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I hope not!


  

 
Dr. Charles Nozicka 
Medical Director 
Pediatric Emergency Medicine
Advocate Condell Medical Center
Clinical Associate Professor of Emergency Medicine
Rosalind Franklin University
Libertyville, Illinois


Courage is being scared to death – and saddling up anyway.
–John Wayne 
 

 

 



-----Original Message-----
From: [log in to unmask]
To: [log in to unmask]
Sent: Fri, Jan 14, 2011 12:49 pm
Subject: Re: crp


I too do a lot of Expert Witness work, defense only, and I would imagine some of 
ur colleagues here who talk on this list are working for the plantiffs. 
mmmmm...

r. Todd Zimmerman
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hank you.

----Original Message-----
rom: Thom Mayer <[log in to unmask]>
o: [log in to unmask]
ent: Fri, Jan 14, 2011 12:42 pm
ubject: Re: crp


olks, 

s some of you know, I do a lot of defense work in pediatric emergency 
edicine and have for years.  I am currently involved in 3 cases where 
extraneous and unnecessary" lab work has caused significant problems in 
etting defense experts to take cases and allowing plaintiff's "experts" 
o opine things such as "of course any child with that level of ...CRP, 
ed rate, etc should have been admitted, and started on IV antibiotics." 
ne even noted that "all children in which these tests are even 
onsidered should be admitted to the Pediatric ICU."  (I swear this is 
rue-you can't make this %^$& up...) 

o, far from constituting defensive medicine, these tests, in my 
xperience, can load the cannon for the plaintiff's bar and their 
o-called experts.  I would be cautious in ordering a test of any kind 
hich is not going to change your clinical care and may give you results 
ou really didn't want.  In subtle cases (e.g. work-up of a potentially 
eptic hip), all well and good, but there may be trouble in these weeds 
f it is not clearly a test which is indicated. 

ust my thoughts... 

est, 
hom 
hom Mayer, MD, FACEP, FAAP 

----Original Message----- 
rom: Pediatric Emergency Medicine Discussion List 
mailto:[log in to unmask]] On Behalf Of Scarfone, Richard 
ent: Friday, January 14, 2011 11:55 AM 
o: [log in to unmask] 
ubject: Re: crp 

bviously, I wasn't at the bedside and so I don't want to pass judgment 
n your management. By your own admission, though, the lab work was 
robably not indicated. 

 have found that my time is much better spent patiently explaining to 
orried parents why tests are not likely to be revealing, instead of 
rdering unnecessary tests. I almost never encounter parents who don't 
espond well to that approach. Inappropriate tests are fraught with 
roblems. Pain for the child, costs, radiation exposure, delays in 
atient care are just a few. Further, they often lead to more 
nnecessary testing: the CBC that clots and needs to be repeated, the 
levated potassium that may or may not be due to hemolysis, the shadow 
n the CXR that leads to a chest CT. 

ecently, a 9-year-old boy was transferred to us after being seen for 
hroat and mild abdominal pain. The docs at the referring hospital had 
btained an abdominal CT. We diagnosed him with strep pharyngitis and 
ent him home. The dose of unnecessary radiation that he was exposed to 
as equivalent to that of hundreds of CXRs. 

hanks to vaccines, our landscape is covered with febrile children who 
ave viral illnesses who won't be aided by testing. Thanks to recently 
ublished multicenter studies, we have compelling data to guide our 
ecision making about when head CTs can be safely omitted in the setting 
f head trauma.  

t's very rare when a test reveals an unsuspected diagnosis. Often when 
t comes to testing, less is more. 

ich 

_______________________________________ 
rom: Pediatric Emergency Medicine Discussion List 
[log in to unmask]] On Behalf Of Don Zweig [[log in to unmask]] 
ent: Thursday, January 13, 2011 9:37 PM 
o: [log in to unmask] 
ubject: Re: crp 

 of course did send kid home. I Saw her back today and she was 
ompletely well and the hematuria was gone/resolved.  I did not repeat 
he crp. 

on - via iPhone 

n Jan 13, 2011, at 10:43 AM, Gill Winnik <[log in to unmask]> 
rote: 

 This story is a great example why one should not give in to parental 
ressure and do what is right for the PATIENT! 
 Since you have done the tests already...and the child looks well.... I 
ould have discharged the child with a close follow up. 
 
 Giora (Gill) Winnik MD 
 Maimonides Medical Center 
 Brooklyn NY 
 718-283-6021 
 
 
 
 -----Original Message----- 
 From: Pediatric Emergency Medicine Discussion List on behalf of don 
weig 
 Sent: Wed 1/12/2011 10:04 PM 
 To: [log in to unmask] 
 Subject: crp 
 
 How do you use the crp in evaluating kids?  How do you interpret a 
igh crp with low sed rate.  I had a 8 yo with headache, decreased 
ppetite and dizziness. No nvd.  Neg pmh.  Vitals normal with t=37.4 
ral.  min cough.  no dysuria.  Labs show normal wbc and diff, noraml 
hem7, lft, cxr.  Very healthy appearing with large tonsils that are not 
nflamed. no nodes. supple neck.  crp ws 38. i was hoping for normal. 
rine showed 80 red cells, 4 wbc, no back and 39 epith cells.  no abd or 
lank pain. 
 
 Should i go with my impressing that she is well.  I did labs because 
other was concerned, child seemed to be usually healthy and not a 
omplainer..  Was shooting for reassurance.  did not image brain or tap. 
 
 help 
 
 don 
 
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