What are the other vital signs? If there are any other abnormalities at all I definitely admit.
My probably/most likely admit would be normal vitals, but because she has multilobar findings she stays.
The bottom line is I'd be a bit more aggressive and admit, Give IV Rocephin and Zith (it is multilobar after all)
and plenty saline nebs, but only maybe one or two albuterol nebs.
My only "not admit" scenario is with highly-reliable parents who can/definitely will provide similar aggressive treatment at home (including multi abx and saline nebs) with reliable close follow up in PMD office.
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> Date: Sun, 16 Aug 2009 08:02:26 -0700
> From: [log in to unmask]
> Subject: 7 yo with pna
> To: [log in to unmask]
> 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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