Thursday, January 31, 2008

Little Man has Pneumonia

What's the difference, moms, between diagnosing a cold and diagnosing pneumonia? How do you all figure out your differential diagnosis?

Well, if this were House (which yes, I am watching right now) they'd run a million unnecessary tests and it would look really dire and we'd never figure it out until we were 40 minutes into the episode.

In real life, it looks like this:

Your day care provider calls you and says your son has a slight fever, 99.8 or so, can she give him some tylenol? You say sure and then you call your partner to go pick him. Then you call the pediatrician because this is day 3 of an on-again off-again fever and because he's been a little more listless, and because his fontnelle was puffy. They squeeze your son in a few hours later.

They see the baby. They check his pulse ox. It's 99%. YAY. They nebulize him with albuterol. It doesn't help.

Then the baby gets chest xrays. They see a spot on the xray that looks like the early part of pneumonia. Hence the crackle on exam. Here's the deal: as a stethascopeless parent, Little Man sounds a bit wheezy, but no worse than a cold. Actually, with colds, where he has congestion in his sinuses, they sound worse.

Back to the exam room. Wait longer. Consider having him admitted to the hospital, but the pedes unit was under-staffed. Instead the doc said to go to urgent care later in the evening and have his pulse ox taken again. If it is below 93%, then he needs to go to the hospital.

But what about the fontnelle? Oh. Maybe it's meningitis after all. Maybe he needs a spinal tap.

After Boo being mistreated and overtreated and undertreated, one thing we have learned is that sometimes it is best to say NO, let's wait and see. So Katie said exactly that. Let's rule everything else out.

Now we have a little boy who is getting corticosteroids and pulmicort and antibiotics and saline nebulization ans saline nose spray.

But at least it isn't meningitis.

So, to recap:

Colds make the baby unable to sleep. Pneumonia makes the baby sleepier. That's the big difference. The temp doesn't matter (though the pede said NOT to give tylenol if his fever is below 101... otherwise it's good to let him burn off stuff). Nor does the sound of the cough externally.

And, going to the doctors with concerns is always good policy. That's why you have health insurance if you are lucky enough to have it.

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