The most recent meningococcus I saw was in a young boy with a few very
untypical spots (they were slightly raised above the skin - small papules)
which he'd had for 2-3 days. He'd vomited twice in the previous 24 hours and
was complaining of a headache. He didn't look that unwell, but he was sleepy
(though fully rousable). Something told me not to send him home, thank
goodness. The meningococcus was confirmed on blood cultures - I hadn't given
Pen V
Margaret
>I suspect that the purpuric rash in a child with NOTHING else is innocent,
> especially in the common situation, of a parent having noticed it the
> night
> before and ambled down to the surgery for an opinion. The purpura of
> septicaemia means that DIC is occurring and that really is happening to an
> ill child. I've seen this in many kids in the days when I worked at a
> regional ID unit, some had no fever, but all looked sick. Of the two in GP
> (
> only two, thank God) both were sicker than the objective findings would
> have
> you believe.
>
> Now, what we need to do is persuade the powers that be that A GP's eye,
> and
> opinion on clinical diagnosis, are valuable.
>
> -----Original Message-----
> From: GP-UK [mailto:[log in to unmask]] On Behalf Of Declan Fox
> Sent: 23 April 2007 17:50
> To: [log in to unmask]
> Subject: Re: Kids with fine purpuric/petechial rashes.
>
> 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
>
> No virus found in this incoming message.
> Checked by AVG Free Edition.
> Version: 7.5.463 / Virus Database: 269.5.9/773 - Release Date: 22/04/2007
> 20:18
>
>
> No virus found in this outgoing message.
> Checked by AVG Free Edition.
> Version: 7.5.463 / Virus Database: 269.5.9/773 - Release Date: 22/04/2007
> 20:18
>
>
>
|