This is what general practice is about - not all that BMI measurement stuff.
F
Declan Fox wrote:
> I have had this while working part time as a staff grade in a paeds
> day unit in a small general hospital--proper paeds unit 27 miles away
> over poor roads. Never really got a good ruling from the consultants
> other than clinical impression. ie fever, prob UTI, couple of wee dark
> spots, already started on oral antibiotic, send along for overnight
> stay. Well kid with cough and a few tiny spots which may have been
> there for ever, keep an hour or two, let home if ok, return asap if
> any changes.
> Kid with malaise and fever for day and few jagged bad looking dark
> spots on one arm (tho pretty small)--the works. That particular kid,
> as I recall, was negative on all tests but got the full treatment anyway.
> Which raises question of what is the gold standard, diagnostically?
> Consultant on the last kid was positive it was meningococcal and
> pointed out that the tests can be negative in a few cases.
>
> Personally I have some reservations about the Pen G shot--it pretty
> much condemns the kid to a few days of IV antibiotics in hospital. PCR
> testing takes about a week, round here.
>
> I think this illustrates the conflict--and it may not be possible to
> reconcile the two extremes--between protocols (which work v well for
> life threatening illness, eg ATLS, ACLS, PALS etc) and clinical
> judgment which is probably safer for the bulk of community work.
>
> A parallel is patients admitted with chest pain. How suspicious of IHD
> do you have to be to put them on monitor, give low molec wt heparin,
> ASA, beta blocker and 40mg statin? In other words, at what point does
> the protocol cut in?
>
>
> Declan
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