| |
EM Forum Case #97 "A Pain in the Rear and Ear"
by Charlene Babcock Irvin, MD, FACEP
 |
|
An 11 y/o female presents with her mom complaining of ear pain. She is on the summer swim team and frequently gets ear infections. This one is particularly bad as the pain is quite severe. Mom also describes a ’boil’ on her buttock, and shares with you that she has no insurance and is worried about the expense of the ED visit.
PE: Normal Vital signs, and exam remarkable only for:
Obesity: Weight approximately 170 lbs, height 4’10”inches. (BMI=35.5)
There is pain on traction of the right pinna. The right ear has significant swelling to the external canal. TM is not visualized because of the significant swelling. Some lymph nodes are palpable. Otherwise, HEENT is unremarkable.
Back: Small 1 inch fluctuant abscess with surrounding 1 inch of erythema on buttock cheek. Tender to touch, consistent with small abscess with surrounding cellulitis.
Questions:
1. How can you be sure the antibiotic drops for the otitis media will get into the ear with all of the swelling in the canal? If you decide to use cortisporin otic drops, should you use the suspension or the solution? Are there any adverse side effects from using cortisporin? What can mom do to prevent any future otitis externa?
2. If you decide to treat the buttock cellulitis with antibiotics, where can you suggest this patient go for free antibiotics? What drug stores offer discounted medications?
3. Do you need to pack the abscess after you drain it?
4. Is there anything else besides the medications for the ear and draining the abscess you can do for this child?
Click here for answers and to respond
|
|
Previous Articles
"Sickly Obstruction" (09/09/09)
"It’s Higher than You Think" (09/02/09)
"Jump Up and Down!" (08/24/09)
"Ready Or Not, Here He Comes!" (08/17/09)
"Passed Out in a Running Car" (08/10/09)
"Limp and Pale" (08/03/09)
"Hot and Hyper" (07/29/09)
"An Exertional Headache" (07/22/09)
"Do you remember that patient?" (07/15/09)
"My Aching Back" (07/09/09)
"The Mat Bat" (06/30/09)
"Guns and Roses" (06/23/09)
"Not a Simple Cough!" (06/16/09)
“Wrong Chief Complaint” (06/10/09)
“Bellyache!” (06/03/09)
“Midnight Willies!” (05/27/09)
“The Delicate Discussion” (05/19/09)
“Time is Tooth” (05/12/09)
“Do I Have the Swine Flu?” (05/02/09)
“Red and Getting Worse..Fast” (04/29/09)
“A Really Bad Sore Throat” (04/22/09)
“Sweet and Sour and Sick!” (04/15/09)
“Will She Do It?” (04/08/09)
“Be Prepared!” (04/01/09)
“Blood is Sweet, Fluids Replete!” (03/25/09)
“Surprise, Surprise!” (03/18/09)
“Whole Lotta Shaking Going On!” (03/11/09)
“The Hot Engineer” (03/0409)
“The Sleeping Baby Doll Angel” (02/26/09)
“Staying Alive’ and Keeping it Cool” (02/19/09)
“She FOOSHed!” (02/11/09)
“Off the Merry-Go-Round” (02/03/09)
“Stuck On You!” (01/27/09)
“Can I Have a Sandwich Now?” (01/20/09)
“Scared to Death…” (01/12/09)
“The Last Cruise” (12/30/08)
“Flying Too High!” (12/23/08)
“Trauma - Sweet and Salty Issues” (12/16/08)
“Sticky Bun Plus One” (12/09/08)
“Party Hearty, Now Sorry!” (12/02/08)
“This Pain is Killing Me!” (11/18/08)
“One Flu Flew Over…” (11/12/08)
“Shaking With the Pink Stuff…” (11/04/08)
“Doc, Am I Gonna Die?” (10/28/08)
"Not Too Sick…Yet" (10/2308)
"Executive Decision" (10/15/08)
“Oh, By The Way, Can You Also Check Out…." (10/07/08)
“The Losing White Runner!” (09/30/08)
“A Cat Fight Bite!” (09/23/08)
“You Treated This Guy!” (09/16/08)
“I’ve Gotta Get a Line” (09/11/08)
“The Life Saving Shot” (09/03/08)
|
| |
The EM Forum has been developed as a service of EMS. Like any other service, in spite of our best efforts the information in this Web Site may become out of date over time. Nothing on this Web Site constitutes medical advice, nor are any discussions intended to be construed as medical advice. EMS accepts no liability for the accuracy or completeness or use of, nor any liability to update, the information contained on this Web Site.
All Content is Copyright of the author(s), and reproduction is prohibited without explicit permission.
|
