Thanks Barry. Out of curiosity I did phone 3 near by depts, but thankfully
they haven't had anything (as of yet). However, they are now alerted to the
very small possibility of a bigger pattern.
In terms of wider communications, this list is very useful for flagging up
potential patterns.
Looking over the past, interesting cases which are noted include the
botulism outbreak in 1989 and the more recent possible anthrax contamination
of heroin. The 'media ' are good at flagging up this type.
I also remember the 'thunder storm asthma' night when we saw 20 or so with
acute severe asthma. I'm not sure how the pattern was discovered, but it
would be very easy to get a big picture with the use of lists like this.
----- Original Message -----
From: "Barry Salkin" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, June 08, 2006 11:51 PM
Subject: Re: Atypical pneumonia.
In article <000801c68b41$6794fbf0$0202a8c0@STUDY>, Adrian Kerner
<[log in to unmask]> writes
> I'm always looking for abnormal patterns in the department (well
> you have to keep yourself amused some how).
>
> Had 2 ill pneumonias in. Not uncommon.
> Age - 24 and 32 - not so uncommon.
> Both with severe pleuritic chest pain and progressive SOB - not
> uncommon.
> Both had diffuse patchy changes on CXR - {I don't think are
> entirely 'typical'.}
>
> The 24 year old required inotropes and ET IPPV on ICU. CT shows
> extensive right pneumonia with some 'nodular changes' on the
> left.(still waiting formal radiology report) No PE.
>
> No identifiable factors eg travel, pets, obvious dead birds etc.
>
> The question is: do I get worried if I get a 3rd young patient with
> an 'atypical picture' in the next few hours?
>
> Then the hypothetical question would be; what happens next?
>
> Adrian Kerner
> Cons
> Emergency Dept
> Dewsbury
> West Yorkshire
The 3rd could again be a temporal co-incidence, but by now I feel one
has to assume they are linked until e.g. different diagnoses are made
for each.
1) Involve your Consultant Medical Microbiologist? (aiming to get some
rapid diagnostic testing e.g. urinary antigens), as well as priming the
microbiology dept for other specimens from these patients.
2) Involve the CCDC / HPU ?
Firstly to exclude any epidemiological link between patients, and the
time taken to do this is perhaps better spent by them as their area of
expertise, rather than by you. (I'm sure you can do so, but is it for
Emergency Medicine to do the investigation or is it for E.M. to note a
problem and call the 'experts'?) and :
Secondly, because if you don't, you may later be criticised for NOT
telling them early, if it turns out to be the start of an outbreak that
you had detected.
3) Call round other local ED's / ICU's and the AMU (in case they have
seen patients with similar) - if you were undecided about calling the
CCDC.
Best Wishes,
--
Barry Salkin
(Microbiology SpR and St. John Ambulance Doc, - writing in a personal
capacity).
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