How Can You Be Sure?

“How can you be sure?” That question stopped our discussion for a second. During some down time, several nurses and I were talking about childhood coughs. Her 6 month old child had just started daycare 2 weeks ago and has been coughing ever since. The child was put on amoxicillin and then Zithromax by her pediatrician but … [GASP] … her cough wasn’t getting any better. The nurse thought her child had pneumonia. “What should she be taking now?” I was in a particularly snarky mood, so, with a smirk, I said “probably vancomycin … maybe add gentamycin just for the gram negative coverage, too.” “I’m being serious. She’s not getting better with antibiotics.” “BINGO! That’s because she has a virus infection and antibiotics don’t kill viruses any more than RAID kills dandelions.” “But a virus infection isn’t going to last for two weeks.” “Neither is bacterial pneumonia. The fact that she isn’t getting better with antibiotics should tell you that she has a chest cold. It’s a virus.” “How can you be sure?” Ugh. There’s just no good response to that question. The truth is that we can’t be “sure” that there isn’t a bacterial infection present. We can’t be “sure” she didn’t aspirate a foreign body. We can’t be “sure” that she doesn’t have tracheomalacia...
Source: WhiteCoat's Call Room - Category: Emergency Medicine Authors: Tags: Random Thoughts Source Type: blogs