Print

Print


Are folks not using PAS?  Been validated multiple times now.
Mike Falk


Sent from my iPhone

> On Jun 29, 2017, at 23:56, Todd Zimmerman <[log in to unmask]> wrote:
> 
> I know your angle, but too clarify,
> I use RLQ pain, fever, WBC > 15 and CRP > 6.
> This may be stating the obvious, but if I have that, they are getting  
> admitted with a call to a surgeon. I don't need a CT to tell me this is very  
> likely appendicitis.
> I do remember reading, maybe in Peds EM Reports, or something like that,  
> that once you have that, the Sn is equally as good as a CT. 
> I hope no one slams me on the data nuances here...its been a while, can't  
> remember where I read it, but it works for me, and has kept the patient (and 
> me), knock on wood, safe.
> Todd Z
> Thank goodness Phil Jackson and the Triangle are outta NY!
> 
> This email  and any files transmitted with it are confidential and intended 
> solely for the  use of the individual or entity to whom they are addressed. 
> If you have received  this email in error please notify the system manager. 
> This message contains  confidential information and is intended only for 
> the individual named. If you  are not the named addressee you should not 
> disseminate, distribute or copy this  e-mail. Please notify the sender 
> immediately by e-mail if you have received this  e-mail by mistake and delete this 
> e-mail from your system. If you are not the  intended recipient you are 
> notified that disclosing, copying, distributing or  taking any action in reliance 
> on the contents of this information is strictly  prohibited.  
> 
> 
> In a message dated 6/29/2017 3:09:37 P.M. Central Daylight Time,  
> [log in to unmask] writes:
> 
> Does  anyone have a literature reference on use of the CRP in the diagnosis 
> of  appendicitis?
> 
> Thanks much.
> 
> Pam
> 
> 
> 
> Pamela S. Murphy,  MD, FAAP
> 
> Mendy's Place, Children's Emergency Center
> HonorHealth Deer  Valley Medical Center
> 
> Lead Physician
> Myelomeningocele Planning  Clinic
> Children's Rehabilitative Services, District Medical Group
> 
> On  Jun 29, 2017, at 11:47 AM, Dennis Hernandez  
> <[log in to unmask]<mailto:[log in to unmask]
> .EDU>>  wrote:
> 
> We also follow what Todd is doing at his shop. WBC and CRP -  both labs 
> normal but  inconclusive ultrasound generally buys themselves a  24 hour 
> recheck. If either WBC or CRP are elevated and high probability we do  CT but 
> without oral contrast. No rapid MRI yet....
> 
> Dennis
> 
> Sent  from my iPhone
> 
> Dennis A. Hernandez, MD, MBA, FACEP
> Medical Director,  Pediatric Emergency Services
> Immediate Past Chief, Florida Hospital for  Children, Walt Disney Pavilion
> Florida Emergency Physicians
> Core  Faculty, Florida Hospital Emergency Medicine Residency Program
> Assistant  Professor, University of Central Florida School of Medicine
> Assistant  Professor, Florida State University School of Medicine
> iPhone:  727-798-0147
> 
> On Jun 29, 2017, at 12:54 PM, trzim29  
> <[log in to unmask]<mailto:[log in to unmask]>>  
> wrote:
> 
> I get the data on the MRI...But do you have open MRI?Are you not  running 
> into issues with getting kids into the MRI machine?Are you sedating  these 
> kids?Trying to rap my hands around this one.We have been utilizing non  oral 
> contrast ct for quite some time and I cant remember one bad outcome.With  
> saying that, I maybe have done 1 or 2 abdominal CT scans in the past year or  
> two looking for appendicitis and thatcus is only if there is something  
> atypical on the history...History and physical exam with a tincture of wbc and  
> crp for me.Equivocal gets placed in obs or gets timed follow up with pcp or  
> back in the er in some atypical cases.US, I do, but honestly, thinking more  
> and more it is a waste...sort of...
> Todd Z
> 
> 
> Sent from my Verizon,  Samsung Galaxy smartphone
> -------- Original message --------From: Niel  Miele 
> <[log in to unmask]<mailto:[log in to unmask]>> Date:  6/29/17  7:25 AM  (GMT-06:00) To:  
> [log in to unmask]<mailto:[log in to unmask]> Subject:  Re: 
> not using oral contrast
> Easy answer. Emergent MRI approved.  :-)
> Niel
> Rutgers
> 
> Sent from my iPhone
> 
> On Jun 28, 2017, at  5:23 PM, Mayer, Thom  
> <[log in to unmask]<mailto:[log in to unmask]>>  wrote:
> 
> Friends,
> 
> Don't you wonder what these radiologists would  do if it was their kid?
> 
> Just a  thought...
> 
> Best
> 
> Thom
> Thom Mayer MD
> 
> Sent from my  iPhone
> 
> On Jun 28, 2017, at 9:33 PM, Rick Place  
> <[log in to unmask]<mailto:[log in to unmask]>> wrote:
> 
> We  have not been able to completely convince the radiologists to abandon
> oral  contract here. Partially.
> 
> We can on males who are above a certain BMI.  The feeling is that skinny
> people don't have much adipose tissue and  stranding might not be seen.
> 
> They are reluctant to abandon this in  kids.
> 
> There is solid adult data supporting this. Is there strong  literature
> supporting expanding this change to  pediatrics?
> 
> Rick
> Fairfax
> 
> On Wed, Jun 28, 2017 at 2:04 PM,  Maureen McCollough  <
> [log in to unmask]<mailto:[log in to unmask]>>  wrote:
> 
> Hi all,
> I am having difficulty getting oral contrast removed  from pediatric
> patients needing abd/pelvic CT scans in the ED.  I know  many institutions
> have abandoned it for ED patients both adult and  kids.  I work at one place
> and am associated with another place that  both have abandoned oral
> contrast, and another one that hasn't  yet.
> 
> I am wondering if folks who have protocols that no longer include  oral
> contrast, address this issue, etc could send them to me  off-line.
> 
> thanks!!
> Maureen McCollough
> 
> For more information,  send mail to  
> [log in to unmask]<mailto:[log in to unmask]> with  the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page  is:
> http://listserv.brown.edu/ped-em-l.html
> 
> For more information, send mail  to 
> [log in to unmask]<mailto:[log in to unmask]> with  the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
> http://listserv.brown.edu/ped-em-l.html
> 
> For more information, send mail  to 
> [log in to unmask]<mailto:[log in to unmask]> with  the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
> http://listserv.brown.edu/ped-em-l.html
> 
> For more information, send mail  to 
> [log in to unmask]<mailto:[log in to unmask]> with  the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
> http://listserv.brown.edu/ped-em-l.html
> 
> 
> For more information, send  mail to 
> [log in to unmask]<mailto:[log in to unmask]>  with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page  is:
> http://listserv.brown.edu/ped-em-l.html
> 
> For more information, send mail  to 
> [log in to unmask]<mailto:[log in to unmask]> with  the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
> http://listserv.brown.edu/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://listserv.brown.edu/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://listserv.brown.edu/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://listserv.brown.edu/ped-em-l.html