7 week save

I helped save a 7 week little girl today - well yesterday but the fruits of my labor paid off today.

7 week female into the office for a rash on the right cheek. Mom reports a "fever" of 99 under the armpit and added a degree to call it 100. I explained I was glad she came in although we don't usually get to worked up about these "fevers" unless they are 99.4axillary or 100.4 rectal. But glad you brought her in to be on the safe side. I thought her rash was bad irritateed ezcema that they'd been using the horrible baby magic on and some wicked seborrhea. She looked nontoxic - smiling cooing, eating ok, sleeping ok. My preceptor thought the rash and ear looked impetigo and yeasty so we attempted a culture of the front part of her ear. So with this feverthing - do you work her up because she is less than 2mo? or treat her rash once the culture grows out. It was my call... so I said draw a CBC, CRP and since we're sticking her a blood culture thinking if we're going to the trouble might as well go all the way. Her culture came back on her ear - yeast so a little lotrimin cream to the cheek. This morning though her blood culture had already grown streptococcus which means she has bacteremia - bacteria in the blood. SO she needs to be admitted and have an LP. So she comes into the office for a cath and LP. Long story short her LP CSF had >10WBCs (bad new bears...+meningitis) and Group B strep and another strep unknown still pending so this is one sick sick kid. Theoretically for as sick as this kid is and had the cultures not been done, just the CBC and CRP which were essentially normal - yes normal.... she most likely would have spiked a temp tonight and seized and then died or been brain dead from the extent of the meningitis and brain edema. That is really scary to think about. if I would have been on my own in clinic...would I have ordered the lab with the questionable temps? She was afebrile in the office without motrin on board and didn't appear sick. her rash is gone today and she still looks nontoxic. She's the kind of kid who would've crumped...just like that crumped. Needless to say it scared me enough that I will be a little lab-happy and jumpy for awhile. I know it's an expense and pain to the patient but if I ever doubt myself and lose a kid - I would be devastated. But for today I am relieved 9although mom wanted kiddo to be admitted to Children's which is a half hour away - which was before we knew what her LP showed and after 2hrs she still hadn't shown up with the id even though we were adamant that she had to go straight there...so I pray she made it). So like I said - for now, I say today - well yesterday...I helped save a 7week little girl - now the rest is up to something bigger than me.