Well thank goodness u "didnt image his brain nor tap him." Probably should have though since u did eveythg else. Reassurance and a thorough exam was all tht was needed. You need to trust yr clinical impression when taking care of kids. What to do with the crp? It should hve never been ordered. Rule of thumb...if you are not prepared to change yr management when sending a lab ie a crp....then don't order them.
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----- Reply message -----
From: "Bergmann Terence" <[log in to unmask]>
Date: Thu, Jan 13, 2011 7:57 am
To: <[log in to unmask]>
Ignore it! Go with your gut and clinical impression.
I think I would have been more of a test minimalist in this situation. Did the history really lead you to need a CXR, urine, or labs? Does an ESR or CRP in this situation at all help you one way or another? (is there a study that shows that a negative CRP or ESR rules out all disease)
I know fighting anxious parents is sometimes a losing battle, but this mom has now been empowered to ask for at least the same if not more next time. (Deep down inside I would have wanted to ask the lab to poke the mom for a couple of sets of blood cultures to rule out endocarditis, and then asked her if she wanted her little one poked also)
On 2011-01-12, at 9:04 PM, don zweig wrote:
> How do you use the crp in evaluating kids? How do you interpret a high crp with low sed rate. I had a 8 yo with headache, decreased appetite and dizziness. No nvd. Neg pmh. Vitals normal with t=37.4 oral. min cough. no dysuria. Labs show normal wbc and diff, noraml chem7, lft, cxr. Very healthy appearing with large tonsils that are not inflamed. no nodes. supple neck. crp ws 38. i was hoping for normal. urine showed 80 red cells, 4 wbc, no back and 39 epith cells. no abd or flank pain.
> Should i go with my impressing that she is well. I did labs because mother was concerned, child seemed to be usually healthy and not a complainer.. Was shooting for reassurance. did not image brain or tap.
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