talk at the CORD Academic Assembly 2020, Dr. Christina Shenvi, EM Physician and Associate Residency Director at UNC, provided 5 key actions to help us be productive, complete our work effectively, and strive for work-life balance. Dr. Shenvi recorded her lecture again to be shared with the ALiEM Faculty Incubator. This series of posts breaks down her talk into 3 sections in order to summarize her key points and to help us “Banish Busy” from our lives. This second post will discuss seven ways to avoid self-sabotage.

(more…)

By |2020-08-25T18:03:30-07:00Jul 3, 2020|Life, Professional Development|
Read More

Banishing Busy: Part 1

banishing busy

Medical professionals are busy people and exist in a constant state of “being busy.” How do we resolve chronic “busy-ness”? How do we manage our time effectively? In her recent talk at the CORD Academic Assembly 2020, Dr. Christina Shenvi, EM Physician and Associate Residency Director at UNC, provided 5 key actions to help us be productive, complete our work effectively, and strive for work-life balance. Dr. Shenvi recorded her lecture again to be shared with the ALiEM Faculty Incubator. This series of posts breaks down her talk into 3 sections in order to summarize her key points and to help us “Banish Busy” from our lives. This first post will address the importance of value-based scheduling and how to avoid self-sabotage.

(more…)

By |2020-08-25T18:02:15-07:00Jun 26, 2020|Life, Professional Development|
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Making Heads or Tails of the Flipped Classroom: Tips and Tricks for Students

Now more than ever, medical educators are excited about the flipped classroom, defined by Bishop and Verleger as “a new pedagogical method, which employs asynchronous video lectures and practice problems as homework, and active, group-based problem-solving activities in the classroom” [1]. The premise is that students will learn basic concepts during self-study, at their own pace, and come to the classroom ready to dive into small groups and problem-based application [2].

This approach may be unfamiliar and you may find yourself asking: 

  1. Why should I care? 
    and
  2. How do I get the most out of it?

Let’s begin with the first question. Several studies looking at the flipped classroom conclude it is good for your learning. Though it may initially be perceived as extra work, once the student realizes that the work just replaces the after-class homework they used to do, students’ report a generally high satisfaction, and high engagement with the in-class activity [3-6]. The flipped classroom can make you a more effective “lifelong learner.” While assessing learning efficacy is challenging, some studies have shown improvements in analytical and problem-solving skills in students who come prepared and fully engage in the in-class activities [3,7]. 

As for the second question, to ensure that you get the best flipped classroom experience, we compiled a list of must-do steps to engage with this educational strategy successfully.

Tips and Tricks:

Prepare (yes, really)

The proverbial wisdom that “by failing to prepare, you are preparing to fail” holds true with this pedagogy. Don’t walk through the door if you haven’t done the prep work. Assigned videos and podcasts are not just “suggestions,” but rather the building blocks for your in-class time. The point of the flipped classroom is for you to do the “easy stuff” at home and the harder, application-type activities, with your educator present. It’s essential that you complete them prior to class. Think of it as doing the classwork at home, and the homework in class! By reviewing material ahead of time you will be ready to ask clarifying questions and grasp higher-level concepts, in order to make the best use of your teacher’s direct attention.

Don’t skip ahead (or you’ll end up behind)

With access to the learning material online, you may be tempted to “skip ahead” to answers. However, the course will often build on itself and part of the learning process will be to work through application problems with only the information you have at the moment. Future sessions may allow a second-look with a new lens, so staying true to the current schedule is best. Similarly, allowing yourself to fall behind and expecting to catch up later will put you at a disadvantage during the in-person sessions.

Commitment (like any good relationship)

In order to bring a complex topic to a class, there are often multiple moving parts for a flipped classroom activity. If you’re set up in a team, designate 1-2 classmates to hold the rest of your team accountable for the work that you need to get done and the deadlines that you need to complete. Rotating responsibilities part of the way through the course will allow every member to experience different roles. If you’re not working in a team, find an accountability buddy and commit to keeping each other on task and on schedule, so that you can come to your in-class sessions as prepared as you can be.

Feedback (talk to me!) 

Let’s face it, you’ve spent a lot of time searching for useful learning resources and have probably found some gems. Instructors may not have known about a great new video or podcast when the material was compiled. Let them know what you’ve found and why you think that it’s a helpful resource for your classmates. Sometimes what you’ve found will help make the next class better, or can be added as supplemental material. Remember that you appreciate high-quality feedback and your instructors aren’t much different. 

How do you get to Carnegie Hall? (Answer: practice, practice, practice) 

It may be the case that concepts being discussed during a flipped classroom setting seem far removed from clinical practice, especially in the pre-clinical years when you are fully immersed in the basic sciences. The key is practice. In the flipped classroom, the skills acquired through dedicated medical topics, learning how to navigate the vast amount of resources available, working as a team, and dissecting problem-solving challenges will help you in the clinical setting. Be intentional about the skillset you’ve acquired and apply it to past/present/future patients. 

For example, if you learned about risk stratification tools for chest pain during a class, the next time you encounter a virtual case, a standardized patient, or a real patient with chest pain you’ll know if you can apply the TIMI/HEART/Well’s/PERC scores and how to access them online. After calculating the score, you will be able to convey to your attending, admitting team, and consultants your clinical decision-making and application of evidence-based medicine. Bringing your knowledge to the bedside helps solidify the classroom learning and connect it to real live patients which will help you grow as a clinician. 

Want to learn more about the pedagogy of the flipped classroom?  And here’s a great example of curated resources for an emergency medicine intern level flipped classroom by @EMFundamentals.

What do you think? Are there other ways that you as a student have made flipped classroom successful for you? Leave us a comment below or @ALiEMFac on Twitter to let us know! 

Blog post edited and curated by:

Mark Ramzy, DO
Faculty Incubator Multimedia and Communications Editor

References

  1. Bishop, J., & Verleger, M. A. (2013). The Flipped Classroom: A Survey of the Research. In 2013 ASEE Annual Conference & Exposition. Atlanta, Georgia. 
  2. Huu Anh Vuong, Nguyen et al. Students’ Perceived Challenges of Attending a Flipped EFL Classroom in Viet Nam. Theory and Practice in Language Studies. 2018.
  3. Sait MS,et al. Advances in medical education and practice: student perceptions of the flipped classroom. Adv Med Educ Pract. Published May 2017; PMID: 28496377
  4. Young TP, et al. The Flipped Classroom: A Modality for Mixed Asynchronous and Synchronous Learning in a Residency Program. West J Emerg Med. 2014. PMID: 25493157
  5. King AM, et al. Flipping the Classroom in Graduate Medical Education: A Systematic Review. J Grad Med Educ. Feb 2019; PMID: 30805092 
  6. Smallhorn, M. The flipped classroom: A learning model to increase student engagement not academic achievement. Student Success, 2017.
  7. White PJ, et al. Student Engagement with a Flipped Classroom Teaching Design Affects Pharmacology Examination Performance in a Manner Dependent on Question Type. Am J Pharm Educ. 2017; PMID: 29302082

By |2019-11-29T18:31:31-08:00Nov 29, 2019|Academic, Incubators, Medical Education|
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