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Finding EXTRAordinary in the Ordinary

Christian Casteel, DO is the Assistant Professor of Emergency Medicine at Rush University Medical Center and practicing emergency physician at Rush Copley Medical Center in Aurora, Illinois.

Reason for Visit:
Trauma patient presenting with significant periorbital swelling, facial lacerations, and concern for eye injury.

Patient Outcome:
The patient was diagnosed with a retrobulbar hematoma. Dr. Casteel performed an emergency lateral canthotomy to relieve dangerously elevated ocular pressure, preserving the patient’s vision. He was transferred to a Level I trauma center and discharged the next day in good condition.

 

 

Christian Casteel, DO, smiling in business casual attire, headshot over hospital corridor background. Christian Casteel, DO, smiling in business casual attire, headshot over hospital corridor background.

EXTRAordinary Care

While working in the low-acuity area of a very busy ED, Dr. Christian Casteel was asked to assess a trauma patient due to limited bed availability. Expecting a more routine case, he immediately noticed severe swelling around the patient’s eye, extensive bruising, and multiple lacerations that raised concern for a retrobulbar hematoma, a condition that can lead to permanent vision loss if not treated quickly.

Because the patient was in too much pain for a thorough exam, Dr. Casteel prioritized rapid imaging, pain control, and swelling reduction. CT imaging confirmed a retrobulbar hematoma with proptosis, and ocular pressure testing showed pressure too high to register, making emergent intervention necessary.

Although he had not performed a lateral canthotomy outside simulation, Dr. Casteel quickly prepared and communicated with the patient, family, nursing staff, and his attending colleagues so the team understood the urgency. He reviewed the key anatomy and procedural steps before beginning this high-acuity, low-occurrence intervention.

The procedure presented challenges, including significant bleeding and swelling that made visibility and retraction difficult. With coordinated support from his colleagues, Dr. Casteel relied on tactile landmarks to locate the canthal tendon and successfully decompress the orbit. After the procedure, the patient’s ocular pressure normalized.

Dr. Casteel later followed up with the patient’s family and learned he had been discharged within a day, was recovering well, and was scheduled for outpatient follow-up. His family expressed deep gratitude, sharing that the surgeon told them the intervention preserved the patient’s vision. This made the case especially meaningful for Dr. Casteel, who rarely has the opportunity to hear outcomes directly from patients.

“Dr. Casteel consistently demonstrates excellent clinical judgment and composure in high-acuity situations. Beyond his technical skill, he is a supportive and trusted colleague who earns the respect of the entire team.”

Richard Rechenmacher, MD

Medical Director, Rush-Copley Medical Center

Hospital Partner

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Rush Copley Medical Center, located in Aurora, Illinois, is a 33-bed hospital with a 19-bed main emergency department and 14 Express Care beds. The center treats approximately 50,000 patients in the ED each year and performs more than 15,000 surgical procedures, many using state-of-the-art robotic technology. The hospital is home to the only Level III NICU in Kane County and provides high-quality, safe care for the greater Fox Valley community. Aurora offers a suburban setting just outside Chicago, combining small-town charm with access to big-city amenities.