Hot Seat #165: DenouementPosted on: February 4, 2021, by : Mary Beth Howard
The case: 7 yo transferred from an OSH for r/o meningitis with hypotension
n a patient with concern for sepsis vs meningitis vs appendicitis, most were in agreement that antibiotics, and pressers were indicated. The time at which pressors were indicated differed, some would recommend a third bolus while the patient is at the outside hospital ED, while others would start vasoactive agents.
Dr. Agrawal brought up a good point that this patient is likely low risk for bacterial meningitis using this validated score.
Denouement: He was continued on ceftriaxone and vancomycin and admitted to the PICU, where BiPAP was initiated for worsening hypoxic respiratory failure. He underwent an extensive work-up that results negative. He was diagnosed with MIS-C (neurologic/pulmonary/GI) and started on appropriate treatment, later to be discharged home.
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