Discharge Instructions - Viral Conjunctivitis

As discussed in the Emergency Department prior to discharge, you were diagnosed with viral conjunctivitis also known as ‘pink eye.’  Pink eye is the everyday term people use to describe an infection or irritation of the eye.  The medical term for pink eye is "conjunctivitis."

If you have pink eye, your eye (or eyes) might:

    -Turn pink or red

    -Weep or ooze a gooey liquid

    -Become itchy or burn

    -Get stuck shut, especially when you first wake up

Pink eye can be caused by an infection, allergies, or an unknown irritation.

When pink eye is caused by an infection, it can spread easily.  Usually, people catch it from touching something that has been in contact with an infected person's eye.  It can also be spread when an infected person touches someone else, and then that person touches his or her eyes.

If you know someone with pink eye, avoid touching his or her pillowcases, towels, or other personal items.

Most cases of pink eye go away on their own without treatment.  But some types of pink eye can be treated.  When pink eye is caused by infection, it is usually caused by a virus, so antibiotics will not help.  Still, pink eye caused by a virus can last several days.  Pink eye caused by an infection with bacteria can be treated with antibiotic eye drops or gels.  Pink eye caused by other problems can be treated with eye drops normally used to treat allergies.  These drops will not cure the pink eye, but they can help with itchiness and irritation.

When using eye drops for infection, do not touch your good eye after touching your affected eye, and do not touch the bottle or dropper directly in one eye and then use it in the other.  Doing these things can cause the infection to spread from one eye to the other.

If you wear contact lenses and you have symptoms of pink eye, it is really important to have a doctor look at your eyes.  In people who wear contacts, the symptoms of pink eye can be caused by "corneal abrasion."  Corneal abrasion is a scratch on the eye and can be a serious problem.

During treatment for eye infections, you might need to stop wearing your contacts for a short time.  If your contacts are disposable, you will want to throw them away and start fresh.  If you contacts are not disposable, you will need to carefully clean them.  You should also throw away your contact lens case and get a new one.

Return to the Emergency Department for worsening eye pain, loss of vision, double vision, drainage of pus from the eye, or any new or concerning symptoms.

Discharge Instructions - Allergic Conjunctivitis

As discussed in the Emergency Department prior to discharge, you were diagnosed with allergic conjunctivitis.  Conjunctivitis, also called "pink eye," is defined as an inflammation of the conjunctiva.  The conjunctiva is the thin membrane that lines the inner surface of the eyelids and the whites of the eyes (called the sclera).  Conjunctivitis can affect children and adults.  The most common symptoms of conjunctivitis include a red eye and discharge.

Allergic conjunctivitis is caused by airborne allergens that come in contact with the eye.  Symptoms may be sudden in onset (acute), seasonal, or present year-round (perennial), depending upon the allergen.

The most common symptoms of allergic conjunctivitis include redness, watery discharge, and itching of both eyes.  Other symptoms can include burning, sensitivity to light, and swelling of the eyelids.  Both eyes are usually affected, although symptoms may be worse in one eye.  Rubbing the eyes can worsen symptoms.

People with allergic conjunctivitis often have a history of other allergic conditions, such as eczema, seasonal allergies, or a specific allergy (eg, to cats).

There are a number of treatments available for the symptoms of allergic conjunctivitis.  In addition, basic eye care is important.

Basic eye care:

-Avoid rubbing the eyes. If itching is bothersome, use artificial tears, a cool compress, or antihistamine eye drops.

-Minimize exposure to pollen by staying inside when possible, using air conditioning, and keeping car and home windows closed during the peak allergy seasons.

-People with year-round allergic conjunctivitis should consider consulting an allergy specialist to determine which allergens are responsible for their symptoms (eg, dust mites, cat dander, others).

