Harvey Louzon from Canada writes :
""Whether antibiotics are continued in hospital in these cases of aseptic
meningitis until culture results are available is left up to the floor
* I think this is a "cop out"- when you punt kids to the floor service as if
something magical is going to happen there in terms of decision making etc.
It is precisely this attitude of "punting" the hard decisions to the floor
that has the potential of reducing the role of an EM provider to that of a
"traffic cop". There are many centers in this country where we as PEM
physicians routinely take turns in serving as inpatient/ward attendings.
This decision and all others should be made in a conjoined fashion.
* "Aseptic meninigitis is NOT synonymous with viral meninigits and a 23 hour
admission during which time the clinical picture will become clearer as the
I disagree with you. If you send these kids home in 23 hours you are rushing
this management to the kids detriment. If the patient has improved after
your antibiotics, how do you know in 23 hours of culture time that this was
not bacterial meningitis that you have partially treated. Pneumococcus or
Staph can take 48-72 hours to grow out!!
* "Furthermore those who would keep the child in the ED and repeat the tap
in 6 hours in those presenting initially with a PMN pleocytosis have
simply too much time on their hands. It's either THAT or a reflection of
managed care interference with good clinical practice".
You are being way too presumptuous here. What are observation units for? For
observation of some of these kids where the picture is equivocal!!. BTW, I
work in a center that last year saw close to 55000 pediatric ED visits. We
never have the luxury of time BUT we always MAKE time when the patient needs
it!!!. That is part of being an emergency physician.
Thanks for the reference on "LP adverse outcomes". Good one for the files. I
agree fully with the sentiment expressed from the gentleman from TX about
not delaying abx for the CT. This is a ploy used to brain wash young interns
& residents by some academic ivory tower ID folks who hold the "purity" of
cultures higher than god, often to the detriment of everything else
including the patients they serve.
Jay Pershad, M.D.
"We care for wee folks"
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