The Emergency Clinician
Review the documented subjective and objective history in the two rooms below, Provide scholarly support to identify a differential diagnosis based on the reported findings. Include additional subjective or objective data that would support this diagnosis for each.Room 1:Demographics:2-year-old male, Richie, brought to the clinic by his mother Rachel Regis for nasal congestion and tugging at his left ear.Subjective:Chief complaint (CC): he has nasal congestion and he has been tugging on his left earHPI: The patient presents accompanied by his mother who gives the history. Richie has had nasal congestion for the past 5 days. He has been slightly irritable but he has been eating as usual until this morning. The mother reports he woke up suddenly at 5 am crying and she was unable to console him with the usual measures. He was extremely irritable and refusing the water that the mother offered him. She noticed that he was tugging on his left ear intermittently. He felt warm as if he has a fever but the mother did not have a thermometer at home to check his temperature.Objective:Vitals: T-103.5, BP- 122/85, P-101, R-30Richie is a 2-year-old male seen today with his mother. The mother is holding and rocking him on her lap. He appears to be acutely moderately distressed. He is expectedly uncooperative and resisting the physical exam. His face is flushed, his skin is warm and slightly moist. Otoscopic examination reveals the left eardrum is red, inflamed, and convex. No drainage noted.Room 2Room 2: 47yo Roy Regis reports history of itching and irritation around his right eye.HPI: 47yo Roy Regis reports history of itching and irritation around his right eye. Symptoms began 2 days prior during a wood chopping event and reports discharge, turning crusty when he wakes. Right eye glued shut in mornings, itching. No sick contacts. No eye trauma. Pt rates pain to right eye 6/10.PE: T-98.4; BP 131/78; P 78; RR-17.Eye trauma is when the eye receives a direct or close blunt to the eye. When the eye receives a blow, it can cause blood to collect underneath the hit area, which leads to many of the mutual symptoms of eye trauma. (Bausch, Lomb,2020) Some of these symptoms can be itching, pain irritation, as well as redness. (Bausch and Lomb,2020) Every single eye trauma incident could present differently but with similar signs and symptoms. The initial approach to eye injury, must involve careful triage. (Uptodate,2020) Eye injuries are extremely fragile, and it is imperative emergent eye injuries are recognized at a glance and evaluated. Questions regarding the injury will be beneficial to complete the assessment. How the injury happened? How long ago did the injury occur. When did the pain start in the eye? Management of an injured eye requires meticulous history taking, evaluation of vision that measures the acuity and if there is a relative pupillary defect as well as careful inspection of the eyes, under anesthetic if necessary. (Scott,2011) The moment life-threatening injuries eliminated treated, the emergency clinician should identify threats to vision using a focused history and an organized approach. (Gardiner,2020)