You may use an over-the-counter antihistamine or vasoconstrictor eye drop for these symptoms like Visine up to 4 times a day for up to 2 weeks.  You may have been prescribed an antihistamine/mast cell stabilizer eye drop such as Ketotifen for persistent symptoms.  In addition, you may have been prescribed an antihistamine oral medication, such as Fexofenadine (Allegra), Loratadine (Claritin), Desloratadine (Clarinex), Cetirizine (Zyrtec), and Levocetirizine (Xyzal).  Loratadine and Cetirizine are available in the United States without a prescription.

If symptoms of allergic conjunctivitis do not improve after two to three weeks of the above treatments, the person should see an ophthalmologist for evaluation.

Return to the Emergency Department for worsening eye pain, loss of vision, double vision, drainage of pus from the eye, or any new or concerning symptoms.

Discharge Instructions - Sinusitis

As discussed in the Emergency Department prior to discharge, you were diagnosed with sinusitis.  Sinusitis is a condition that can cause a stuffy nose, pain in the face, and yellow or green discharge (mucus) from the nose.  The sinuses are hollow areas in the bones of the face.  They have a thin lining that normally makes a small amount of mucus.  When this lining gets infected, it swells and makes extra mucus.  This is what causes the symptoms of sinusitis.

Sinusitis can occur when a person gets sick with a cold.  The germs causing the cold can also infect the sinuses.  Many times, a person feels like his or her cold is getting better.  But then he or she gets sinusitis and begins to feel sick again.

Common symptoms of sinusitis include: stuffy or blocked nose, thick yellow or green discharge from the nose, pain in the teeth, and pain or pressure in the face (often feels worse when a person bends forward).

People with sinusitis can also have other symptoms that include: fever, cough, trouble smelling, ear pressure or fullness, headache, bad breath, or feeling tired

Most of the time, symptoms start to improve in 7 to 10 days.

To reduce your symptoms, you can:

    -Take an over-the-counter pain reliever to reduce the pain

    -Rinse your nose and sinuses with salt water a few times a day

Antihistamines do not improve symptoms of sinusitis.  They can treat allergies, but not sinus infections, and could increase your discomfort by drying the lining of your nose and sinuses, or making you tired.

You may have been prescribed a steroid nose spray to reduce the swelling in your nose.  Take this medication as instructed.  You may also have been described a decongestant nose spray, such as Oxymetazoline (Afrin), or pill, such as Pseudoephedrine (Sudafed).  It is important that you not use Oxymetazoline (Afrin) for more than 3 days, as this may lead to worsening nasal congestion.

Most of the time, sinusitis does not need to be treated with antibiotic medicines.  This is because most sinusitis is caused by viruses – not bacteria – and antibiotics do not kill viruses.  Many people get over sinus infections without antibiotics.

Some people with sinusitis do need treatment with antibiotics.  If your symptoms have not improved after 10 days, ask your doctor if you should take antibiotics.  Your doctor might recommend that you wait 1 more week to see if your symptoms improve.  But if you have symptoms such as a fever or a lot of pain, he or she might prescribe antibiotics.  It is important to follow your doctor's instructions about taking your antibiotics.

Return to the Emergency Department if your symptoms last more than 10 days, if your symptoms get better at first but then get worse, if you develop fever higher than 102°F (38.9°C), you develop sudden and severe pain in the face and head, trouble seeing or seeing double, trouble thinking clearly, swelling or redness around one or both eyes, a stiff neck, drainage of pus from the nostrils, or any new or concerning symptoms.

Discharge Instructions - Cerumen Impaction

As discussed in the Emergency Department prior to discharge, you have been diagnosed with an ear wax (or cerumen) impaction.

Ear wax impaction is when ear wax builds up enough to cause symptoms.  Normally, ear wax helps to protect the insides of the ears and prevents injury or infection.  But having too much ear wax can cause symptoms such as pain and trouble hearing.  The medical term for ear wax is "cerumen."

Young children and older adults are more likely than others to have ear wax impaction.

