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I can't see admitting a child w no hypoxia, no inc wob, no dehydration, no vomiting, and active/well appearing.  I don't think we should be intimidated by a wbc count of 24K, we know what is driving it and we are addressing it by placing the child on abx.  The more interesting question is do you sent the child home on Zmax single therapy after IV CTX in the ER or do you send home on double rx of Amox/Zmax?  I usually just send home on Zmax.

 

James Reingold, M.D.

Cardon Children's Hospital

Mesa, AZ
 
> Date: Sun, 16 Aug 2009 16:02:26 -0400
> From: [log in to unmask]
> Subject: Re: PED-EM-L
> To: [log in to unmask]
> 
> 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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