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: WhiteCoat Tags: Random Thoughts Source Type: blogs
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