Several different things can cause ear wax impaction:

-Diseases that affect the ear – Some health problems can affect the shape of the inside of the ear, and make it hard for wax to move out.  For example, skin problems that cause skin cells to shed a lot can lead to wax build-up in the ears.

-A narrow ear canal – In some people, the ear canals are narrower than in others.  These people might be more likely to have ear wax impaction.  A person's ear canal can become narrower after an ear injury or after severe or multiple ear infections.

-Changes in ear wax and lining due to aging – As people get older, their ear wax gets harder and thicker.  This makes it difficult for the wax to move out of the ear as it should.

-Bad ear-cleaning habits – Some people try to clean their ears using cotton swabs (Q-Tips) or other tools.  This can actually push the wax deeper into the ear instead of getting it out.  Over time, this can cause ear wax impaction.

-Making too much ear wax – Some people make more ear wax than others.  This can happen when water gets trapped in the ear, or when the ear is injured.  But some people have a lot of ear wax for no obvious reason.

There are several treatments to remove impacted ear wax.  Doctors and nurses offer these treatments only to people who have bothersome symptoms.  They do not recommend treatments for removing ear wax in people who have no symptoms, even if their ears are impacted.

In some cases, doctors and nurses will remove ear wax in people whose ears are impacted and who aren't able to let others know if they have symptoms or not.  This can include young children, and people who are confused or have trouble speaking, including some older adults.

There are several different ways to remove ear wax:

-Ear drops – Special ear drops can soften ear wax and help it to drain out.  Ear drops are not usually safe for people with an ear infection or damage to the eardrum.

-Rinsing – In some cases, a doctor or nurse can remove impacted ear wax by squirting water (or a special liquid) into the ear to rinse it out.

-Special tools – A doctor or nurse might use a special tool to remove ear wax.  There are different types of tools that can do this safely.  These include small sticks, hooks, and spoons.  There are also tools that use suction to pull the wax out.

"Ear candling" involves lighting one end of a hollow candle, and putting the other end in the ear.  Ear candling is not recommended for ear wax removal.  It does not work well and can cause injuries or burns.

Return to the Emergency Department for persistent loss of hearing, fever (≥38.0 °C or 100.4 °F), worsening pain, or any new or concerning symptoms.

Discharge Instructions - Corneal Abrasion

As discussed in the Emergency Department prior to discharge, you have been diagnosed with a corneal abrasion.  This happens when you have a scratch on the surface of your eye, over the colored area.  It can feel very uncomfortable because there are a lot of nerve endings in this part of the eye.

Most corneal abrasions heal in 24-48 hours, so you should not have pain after 24-48 hours.  If you still have pain after 24-48 hours, come back to the Emergency Department or see an Ophthalmologist (an eye doctor) right away.

To treat the pain, you can start by using Acetaminophen (Tylenol) or Ibuprofen (Advil or Motrin).  You may also use artificial tears to soothe the eye and prevent drying of the eyes.  You may get additional relief by keeping these artificial tears in the refrigerator so they remain cold.

You may also have been prescribed an antibiotic eye drop, to prevent the eye from becoming infected.  Unless you were directed to do so by the Emergency Physician or Ophthalmologist, do not cover the eye with an eye patch, either during the day or overnight.

Return to the Emergency Department if you still have pain 48 hours after the injury, if your eye pain is getting much worse within 1-2 day, if there is pus coming out of the eye, if you experience changes in your vision, if you develop a fever (≥38.0 °C or 100.4 °F), or have any other new or concerning symptoms.

Discharge Instructions - Otitis Externa

As discussed in the Emergency Department prior to discharge, you have been diagnosed with an infection of the external ear canal known as otitis externa.  Otitis externa is an infection of the outer ear canal.  The outer ear canal is the passageway that leads into your ear – the same canal which we use to put in ear plugs and earbud headphones.  An infection can happen if the canal gets scratched or if there is water trapped inside.

