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JOE'S ANSWERS IN CAPS...

Quoting Abdul Nasir <[log in to unmask]>:

> Hi simnte
>
> i wanted to tell you one interesting story ..it was 10;00 pm when we 
> got a feverish 39 C  child of 4 years in our ER , the pediatrician 
> called and attended him  she ordered for WBC which was 5.5 , she gave 
> him naalgsics and augmentine and discharged after fever came down....
>
>  By 4;00 AM the child had been brought dead to ER with full marks of 
> petechial hemmorahge which pathognomonic of Meningococcemia...
>
>  It was a big issua that how could a doctor expecting  meningococemia 
> in a child with fever !!!
>
> In fact till now i couldnt find an answer inspite that our hospital 
> did CME regarding that case and said that onlt around 5% of febrile 
> children will go into Meningococemia, and this is very rarely to be 
> expcted  to appear!

IN FACT ABDUL, THE INCIDENCE IS MORE LIKE 1/2000!! THAT IS  IN KIDS 
3MO-3 YEARS WELL LOOKING FEVER NO SOURCE...


>
> Nowadays, i used to either admit or do at least CBC for any febrile 
> child even without any bad signs...
\
A CBC WILL NOT HELP YOU DECIDE WHO SHOULD/SHOULD NOT GET AN LP...IN 
FACT-AS YOUR CASE PROVES IT-A COUPLE OF RECENT STUDIES HAVE ACTUALLY 
SHOWN THAT THE LR OF MENINGITIS IS HIGHER IF A KID IS LEUKOPENIC/NORMAL 
WBC THEN IF HE/SHE HAS LEUKOCYTOSIS...

i still feel hezitated to
> discharge him , scared will get him back as DEAD .

DEFINITELY HAVE BEEN IN YOUR SITUATION...


JOE
>
> Any one can help me by one guidline or rules for that thing?
>
> thx
> Nasser/
>
> 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