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Doc H,


>When, as you say, the EP makes up their mind based on the signs and symptoms and experience, etc., vomiting will be a factor in that decision. How SENSITIVE the presence of vomiting is for the determination of the need to LP is a percentage which I don't have to hand ;-)... But it does not matter, really...

The point is what happens to that percentage - to the "weight" of the presence of vomiting in your diagnostic equation - if you know that this vomiting can be helped by an anti-emetic. I honestly don't think that it makes a difference - that is why I asked why you asked... ;-)

In summary:
- vomiting is but ONE SIGN which may well tilt me further in the direction of making a diagnosis of "suspected meningitis in need of Rx & LP" as compared to a patient who is not vomiting
- positive response to antiemetic will not reduce this tilt enough to reverse it!


-->I think you misunderstood this whole debate...

I don't care whether or not a person is vomiting...it doesn't figure in my equation when I am thinking meningitis!

Metoclopramide was not given as an antiemetic but as a treatment for H/A and thus the presence or absence of vomiting hasdnothing whatsoever to do with the drug "masking" meningitis.

The argument I have heard regarding this dopamine antagonist masking meningitis is that it can mitigate pain, not its effects on the "puke center"...


jn
________________________________________
From: Pediatric Emergency Medicine Discussion List [[log in to unmask]] On Behalf Of Doc Holiday [[log in to unmask]]
Sent: Friday, April 09, 2010 7:23 PM
To: [log in to unmask]
Subject: Re: "masking" meningitis

From: [log in to unmask]
> just as I presumed..."I recall" evidence is...well...you know!

--> Agreed, in principle. Only anecdotal and not high up on the quality scale. However, you did begin by asking for quality, but then added "any" in brackets and I did pre-warn that I was only at the "any level ;-)

> I think the decision to/not to LP is one of the MD's comfort level...

--> I suspected (from the title) that this was something along the line of the surgeons in the last century being so scared of morphine being given to abdo pains... The thing is that in many sign/symptom complexes which suggest a diagnosis, it is vey common for most or (usually) all of these signs and symptoms to be missing on a patient here and another there.

When, as you say, the EP makes up their mind based on the signs and symptoms and experience, etc., vomiting will be a factor in that decision. How SENSITIVE the presence of vomiting is for the determination of the need to LP is a percentage which I don't have to hand ;-)... But it does not matter, really...

The point is what happens to that percentage - to the "weight" of the presence of vomiting in your diagnostic equation - if you know that this vomiting can be helped by an anti-emetic. I honestly don't think that it makes a difference - that is why I asked why you asked... ;-)

In summary:
- vomiting is but ONE SIGN which may well tilt me further in the direction of making a diagnosis of "suspected meningitis in need of Rx & LP" as compared to a patient who is not vomiting
- positive response to antiemetic will not reduce this tilt enough to reverse it!

> Anecdotal/hearsay evidence just doesn't cut it

--> You may appear to some to be somewhat idealistic. In most cases it's the best we have! In some cases it's the best one can get practically/ethics-wise...
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