Ear infections can cause a lot of pain and itchiness inside the ear.  Patients who are immunocompromised (such as people with severe diabetes, on high-dose prednisone medication, or on chemotherapy) may have more serious disease and need to be watched closely.  However, healthy patients will generally make a complete recovery using antibiotic ear drops.  If the ear canal is too swollen for the ear drops to get inside, a physician might use a wick (a piece of cotton soaked in medication) to get the medicine into the ear canal.

The most important thing that you can do is to keep your ear canal dry (after the ear drops have been absorbed).

You can take Acetaminophen (same thing as Tylenol) and/or Ibuprofen (same thing as Advil or Motrin) for pain.

You should feel a significant improvement within 2 days of taking the antibiotics.

Return to the Emergency Department if you do not notice an improvement in 2 days (while taking the antibiotics as directed), if fever doesn’t resolve within two days of taking the antibiotics, or you develop a new fever (≥38.0 °C or 100.4 °F), for spreading redness (around or behind the ear), drowsiness, a stiff neck or confusion, or any new or concerning symptoms.

Discharge Instructions - Acute Otitis Media

As discussed in the Emergency Department prior to discharge, you have been diagnosed with an ear infection, specifically of the inner ear called otitis media.  This type of infection is usually caused by bacteria growing inside the inner ear canal.  The inner ear is drained by a tube that leads from the ear to the back of the throat.  When we get a cold or a viral infection, this tube can become blocked off (due to inflammation and swelling of the tube), drainage can’t occur properly, and this creates an environment for bacteria to grow.  Children tend to have more ear infections because their ear tubes are smaller and more horizontal, making them more easily blocked and less able to drain.

If you were prescribed antibiotics, fill the prescription and start the medication as soon as possible.  Make sure you take your antibiotics as directed for the whole course (don’t stop early).  There should be a significant improvement within 2 days of taking the antibiotics.

You can take Acetaminophen (also known as Tylenol) or Ibuprofen (also known as Advil or Motrin) for the pain.  If the fever hasn’t come down one hour after giving one of these medications, you can try the other medication.  While it is very safe to try both, it is important to make sure that you take (or give your child) the right dose of each, as instructed on each box.

Try to avoid taking any flights while there is ongoing pain.

Return to the Emergency Department for ongoing fever (≥38.0 °C or 100.4 °F) after 2 days of antibiotics use, more fluid coming out of the ear, seizure, feeling drowsy, confused, or lethargic, neck stiffness, or any new or concerning symptoms.

Lethargy is an extreme form of tiredness when a person is only minimally responsive.  An example of a lethargic child is a child who is lying still and does not make eye contact with you when you speak to them.

MDM - Acute Otitis Media

[##-month/year-old male/female] with [ear pain/fever] with history and exam consistent with likely acute otitis media of the [right/left/bilateral ear(s)].

Initial considerations in this patient included acute otitis media, otitis externa, mastoiditis, ear foreign body, tympanic membrane rupture, pneumonia, and other upper respiratory infections (URI) among others.

Patient presented with complaint of [fever/fussiness/ear pain] and was noted to have evidence of erythema, [bulging,] and effusion on examination of the [right/left] tympanic membrane consistent with otitis media.  [Visualization of the tympanic membrane incomplete due to cerumen in the external auditory canal, but no evidence of significant erythema or bulging of the visualized portion.]  Patient noted to have associated fever, ear pain, and [upper respiratory symptoms] consistent with otitis media.  No abnormal lung sounds, sputum production, [abnormal findings on chest x-ray,] or other findings suggestive of pneumonia noted.  No evidence of debris or swelling of the external auditory canal suggestive of otitis externa noted on exam.  No evidence of perforation of the tympanic membrane noted on exam.

We discussed [watch and wait prescription of antibiotics/discharge with antibiotics] with the patient’s [mother/father/parents] who demonstrated understanding and agreement with this plan.  Prior to discharge, we discussed return precautions, specifically for evidence of worsening infection, and follow up with primary care doctor within [2-3 days/1 week] for further evaluation, and the patient’s [mother/father/parents] demonstrated understanding and agreement with this plan.

