Pediatric pressure problem

[Oogilily]

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I recently had a 10 year old patient come in and he wouldn't let me get close to his eyes to take his pressures with a handheld NCT. He just had a really strong reflex and couldn't keep his eyes open with anything close to his eyes. Anyways, any ideas on how to deal with a patient like this? I tried helping him relax, holding his eyes open, etc. and nothing worked.

 

[JMU07]

Sometimes kids feel more at ease if they see you do it on yourself or someone else. I've used this for the NCT a bunch of times. Sometimes you can just blow it on their hand or something and they'll be like oh okay, that really isn't so bad. If people start blinking on me during Goldmann I'll just pretend like I took their pressure once I get close, and they usually say "Wow, I didn't feel anything!" and usually they'll let me do it for real after that. Some people just need a little more reassurance, especially children. Out of curiosity, were you able to get an NCT on this patient?

 

[Oogilily]

I was only able to get it on one eye. It fired for the 2nd eye three times, but it never applanated. I got to bring the patient back to cycloplege so I figured I would try again then. That's why I need some ideas on how to do it next time! I tried puffing the air on his hand, breathing techniques, etc. I got the one eye so he knew what it was like and still had problems.

 

[KHE]

I was only able to get it on one eye. It fired for the 2nd eye three times, but it never applanated. I got to bring the patient back to cycloplege so I figured I would try again then. That's why I need some ideas on how to do it next time! I tried puffing the air on his hand, breathing techniques, etc. I got the one eye so he knew what it was like and still had problems.

If patients are that uncooperative, there is little chance you'll get an accurate reading anyways. Check the optic nerve. If it's normal, and in the absence of history or risk factors, the chances of them having juvenile glaucoma is virtually zero. This is not something worth going to war over.

 

[Oogilily]

If patients are that uncooperative, there is little chance you'll get an accurate reading anyways. Check the optic nerve. If it's normal, and in the absence of history or risk factors, the chances of them having juvenile glaucoma is virtually zero. This is not something worth going to war over.

So you don't have to have a pressure check for billing purposes? Billing is still quite foreign to me so I'm curious.

 

[KHE]

So you don't have to have a pressure check for billing purposes? Billing is still quite foreign to me so I'm curious.

"Soft and equal with digital tension OU. Patient uncooperative with NCT and TAP."


There you go.

 

[Oogilily]

Awesome, thanks!