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.
5 comments:
Good call. Congrats!
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?")
This is how you tell the good EM practitioners: they find the answer despite what the patient is saying out loud. Nice catch.
What was the gram stain and Cx?
Love the + cheetos sign, read the link. Will remember that one.
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