MDM - Epistaxis

[##]-year-old [male/female] with history and exam consistent with epistaxis from [anterior/posterior] source.

Initial considerations in this patient included anterior and posterior vessels as a source of epistaxis, nasal bone fracture and displacement, coagulopathy, nasal foreign body, and nasal tumor among others.

Patient presented [with/without] reported trauma [describe mechanism] with bleeding [not/poorly/minimally] controlled with direct pressure.  On exam the patient was noted to have [no] evidence of symptomatic anemia in the setting of report of approximately [##] mL of blood loss.  Patient [reports/denies] current use of anticoagulants [describe medication/but does report current use of Aspirin].  Direct nasal pressure applied upon presentation to the ED [with/without] adequate control of bleeding.  [Anterior/Posterior] packing with [a anterior Rapid Rhine/Merocel/Foley catheter/a tranexamic acid (TXA) soaked dressing] placed [with/without] adequate control of bleeding.  On speculum examination of the [right/left] nare a bleeding vessel was identified [and packing was placed/it was cauterized].  [Discussed/Considered holding anticoagulation in the setting of bleeding FURTHER.]  Doubt nasal bone fracture given [absence of significant swelling or deformity/absence of significant trauma].

Epistaxis controlled and patient observed in the ED for [duration] without evidence of re-bleeding.  Prior to discharge, we discussed return precautions, specifically for recurrent bleeding, treatment with [packing/antibiotics/discontinuing anticoagulation/etc.], and follow up with primary care doctor within 1-2 days for repeat evaluation [and consideration of restarting anticoagulation], and the patient demonstrated understanding and agreement with this plan.

MDM - Allergic Conjunctivitis

[##]-year-old [male/female] with [eye redness/irritation] with history and exam consistent with likely allergic conjunctivitis.

Initial considerations in this patient included viral, bacterial, and allergic etiologies of conjunctivitis, corneal abrasion, corneal ulceration, and iritis among others.

Patient presented with complaint of red eye with associated irritation, [itching, watery discharge, matting] and eyelid swelling suggestive of allergic conjunctivitis.  Patient denies purulent discharge, and has no other on exam suggestive of bacterial etiologies for conjunctivitis.  Patient noted to have [no/punctate] uptake of fluorescein on [slit lamp/wood’s lamp] examination of the [right/left] eye.  Patient [reports/denies] a history of seasonal allergies [with/without] associated [nasal congestion/rhinorrhea].  Patient noted to have no significant decrease in visual acuity at this time.

Prior to discharge, we discussed return precautions, treatment with topical eye drops and [anti-histamine/antibiotic ointment/NSAIDs], and follow up with primary care doctor within 1 week as needed for further evaluation, and the [patient/patient’s mother/father/parents] demonstrated understanding and agreement with this plan.

MDM - Corneal Abrasion

[##]-year-old [male/female] with history and exam consistent with corneal abrasion of the [right/left] eye.

Initial considerations in this patient included corneal abrasion, intraocular and corneal foreign bodies, corneal ulceration, various etiologies of iritis, and various etiologies of conjunctivitis amongst others. 

Patient presented with eye pain and redness with associated [photophobia, foreign body sensation, and decreased visual acuity] in the setting of recent [describe injury] suggestive of corneal abrasion.  Patient noted to have corneal abrasion on fluorescein examination with [slit lamp/wood’s lamp] of the [right/left] eye.  No evidence of foreign bodies with eversion of the [right/left] eyelid.  Patient [reports/denies] contact lens use, and has no other findings suggestive of corneal ulceration at this time.  No evidence of a positive Seidel test or other findings suggestive of globe perforation on evaluation in the ED.  No evidence of corneal foreign body on exam. 

