Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2024-05-19 Encounter: Photo review (image sent by parent via Spruce text message) CC: Swelling on the side of head that started as a small mark, now marble-sized, suspected insect bite. HPI: Hendricks, age approximately 4, was noted the prior day to have a small mark on the side of his head which the parent initially thought was a bug bite. By the next morning it had grown to the size of a marble. The swelling was present on waking. A photo was sent for review. No other symptoms mentioned. Assessment: Swelling most consistent with an insect bite reaction. Swelling worsened after sleep due to dependent fluid, expected to improve with movement. Antibiotic cream in the photo (first arrow) was noted as not appropriate; mometasone (blue arrow) was recommended. Plan: Benadryl 2.5 mL for swelling. Mometasone (steroid cream) applied topically to the bite site. Monitor for atypical progression. Medications: - Diphenhydramine (Benadryl) 2.5 mL (new) - Mometasone topical, apply to bite site (new) Key clinical quotes: "Bites are very often the cause of that swelling." "The swelling will also get better as he's up and moving around, it worse after you've been sleeping because the fluid settles there" "Blue one. Mometasone" Source: Spruce conversation t_27C02FVS44O00