How do others feel about this "uncomfortable" word that seems to have creeped into our lexicon? I hear it more and more and I find it annoying every time I do. I here it from consultants and hospitalists and in most cases I think it means:
A) I want the patient packaged and wrapped with a bow before they get to the floor.
B) I want a definitive answer before I see or accept the patient.
The peds ED director where I did my residency, always said that the work up of a patient should not end at the door of the ED and I firmly agree with this. It adds to LOS in the ED, ED crowding and I have a hard time believing it improves patient outcomes.
New York, NY
Sent from my iPhone
On Jun 1, 2012, at 10:17 PM, "Goetz, Kathleen" <[log in to unmask]> wrote:
> My first plan of action (and what I told parents) was IV, labs, CT, admit, IV abx, ENT consult. I am aware of the possible complications, have seen venous cavernous sinus thrombosis, though have not seen a case of mastoiditis in several years now.
> Radiology said no to the CT, too much radiation. Even suggested that a head CT would be less radiation (than temporal bone scan) and would still show the mastoids. Wanted ENT input.
> ENT (older, quite experienced) said no need to CT, would not change management, would see first thing in am for tympanocentesis and/or PE tubes. Said all OM includes some mastoid involvement. Try IV abx and drainage 1st.
> Hospitalist also uncomfortable with no CT, called ENT back, same response (after midnight by now).
> IV Unasyn & Vanco started. WBC 30, CRP 7.7
> This am PE tubes placed, MEF cultured, clinical appearance improved by afternoon.
> Of note this child was seen the day before his ED visit with no signs of mastoiditis by PCP.
> Parents said he looked fine that am, low grade fever, then when they picked him up from daycare his ear was sticking out and scalp red.
> This was the happiest, most playful, most comfortable child I have ever seen with mastoiditis. He was blowing bubbles at me during the exam, no tenderness or warmth, just erythema and a markedly protruberant ear on exam. EAC erythema, edema and suppurative OM probably the most impressive signs of infection.
> Blood, MEF and MRSA cultures pending.
> It would be interesting to hear from our ENT colleagues.
> Kathleen Goetz, MD
> Medical Director
> Swedish Pediatric Emergency Services
> Office: 206-386-3313
> ED: 206-386-2573
> Cell: 253-370-7571
> From: Darrell Looney [mailto:[log in to unmask]]
> Sent: Friday, June 01, 2012 4:51 PM
> To: Goetz, Kathleen; [log in to unmask]
> Subject: RE: mastoiditis imaging
> Would definitely image looking for any extension whether cutaneous or for intracranial changes. Concerned because of persistent symptoms despite antibiotics.
> DLooney, MD
>> Date: Fri, 1 Jun 2012 07:19:50 +0000
>> From: [log in to unmask]
>> Subject: mastoiditis imaging
>> To: [log in to unmask]
>> 9 month old healthy immunized child with 17 days OM. Treated with Amoxil x 7 days, cefdinir x 10 days, presents with protruding right ear, suppurative ROM, post auricular erythema, fever, otherwise well appearing.
>> Would you image this child who has clinical mastoiditis?
>> If so - CT?
>> Has your practice changed due to increasing concerns about CT/radiation exposure in infants?
>> Kathey Goetz
>> Kathleen Goetz, MD
>> Medical Director
>> Swedish Pediatric Emergency Services
>> Office: 206-386-3313 ED: 206-386-2573 Cell: 253-370-7571
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
>> The URL for the PED-EM-L Web Page is:
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: