VO EMERGENCY PROTOCOL
Emergency Triage & Intervention
VO Emergency Protocol — Project Perfusion
1
Immediate Action & Triage
- STOP INJECTING IMMEDIATELY. Stay calm and breathe — it's going to be ok.
- VISION CHECK: Ask the patient to cover one eye at a time. If ANY vision loss, blurriness, or ocular pain: CALL 911 / TRANSFER TO EMERGENCY OPHTHALMOLOGY IMMEDIATELY.
- ASSESS: Check for disproportionate pain, immediate blanching, livedo reticularis (mottling), and slow capillary refill.
- DELEGATE: Assign an assistant to be the "Scribe" to log times, doses, and take serial photographs.
2
The Hyaluronidase Protocol
Do NOT wait for allergy testing in an emergency.
| Action | Dosage / Instruction | Frequency |
|---|---|---|
| INJECT | 1500 IU into and around the ischemic area. (Use ultrasound if available). | Every 15–20 min |
| MASSAGE | Vigorously massage the tissue after injecting. | Continuous / After each dose |
| MONITOR | Check capillary refill and tissue color. | Before every new dose |
| CONTINUE | Repeat until perfusion normalizes. | Often takes 60+ min |
3
Adjunctive Therapy — Give Simultaneously
- ASPIRIN: Administer 325 mg orally immediately (prevents secondary clotting).
- HEAT: Apply warm compresses continuously (promotes vasodilation).
Controversial: Nitroglycerin paste or Sodium Thiosulfate.
4
Documentation Checklist — For the "Scribe"
- Take baseline time-stamped photo before the first hyaluronidase injection.
- Log exact time of symptom onset.
- Record exact time and IU dosage of every injection round.
- Take progress photos every 15 minutes to track tissue color changes.
Critical Alert
Anaphylaxis Watch
High, repeated doses of hyaluronidase increase the risk of severe allergic reaction.
Watch for: Widespread hives, shortness of breath, wheezing, rapid facial/tongue swelling, or sudden dizziness/hypotension.
Immediate Action:
- Inject Epinephrine 0.3 mg IM into the anterolateral thigh.
- Call 911 immediately.
- Lay the patient flat with legs elevated (unless breathing is impaired).
- Administer antihistamines/steroids only after Epinephrine and securing the airway.