Ear infection

S:Pt. presents with her mother and brother today.  Mother reports day 4 of "cold-like symptoms, cough, runny nose."  Denies any fever until this morning.  C/O ear pain starting this am, which mother reports giving Motrin 3/4 tsp at 8:00am with a tympanic temp of 101.1 at that time as well.  Pt. sitting in mother's lap, fussing.  Points to right ear when asked which ear hurts.

O: Temp 101.1 now.  Other VS stable.  Eyes with yellow drainage, sclera with pink tinge.  Nose with yellow/greenish drainage.  Non-productive cough, lungs CTA, negative for wheeze.

A: AOM to R ear with bulging TM, sinusitis, conjunctivitis.

P: Cefdinir PO daily.  RTC in 3 days if symptoms worsen.







She'd had a runny nose for 3 days or so.  Typical around here.  Always hard to tell if it is allergies or a cold.  So we let it run the course, and wait and see.  Last night, her typical 13 hours straight sleep was interrupted with several "I am painful cries."  That paired with a fever of 101.1 degrees, I knew something was up.  Because I had to spend $648 dollars on an otoscope set for grad school, I figured I might as well use it and get use to it before I start my pediatric clinicals this Monday.  So I whipped it out, and my fussy 2.5 year old little lady let me take a peek inside each ear.  I didn't even have to look very long in her right ear to "diagnose" (in quotes because I am obviously not qualified to diagnose yet) her with acute otitis media (ear infection).  In fact, the normal pearly, opaque ear drum was red, and bulging.  Poor gal.

So I scheduled her an appointment to see a pediatrician at the office we go to, which around here, is a several hour event unfortuantely.  Not sure why it takes so long to see a provider here...but it does.

Anyway, the pediatrician diagnosed her with AOM, and a bulging right ear drum.  She asked me if K needed to be seen also.  I said not yet.  His ears look just fine to me today, he is afebrile, and only has had cold symptoms for about 2 days... but that I will keep an eye on him and return with him if anything changes.  She went on to educated me about how the common cold spreads, but ear infections don't, so he could end up with just a cold and not an ear infection.  I sat there, and just let her tell me all this stuff about colds/ear infections (that I already knew).  

She prescribed Cefdinir, which I questioned our of curiosity since amox is the first abx of choice for AOM in pediatrics.  She looked at me with a smile, and said - you must be going to school or something.  I said I was going to school to be an NP, and then her smile faded.

Not sure why there is such hostility between MD and NP, but goodness it is...silliness.

It isn't like it is rocket science to diagnose ear infections...

Anyway, my gals ears will start feeling better, but my opinion of the pediatric office I currently take my children to might not.  Unfortunately we live in a more rural area, and since I don't want to drive 45 minutes to the closest pediatrician office when my kids are sick, I suppose I can suck up my pride and continue taking my kids to be seen at the pediatrician office that hates NPs...that is until I become one and can diagnose and prescribe for them myself :).

Take that OCP!