Significant improvement in pain and visual acuity noted with application of topical anesthetic to the eye.  Prior to discharge, we discussed return precautions, treatment with lubricating eye drops and NSAIDs, and follow up with primary care doctor within 1 week as needed for further evaluation, and the patient demonstrated understanding and agreement.

MDM - Periorbital Cellulitis

[##]-year-old [male/female] with [periorbital/eye redness] with history and exam consistent with likely [right/left]-sided periorbital cellulitis.

Initial considerations in this patient included periorbital and orbital cellulitis, dacryocystitis, allergic reaction, various etiologies of conjunctivitis, blepharitis, orbital tumors, cavernous sinus thrombosis, chalazion, stye, herpes simplex, and contact dermatitis amongst others.

Patient presented with redness, [tenderness,] and swelling of the eyelids and periorbital area for the past [time frame].  No evidence of proptosis, loss of extraocular muscle function, pain with extraocular movements, diplopia, or vision loss to suggest orbital cellulitis or mass effect on exam in the ED.  Based on findings on exam, further imaging [was deemed unnecessary at this time/was obtained and noted to be without evidence of orbital cellulitis or other deep space infections].  No significant conjunctival injection, irritation, or discharge noted on exam to suggest conjunctivitis.

Prior to discharge, we discussed plan for treatment with antibiotics and stressed the importance of completing the full course of antibiotics with the [patient/parents].  We discussed return precautions, specifically for evidence of worsening infection or orbital cellulitis, and follow up with primary care doctor within 2-3 days for further evaluation, and the [patient/patient’s parents] demonstrated understanding and agreement with this plan.

MDM - Nasal Fracture

[##]-year-old [male/female] with history and exam consistent with nasal fracture.

Initial considerations in this patient included nasal bone fracture and displacement, septal hematoma, anterior and posterior vessels as a source of epistaxis, and other associated facial bone fracture among others.

Patient presented with report of [describe trauma] with evidence of swelling and deformity consistent with nasal bone fracture.  No evidence of septal hematoma on [speculum] examination of the nares.  Epistaxis well controlled with direct pressure [prior to presentation to/in] the ED.  Reduction in the ED considered, [and performed with appropriate splinting placed due to reasons] but deferred due to significant associated swelling and absence of significant breathing difficulty secondary to nasal swelling.  [No evidence of significant pain or deformity noted/Pain and swelling noted] on palpation of the facial bones with imaging [obtained and notable for findings/felt to not be indicated in the ED].  [No/Minimal] associated periorbital ecchymosis on exam.  No loss of extraocular muscle function, reported diplopia, or other findings suggestive of associated orbital wall fracture.  Doubt associated facial bone fractures at this time based on history and exam.

We discussed discharge with referral to ENT for follow up within 6-10 days for further evaluation and management.  We discussed avoiding blowing the nose to reduce further trauma.  We recommended application of ice to reduce swelling upon discharge.

Prior to discharge, we discussed return precautions, specifically for evidence of worsening pain or findings suggestive of septal hematoma, treatment [with NSAIDs/analgesics/Afrin], and follow up with primary care doctor within 1 week for further evaluation and follow up on ENT referral, and the patient demonstrated understanding and agreement with this plan.

MDM - Cauliflower Ear

[##]-year-old [male/female] with history and exam consistent with auricular hematoma (cauliflower ear) of the [right/left] ear.

Initial considerations in this patient included auricular hematoma (cauliflower ear), otitis externa, and tympanic membrane rupture among others.

Patient presented with [right/left]-sided otalgia with recent history of trauma from [describe], and evidence of swelling of the pinna consistent with auricular hematoma.  No evidence of associated otorrhea, swelling or debris in the external auditory canal, fever, or other findings suggestive of otitis externa.  After discussion of risks, benefits, and alternatives and after obtaining appropriate consent, [incision and drainage/needle aspiration] of the patient’s [right/left]-sided auricular hematoma was performed in the ED.  An appropriate pressure dressing was placed over the ear with discussion of wound care and follow up.  No other evidence of significant injury noted on exam.  No associated hearing loss or evidence of rupture of the tympanic membrane.

