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OBSERVED HEENT
[#10]
Otitis Media
Pathogens
S pneumoniae
H influenza nontypeable
Moraxella catarrhalis
S/S
Acute onset
Pain
Fever
Decreased hearing
Inflammation
Bulging or obscured landmarks
Evidence of effusion =
TM mobility by bulb insufflation or tympanogram
Treatment - Initial
Amoxicillin 80-90 mg/kg/day div Q12 hr (or q 8 hr) OR
Ceftriaxone IM 50mg/kg/day x one dose
Hydration Status
Capillary Refill
Pres nail bed to occlude blood
blow
Color should return to the nail in
less than 3 secnds
Skin Turgor
Pinch the skin between the thumb
and finger
Release skin
Skin fold should return to original
position within one second
(Persistence of pinched fold = loss
of turgor)
Head
Eyes
G shape
G scalp
G hair distribution
G pain on palpation of face
G circumference (cm)__________% graphing________
G anterior landmark (supraorbital ridge) G posterior landmark occipital ridge
G conjunctiva/sclera - discharge, color (erythema, pallor)
G PERRL - direct, consensual
G EOM
G corneal light reflex
red reflex cover-uncover
Ears
G external ear - pain, swelling, discharge, lesions, discoloration (erythema, bruising)
G EAC - pain, cerumen, foreign body, color, discharge
Tympanic Membrane - color, translucency, landmarks, bulging, mobility
Nasopharynx
G septum - midline, intact/perforation
mucosa/ turbinates - color, swelling, discharge
Oropharynx - move anterior to posterior; do not put your hands in the mouth or gauze on the tongue
G anterior - lips, buccal mucosa (moisture, exudates, inflammation)
G middle - tongue (color, exudates, hydration, lesions); check for frenulum attachment
G middle - dentition (discoloration, caries, fillings), gums (inflammation, pain, bleeding)
G posterior - palate integrity, midline uvula
G posterior - tonsils (grading, exudates, inflammation)
Neck
G Palpation - masses, swelling, tenderness
G Lymph nodes - auricular (pre, post), cervical (ant, post), mandibular, submaxillary,
submental, occipital
G Range of motion - supple/rigid (flexion, extension, lateral)
G Clavicle palpation - crepitus, tenderness, masses