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well/ there we have it!! From d/c with Outpatient po?care to inpatient with IV Rx(which I agree with, as this child will return to ED for persistent cough w/o doubt!)Only thing left would be? a PICC line and home IV RX!!?Now, all we need is a legal opinion!! I guess this is why we call it the "art" of medicine.

-----Original Message-----
From: Charles Nozicka DO,FAAP,FAAEM <[log in to unmask]>
To: [log in to unmask]
Sent: Sun, Aug 16, 2009 2:30 pm
Subject: PED-EM-L



Agree with above but...

An additional consideration is there is already a multi lobar consolidation. If 
this is bacterial (community acquired?pneumococcus) oral antibiotics probably 
won't achieve high enough levels then there is the?possibility of resistance 
(pneumococcus/MRSA), all lead me to admit for IV antibiotics (Cefotaxime and 
Vanc)?and zithromax. The aim is to prevent an empyema. Admission and observation 
here, IV antibotics and agressive pulmonary therapy.?



CN



Charles Nozicka DO, FAAP, FAAEM

Director

Pediatric Emergency Medicine

Advocate Condell Medical Center




-----Original Message-----
From: Chamberlain, Jim <[log in to unmask]>
To: [log in to unmask]
Sent: Sun, Aug 16, 2009 12:34 pm
Subject: Re: 7 yo with pna




Suggested criteria for admission:

Dehydration AND inability to rehydrate orally
OR Hypoxemia
OR Toxic/concern for sepsis
OR inability to hold down oral medications.

Patient does not meet any of these.

Afebrile is interesting and consistent with Mycoplasma but consolidation
and high WBC concerning for pneumococcus. Therefore, I would treat with
ceftriaxone, amox, and aazithromycin (or just amox and azithro). 

I can't see a role for bronchodilators in this child.

Close follow-up is needed to ensure improvement in case this is Staph.

Jim



James Chamberlain, MD

Division Chief, Emergency Medicine

Children's National Medical Center

111 Michigan Avenue, NW

Washington, DC 20010

202.476.3253 (O)

202.476.3573 (F)

202.476.5433 (Emergency Access)

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of don zweig
Sent: Sunday, August 16, 2009 11:02 AM
To: [log in to unmask]
Subject: 7 yo with pna

How would you handle this case.  7 yo girl with 3 week hx cough and  
intermittent fever.  Today had a little ha and abd pain.  No nvd.  up  
to date on immunizations.  neg pmh.  no one else sick.  vitals normal  
with no fever and o2 sat 96 on ra.  ON exam looks incredibly well.   
Very cut
e cherubic and playful smiling and happy.  Coughs rarely and  
has deep cough when she does.  Exam entirely normal except rare  
rhonchi on rt.  Cxr choses dense consolidation rul and rml.  So i  
order wbc and bc and wbc is 24k otherwise normal.  bc pending.

Would you admit?

Give rocephin and zithromax?

Give rocephin and high dose amox?

Bronchodilators?

don

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