Prior to discharge, we discussed return precautions, treatment with appropriately placed pressure dressing, and follow up with primary care doctor within one week for further evaluation, and the patient demonstrated understanding and agreement.

MDM - Dental Fracture

[##]-year-old [male/female] with history and exam consistent with Ellis type [I/II/III] fracture of the [specify tooth].

Initial considerations in this patient included anterior and dental fracture, subluxation, and avulsion, and various dental infections among others.

Patient presented with description of [describe trauma] and evidence of fracture to the [specify tooth] on exam.  Patient noted to have an Ellis [I (fracture through enamel only)/II (fracture through enamel and dentin)/III (fracture through enamel, dentin, and pulp)] on exam with the fractured fragment [lost at the scene of injury/in possession of the patient/reportedly swallowed by the patient].  No evidence of significant foreign body aspiration noted on exam.  Remaining tooth noted to be [slightly mobile/without evidence of significant subluxation or dislocation].  Patient noted to have [no other significant injuries/abrasions to the describe location].

[No indication for/Prescription given for] antibiotics based on Ellis [I/II/III] fracture.  Prior to discharge, we discussed appropriate follow up with Dentist in the next [24 hours/48 hours/2-3 days] with the [patient/patient’s parents] demonstrating understanding and agreement with this plan.

MDM - Dry Socket Syndrome

[##]-year-old [male/female] with [dental pain] with history and exam consistent with likely alveolar osteitis (dry socket syndrome) of the [location].

Initial considerations in this patient included anterior and acute alveolar osteitis (“dry socket”), dental fracture, subluxation, and avulsion, bleeding dental socket, and various dental infections among others.

Patient presented [## hours/days] from extraction of [describe tooth] with report of severe pain after initial improvement.  On exam the patient was noted to have evidence of dislodged clot [and exposed socket] at the extraction site.  The socket was gently irrigated and packed with iodoform gauze soaked in eugenol (oil of clove).  No evidence of purulent drainage from the extraction site, significant swelling of the gingiva, fever, or other findings suggestive of fever at this time.

Pain well controlled in the ED with [NSAIDs/opioids] prior to discharge.  Prior to discharge, we discussed return precautions for evidence of worsening infection, treatment with analgesics, [dry socket paste/Eugenol and] prophylactic initiation of antibiotics [Penicillin VK/Clindamycin], and follow up with Dental in 24-48 hours, and the patient demonstrated understanding and agreement.

MDM - Viral Conjunctivitis

[##]-year-old [male/female] with [eye redness/irritation] with history and exam consistent with likely viral conjunctivitis.

Initial considerations in this patient included viral, bacterial, and allergic etiologies of conjunctivitis, corneal abrasion, corneal ulceration, and iritis among others. 

Patient presented with complaint of red eye with associated irritation and watery discharge suggestive of viral conjunctivitis.  Patient [reports/denies] contact lens use or purulent discharge, and has no other findings suggestive of bacterial etiologies of conjunctivitis.  Patient noted to have [no/punctate] uptake of fluorescein on [slit lamp/wood’s lamp] examination of the [right/left] eye.  Patient [reports/denies] recent upper respiratory symptoms [consistent with viral etiology of conjunctivitis].  Patient [reports/denies] associated itching with no evidence of swelling or irritation of the eyelids to suggest allergic etiology of conjunctivitis.  Patient noted to have no significant decrease in visual acuity in the ED.

Prior to discharge, we discussed return precautions, treatment with topical eye drops [and antibiotic ointment/NSAIDs], and follow up with primary care doctor within [2-3 days/one week] for further evaluation, and the [patient/patient’s mother/father/parents] demonstrated understanding and agreement with this plan.