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Returning to the issue of my adolescent body-piercer with pericarditis-
Agree with Dr. Herman that
STD's should be considered. This very open adolescent described her
sexual history in detail both with and without the mother present and
both patient and mother agreed that their communication about sex had
been entirely open for several years. Her present history was that her
last sexual relationship was over 9 months ago, and she had no other
symptoms of gyn disease- so, believe it or not I didn't do a pelvic.
I felt this patient should be admitted simply because even if her echo
did not show constiction, effusion or vegetations- we simply have very
little data on what her risk of deterioration is in the next 24 hours.
In an era in which some are evaluating and treating fever without source
to prevent one meningitis or meningococcemia in 2-3000 patients (a
practice I think is reasonable), where is the data to suggest that there
isn't a 1 in a 100 (for arguments sake) chance of profound
detererioration in the next 24 hours?
 
 
Jay Fisher MD
 
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