I just called her parents and she is much better today and is on
On Aug 17, 2009, at 12:56 PM, <[log in to unmask]> wrote:
> I've read some of the other approaches and I have to admit that I
> don't feel the same level of anxiety. The key point here is "looks
> incredibly well." I teach my residents - treat the child, not the
> lab. You don't mention if the parents have sought any medical care
> during this period, and if they haven't, it suggests that they
> weren't particularly worried. I would not admit her, and treat her
> for mycoplasma. Azithro would be fine, although I love doxycyline
> for these cases - it works magic in 48 hours (not practicing in the
> states, I don't have the same fears as US docs do about doxy). My
> experience is that consolidation, even multi-lobar, rarely causes
> decreases saturations. I would give her nebs and maybe even
> steroids. What about a FB? I think close follow-up is the key with
> a repeat film in 3-5 days demonstrating response to therapy.
> Lisa Amir, MD
> Unit of Emergency Medicine
> Schneider Children's Medical Center of Israel
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]
> ] On Behalf Of don zweig
> Sent: Sunday, August 16, 2009 5:02 PM
> To: [log in to unmask]
> Subject: 7 yo with pna
> How would you handle this case. 7 yo girl with 3 week hx cough and
> intermittent fever. Today had a little ha and abd pain. No nvd. up
> to date on immunizations. neg pmh. no one else sick. vitals normal
> with no fever and o2 sat 96 on ra. ON exam looks incredibly well.
> Very cute cherubic and playful smiling and happy. Coughs rarely and
> has deep cough when she does. Exam entirely normal except rare
> rhonchi on rt. Cxr choses dense consolidation rul and rml. So i
> order wbc and bc and wbc is 24k otherwise normal. bc pending.
> Would you admit?
> Give rocephin and zithromax?
> Give rocephin and high dose amox?
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