AL didn't have surgery today. Strike Three. The herculean task of getting an ICU bed for his post-op day wasn't the issue. The anesthesiologists refused to do the case, on some whim, but basically saying they didn't think he was optimal (note: if her were optimal, would he need surgery?), and want to wait a month. The excuse they used was concern that he had been admitted for pneumonia (or rather what we learned was heart FAILURE). What-ever. The thing is, this kid is looking fantastic, and it sucks, but he's laughing, happy, he looks like a normal kid. I would take this kid home in a heart-beat. So, we're going to discharge him tomorrow, to follow up at the ENT clinic in a month (when the gassers have decided-albeit arbitrarily). This kid looks sooooo much better than we I met him on July 1, that I really have a tough time sending him out with a prescription for lasix, potassium, and a prescription for good luck in not getting lost in the system.
My jaundiced kiddo.. turns out to have... Biliary Atresia. I've gone 3 years without seeing a kid w/ biliary atresia, and now we have 2 on our ward?? Whoa! She's adorable, and smiles. And is likely off to the OR on Monday.
Pleasant surprise of the day: My extremely malnourished 1 year old is.. HIV negative. By PCR. It's official. He's not doing too well. His CRP (measure of inflammation) is now over 200 (normal < 10), and still going up. He's at least feeding. He's so sad looking. He makes eye contact, but that's about it. Ug.
We admitted to kids with meningitis tonight. One has meningococcal meningitis---another turbid tap. The other is strep pneumoniae. I have my stat dose of antibiotics to take since we were exposed to the meningococcal kid. But, I'm having a beer right now, so wasn't sure alcohol and the antibiotic were wise. Decided to leave the med for the morning, thinking the beer was more beneficial right now.
I think I've previously mentioned organophosphate poisonings.. Wiki it, but it's a nasty chemical which is used as a fertilized. I found out today that it is readily available. Sold in clear plastic bags. They are small black bead looking pellets, and are used as poison for rats etc. Which help in realizing how kids accidentally ingest them. Hell, if I saw a bag of them on the desk I'd likely pop a few of them in my mouth. Candy?
Except that my patient who I admitted w/ organophosphate poisoning this evening is a 13 year old who intentionally took the OD after she had a fight with her Aunt.
