Treat 'em and Street 'em
I worked evening clinic last night, something that I do three days a week. Since people rarely get sick from 8 to 5, having some after-hour appointments has greatly improved the services we provide for our patients. In the past, the medical group would send people to the urgent care facilities or the emergency room. Although a child with an ear infection is not considered a life-threatening problem, it is something that should be managed promptly. Last night we were not particularly busy, so I had a rare opportunity of spending 45 minutes with a worried mother holding a child with a 103 fever and a suspected ear infection. The child actually had a viral infection, so there was little that I could do to shorten the course of this illness, but the time that I spent with this worried patient was invaluable. The mother left with some new knowledge about the therapeutic advantages of fever (she thought there would be brain damage at 103), that children who pull their ears do not necessarily have an ear infection (boys often pull their penises and they don't have a penis infection!), and that fever-causing viral infections are something that children about 6-9 times per year, mostly in the fall/winter months.
Emergency rooms are geared for emergencies - things that may cause a loss of life or limb. When a child comes in at 10 PM with a possible ear infection, they are triaged, often to the bottom of the list. People often do not understand how the triage process works - the sicker patients are seen first; not first come/first serve. Basically, a child and their sleep-deprived parent could sit there for hours waiting for their turn, only to be trumped by an alcoholic with a minor head injury brought in by the police. The longer a family waits, the more frustrating a simple encounter becomes. Having worked both in emergency rooms and urgent care facilities in the past, I know what it is like to finally face a ticked-off mother with a crying, ear-pulling child. After waiting hours, many ER medical providers will quickly make a diagnosis, and basically "treat 'em and street 'em".
I cannot tell you of the number of bogus ear infection diagnoses that come out of busy emergency rooms. It is certainly time-efficient and easy for a provider to say, "Yes, your child has an ear infection. Here is a prescription for amoxicillin", but many times, this diagnosis is pure bull! When you see the same child five hours later in your clinic, before they have even had one dose of an antibiotic, this "ear infection" seems to have miraculously resolved. Now, granted, the child's eardrum could have been red, and some ear infections are so darn obvious after a one-second look that the diagnosis is a no-brainer, but many ear-infection diagnosed children do not have either of these. Why? The child had a fever. Fever causes in increase in blood flow, and blood is RED!
Crying can also make the eardrum red. Diagnosing a middle ear infection is more than just checking for the color of the eardrum...you also need to check for mobility. Many ear infections will not cause the eardrum to be red; some can be yellow, but all children with middle ear infections have a decreased mobility (movement) of their eardrums. It only takes a few extra seconds for a medical provider to puff a little air from a bulb syringe attached to the otoscope to observe for movement of the eardrum. This is called pneumatic otoscopy and it is infinitely more accurate than simply looking at the color of a crying, feverish child's eardrum.
A pneumatic otoscopy is "standard of care" for making a diagnosis of a middle ear infection, but I bet many families have not seen their medical providers use it. ER medical providers, at least the ones that I have seen over the last 30 years, RARELY use a pneumatic otoscope....takes too much time. More importantly, many of those medical providers that have the "treat 'em and street 'em" mentality will not spend the time to explain to a parent that their child does NOT have an ear infection....takes too much time. After hours in a busy, scary ER waiting room, a parent wants to just get out of there. After a long-shift in the ER, the provider may have the same goal.
If medical care was this easy and straight-forward, we would have drive-up windows and antibiotic vending machines.
So, what am I proposing? First, if your child has an ear infection, try and stay out of the ER. Treat the EAR PAIN at home with an appropriate dose (based on weight) of acetaminophen or ibuprofen. Ask your medical provider for a bottle of pain-relieving eardrops (like Auralgan) to have on hand for these after-hour events. Buy a good home otoscope and learn how to use it....this additional information is invaluable. And, finally, see your own medical provider - someone that knows your child - as soon as you can, the next morning, to properly manage this problem. A better philosophy would be to "treat 'em and teach 'em".
Related Topics:Should I Give My Child Antibiotics For An Ear Infection?, Signs and Complications From An Ear Infection
Emergency rooms are geared for emergencies - things that may cause a loss of life or limb. When a child comes in at 10 PM with a possible ear infection, they are triaged, often to the bottom of the list. People often do not understand how the triage process works - the sicker patients are seen first; not first come/first serve. Basically, a child and their sleep-deprived parent could sit there for hours waiting for their turn, only to be trumped by an alcoholic with a minor head injury brought in by the police. The longer a family waits, the more frustrating a simple encounter becomes. Having worked both in emergency rooms and urgent care facilities in the past, I know what it is like to finally face a ticked-off mother with a crying, ear-pulling child. After waiting hours, many ER medical providers will quickly make a diagnosis, and basically "treat 'em and street 'em".
I cannot tell you of the number of bogus ear infection diagnoses that come out of busy emergency rooms. It is certainly time-efficient and easy for a provider to say, "Yes, your child has an ear infection. Here is a prescription for amoxicillin", but many times, this diagnosis is pure bull! When you see the same child five hours later in your clinic, before they have even had one dose of an antibiotic, this "ear infection" seems to have miraculously resolved. Now, granted, the child's eardrum could have been red, and some ear infections are so darn obvious after a one-second look that the diagnosis is a no-brainer, but many ear-infection diagnosed children do not have either of these. Why? The child had a fever. Fever causes in increase in blood flow, and blood is RED!
Crying can also make the eardrum red. Diagnosing a middle ear infection is more than just checking for the color of the eardrum...you also need to check for mobility. Many ear infections will not cause the eardrum to be red; some can be yellow, but all children with middle ear infections have a decreased mobility (movement) of their eardrums. It only takes a few extra seconds for a medical provider to puff a little air from a bulb syringe attached to the otoscope to observe for movement of the eardrum. This is called pneumatic otoscopy and it is infinitely more accurate than simply looking at the color of a crying, feverish child's eardrum.
A pneumatic otoscopy is "standard of care" for making a diagnosis of a middle ear infection, but I bet many families have not seen their medical providers use it. ER medical providers, at least the ones that I have seen over the last 30 years, RARELY use a pneumatic otoscope....takes too much time. More importantly, many of those medical providers that have the "treat 'em and street 'em" mentality will not spend the time to explain to a parent that their child does NOT have an ear infection....takes too much time. After hours in a busy, scary ER waiting room, a parent wants to just get out of there. After a long-shift in the ER, the provider may have the same goal.
If medical care was this easy and straight-forward, we would have drive-up windows and antibiotic vending machines.
So, what am I proposing? First, if your child has an ear infection, try and stay out of the ER. Treat the EAR PAIN at home with an appropriate dose (based on weight) of acetaminophen or ibuprofen. Ask your medical provider for a bottle of pain-relieving eardrops (like Auralgan) to have on hand for these after-hour events. Buy a good home otoscope and learn how to use it....this additional information is invaluable. And, finally, see your own medical provider - someone that knows your child - as soon as you can, the next morning, to properly manage this problem. A better philosophy would be to "treat 'em and teach 'em".
Related Topics:Should I Give My Child Antibiotics For An Ear Infection?, Signs and Complications From An Ear Infection
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