Hot on the heels of this great Archimedes on whether or not you should routinely do an LP in infants with a urinary tract infection, comes another publication, covered with a fairly critical review in Journal Watch. What’s fascinating here is both “sides” drawing a conclusion that they can’t draw. […]
Category: diagnostics
LP post-seizure – do white cells indicate infection?
Obviously, I’m excluding the rather large proportion of my workload where the presence of white cells in the CSF indicate metastatic disease … but in normal children, if you did an LP on a child after a seizure and got a total white cell count of 19, would you be treating for meningitis? […]
Do neonates produce CO2?
Well, I know that they do to some extent, but do they do it enough to make those expensive little burp-detector kits turn yellow when you intubate correctly? They do in grown ups, and in proper children with big breaths, but what about teeny tiny children? […]
What’s a normal CSF opening pressure?
Bob has kindly let one or two of us into his Archimedes blog to write about some of the papers we’ve consider for Picket in E&P This letter in the NEJM (Avery RA, Shah SS, Licht DJ, et al. Reference range for cerebrospinal fluid opening pressure in children. N Engl J Med 2010;363:891-3.) gives us, potentially, […]
Diagnostic tests: as easy as I, II, III
Diagnostic testing keeps coming back to bite Archi, and that’s not just because of a probability-based failure about a small relative and a missed diagnosis of congenital heart disease. No, the problem with diagnostic tests and their use and abuse remains difficult because the methods of research, the quality of research and the consequence of […]
Natural frequencies “keeping it real”
So, on hearing Matthew Thompson open up a mini-session with natural frequencies my mind turned to the healing power of crystals, and I become acutely concerned that the open-minds approach of the Teaching EBM Conference had gone too far. But this was quashed quickly by his description: […]
Squiggly lines and tea leaves
My grannie-in-law knew a lady who would look at your tea leaves and tell you the future (younger readers – see here – tea is not always bagged & tagged). I had a similar experience with a neonatologist who would look at the seismograph attached to a babies head and declare the child needed more […]
Q: Echogenic bowels and new babies
It was a vogue around the start of regular antenatal ultrasound scanning to note everything, associate wildly and some up with ‘antenatal markers of disease’, as I recollect. Some of these things turned out to be quite useful (nose bones, for instance, or their absence) and others still confuse me … like the ‘echogenic focus […]
Q: Parental presence and lumbar punctures
Does having the a worried mum or fretful dad in the room with you make a lumbar puncture less likely to succeed? It’s an interesting question, and one that has been posed following an evening on call in Yorkshire. What’s the opinions of folk out there – and any evidence that you can quote to […]
Why (wo)men always think they are right.
Have you ever been involved with a debate with a partner or colleague, travelling from one place to another, and when the course they took has got you to the destination safely, they turn to you and say “So, [add endearment here], you see my way was right.”? If you have, I doubt that you […]