Here's what the doctor wrote on the chart::
"Child has had cough and difficulty breathing for two weeks. Mother is RN and father Respiratory therapist and they have been giving her xopenex and albuterol every two hours at home since 0300 today. She has not been diagnosed with asthma. Mother states "she hates people." Mother has called their pediatrician and report was called to ED to avoid drawing blood on the child.
"Duoneb times two and worked to get cooperation to take steroid. After second neb still with wheeze inspiratory (scant) and full exp cycle. CXR neg. Solumedrol given IM and RX pediapred and atrovent for home. Mom is RN and Dad is resp therapist. They have home nebulizer and expressed preference to continue treatment at home.
Responds well to DuoNeb howevr still wheezing. Added steroid and to send home on Albuterol and Atrovent neb and PO Pediapred.I think it's pretty clear the doctor was irritated my daughters pediatrician called with recommendations on how to treat my daughter. It was actually more us than our pediatrician. My wife and I are minimalists, and we know by our clinical experience that ER doctors have to order a bunch of stuff just to cover their butts.
Figuring my daughter's asthma is similar to mine, she didn't need a bunch of labs and an IV. All she needed was the steroids. I also had this distinct feeling this doctor wanted to admit my daughter too. The doctor was also not one of our regular doctors, which may explain the poor attitude.
And guess what. The steroids worked great.
Related links: My daughter's asthma attack and the arrogant doctor