03 October 2009

Dodged one


Saw a nine-year old with a headache today.  His dad brought him in, and explained that all the men in his family get migraines; he figured this was his son's first one.  The kid seemed perfectly well, with a positive Cheetos sign and my gut instinct was that I would discharge him with no work-up.  But when I flexed his neck fully, he winced.

Just a tiny bit, for a fleeting moment.  I almost missed it.  I asked him, "Did that hurt?"  He said no, without hesitation.  Flexed it again.  No resistance, not a shred, but again the minuscule flicker of discomfort across his face.  "That hurt, didn't it?"  He assured me that it did not.

I decided to tap him. 

Very satisfying tap: first poke, as it should be, and almost painless for the lad.  Positive white cells on the tap, and a non-reassuring differential (almost all neutrophils, indicating possible bacterial meningitis).  Weird -- he looked great, still eating Cheetos when I got the tap results.  Not even a fever.

I'm hoping it's viral, for his sake.  But still: I came that close to just sending him home.

I should buy myself a lottery ticket.

His dad should buy one, too.


Vijay said...

Good call. Congrats!

Mary said...

I'd hug you if it was my kid.

But wait you mean you didn't send him for a head CT first? What gives?

(I think I've been told 5 or 6 times this year "remember that kid you did a CT and cxr on 2 hours ago, yeah they have meningitis--you want a dose of cipro?")

Febrifuge said...

This is how you tell the good EM practitioners: they find the answer despite what the patient is saying out loud. Nice catch.

ERP said...

What was the gram stain and Cx?

doclectic said...

Love the + cheetos sign, read the link. Will remember that one.