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PED-EM-L  August 1998

PED-EM-L August 1998

Subject:

Re: Outpatient management of meningitis

From:

Richard Hemmer <[log in to unmask]>

Reply-To:

Richard Hemmer <[log in to unmask]>

Date:

Fri, 21 Aug 1998 20:27:37 -0300

Content-Type:

text/plain

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Parts/Attachments

text/plain (60 lines)

In the cases the I have been exposed to,  none of them were scene initially
at my hospital,  but were sent to us from other hospitals.  One case that
really stands out in my mind was a child of a pediatric nurse.  Was examined
by her pediatrician  days earlier and was suspected of viral meningitis and
was being managed at home.  That night she was brought to the ER and was
sent home (after discussion with her pediatrician).  The next morning was
brought back to the ER.  The child was lethargic, rigid, groaned with any
movement of her head.  The child was rapidly transferred to us. This child
was dead within 45 minutes of arrival.  The problem here is that the initial
clinical exam and ER exams did not include an LP or a real consistent neuro
exam.  The child was reported as afibrile however, as we found out later,
had been given Tylenol because the child was irritable.  Thus no fever.  The
bottom line is that if this child had been admitted in the first place, she
would still be alive.  (As I recall, the post mortum showed H-Flu
meningitis)
 
The other cases that I have scene did not have great initial exams.  Most
did not have an LP.  Most did not even have a CBC.
 
I guess it comes down to the real assessment of the child in the first
place.   I would prefer to have everyone error on the side of safety,
rather than on the side of saving a few dollars.
 
Rich Hemmer
 
 
-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]]On Behalf Of Jay D. Fisher
Sent: Thursday, August 20, 1998 1:03 PM
To: Multiple recipients of list PED-EM-L
Subject: Re: Outpatient management of meningitis
 
 
Great topic and discussion.
 
Dr. Louzon-
 
Does the data on outpatient treatment of bacterial meningitis does
involve the treatment of  patients on day one of their illness? My
recollection is that it does not.
 
Dr. Hemmer-
 
If you have a series of cases of presumed viral meningitis treated as
outpatients that went on to die of bacterial meningitis you should
consider publishing them. Could you post an example with details? I am
not aware of a large number of published cases such as you describe.
 
Jay Fisher MD
 
For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

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