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Hello Don and Everyone.

Given the probability for a bacterial source/SBI (serious bacterial
infection), it is difficult to send this infant home regardless of how he
looks.  If he does receive antibiotics, I believe that an LP would be
necessary.

That being said, 2 questions:

1. Has the "Pediatrician" in this case come in and seen the patient or is
he/she working with you in the ED?  If not, it is your decision.

2. What would you and others on this list-serve do with a 7 week old with a
runny nose, fever of 102.1, normal pulse ox and respiratory rate, slight
cough (bronchiolitis season) who looks normal except for the congestion?
a. Do you do a CBC?
b. DO you do an LP?
Regarding the LP question - I would not do one.  The reason I mention it is
that there are leaders in our field (Peds EM and EM) who feel strongly that
any infant under 8 weeks (not 6, not 4...but 8)should have an LP. Some of
these physician(s) have even voiciferously objected to my approach recently
at a dinner. Can you believe that a friend, over a nice Cabernet, told me
that they would be willing to be a plaintiff's expert were they asked to
review a case in which an LP was not done on a infant 6 to 8 weeks of age.
After gagging and almost spilling my drink, I managed to finish my dinner
but I vowed to get even and send it to the the real authorities on Peds EM
standards of practice - the PED-EM-Listserve.

Merry Christmas.

Mike Gerardi

-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]
Sent: Monday, December 23, 2002 1:38 PM
To: [log in to unmask]
Subject: febrile 7 week old


Would you think an LP would be necessary in the evaluation of a previously
healthy, non preme, 7 week old boy with a two day history of cough and one
day of fever (102.1 rectal in er) who looks well and is feeding (bottle)
whose xray shows a clear RLL infitrate.   His sats are above 95 and he is
not
tachypneic.   His WBC is normal and is c-reactive protein is 5 .   The
pediatrician wants to send him home after a shot of rocephin.   I was
thinking that he'd be more likely to have meningitis with the infiltrate
than
less likely.   I would appreciate any feedback.

don zweig 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