Pediatrics - Pediatric Emergencies News Article | Who needs admission among infants with acute otitis media |3961771

Pediatrics - Pediatric Emergencies News Article | Who needs admission among infants with acute otitis media |3961771


We have had a few cases of acute otitis media in young babies & this dilemma always exists whether to admit & give intravenous antibiotics or oral antibiotics.Between me & referring pediatrician ,we take a joint decision of intravenous antibiotics in a neonate or very young baby.

This article describes below 2 months as very young babies who needed admission in their study.The older babies i.e. above 2 months were followed up out patient basis.Doing septic screening is also a valid point.

I always insist upon the parents the preventive aspect.No water should enter the babies ears for 4 weeks following infection & ear buds should never be used.As far as ear buds are concerned they should not be used in any baby or adults.Ear is self cleansing organ & people who produce lot of wax need ear suction done by a medical professional.

Nose bleeds or epistaxis

Nose bleeds can be very frightening experience.Though all nose bleeds are not dangerous,it is better to seek help if it is recurrent & of course continous/profuse.

1 in 7 of us will have some episode of nose bleeds in our lifetime.Nose bleeds are common in children aged 2-10 & the elderly.

The common causes of nose bleeds I see in my practice are

-Trauma:any fall or injury over the nose/face,nose picking

-Exposure to warm dry weather leading to dry crusty nose

-People on blood thinners eg Aspirin

-Medical conditions i.e.Liver conditions & high blood pressure

-Nasal foreign bodies in children

-Allergic rhinitis & deviated nasal septum

-Vigorous nose blowing


However there are less common causes of nose bleeds like bleeding disorders,leukemia,nasal tumors & autoimmune diseases like Wegeners disease.Especially with recurrent nose bleeds,we should be on the look out for more than common causes.We diagnosed two cases of Osler Weber Rendu disease last year in patients with recurrent nose bleeds.Careful examination revealed classical telangiectasia over the septum & nostrils.Proper diagnosis & treatment is a team work & we send them to other specialists for further work up & management.

Here I would like to mention that various medical conditions first present to ENT surgeons with initial symptoms.Though rare conditions are difficult to diagnose-if we are on the look out & pick it up early,it is of great benefit to the patients.For example:Wegeners Disease,Osler Weber Rendu Disease.
In children there is a vast range of symptoms which present to ENT's .It can be nasal polyposis in children leading us to cystic fibrosis or a speech delay child can have deafness or be in autistic spectrum.As an ENT surgeon,I need to be looking beyond just checking ear,nose & throat.

Coming back to nose bleeds-they can be divided as anterior or posterior bleeds.Anterior bleeds are from the Little's area (Kiesselbach's Plexus) over the septum & can be managed with chemical[silver nitrate] or electric cautery in the opd.
Posterior bleeds need much more attention & usually need admission in the hospital.Bleeds which do not settle with local pressure need anterior or posterior packing of the nose.
For refractory posterior bleeds which do not settle even with anterior & posterior packing need endoscopic ligation of artery commonly the sphenopalatine artery.

Below are the pictures of anterior & posterior bleeds & vessels/arteries mainly involved.

A-anterior nose bleeds
B-posterior nose bleed

In the end,I would like to write about what you should do first when facing a nose bleed :

• Remain calm.
  
• Sit up straight and lean slightly forward.
  
• Lean your head forward. Tilting your head back will only cause you to swallow the blood.
  
• Pinch the nostrils together and apply direct pressure with the thumb and index finger for approximately 10 minutes. Time it to make sure the nostrils are not released earlier.
  
• Spit out any blood in the mouth. Swallowing blood may make the affected individual vomit.
  
• This technique will stop the majority of simple nosebleeds

However anything more than this -you need to go to your nearest emergency department.