<p>The fluid from the spinal tap is generally not only sent for culture which does take 24-48 hours to grow out but also white blood cells, glucose , protein etc
They might also check the pressure of the CSF(spinal fluid) when they initially tap the spinal column. Increased pressure may indicate inflammation in the brain. Spinal fluid that displayed white cells, abnormal glucose and protein might indicated possible menigitis and lead one to begin treatment prior to the culture results. Generally these other tests are ready pretty quickly after the tap...if the tap was clear of all these issue then antibiotics would not have been indicated I would think</p>
<p>Wow, this feels almost like a medical forum. I'm thinking we are all just reacting to the idea that tragedies like this can be prevented, which gives me at least, a sense of control. It also probably leads to the impulse to blame someone. Not sure if anyone is feeling better yet..</p>
<p>Tragedies like this cannot always be prevented. It is possible that care was given quite appropriately and unfortunately the young woman died.
It is not always malpractice when a tragic outcome occurs.</p>
<p>Exactly, Momof2sons. Thank you.</p>
<p>Just to clarify; I was not suggesting tragedies can be prevented. I was saying the immediate response is to want to BELIEVE they can to look for what someone could have done differently, and from there, to place blame. I find I always look for ways of believing terrible things won't happen to me, that if I do everything right I can prevent it. I know I can't.</p>
<p>roberthhid --If you are right, then they should certainly have insisted she stay in the hospital. In a situation like this, where outcome can be death, it seems something different should have been done. I tend to think the CDC person quoted is correct regarding the protocol. But fear of antibiotics --even in extreme and risky cases like this-- has become overblown in medicine today. We've gone from the ridiculous to the sublime on this count --I say this not as doc but as a science reporter covering this issue extensively. This is my personal $.02. Withholding that abx may be considered the standard of care in many cases --that argument CAN be made-- but the standard may be reactionary, and look at the result. What a terrible tragedy. This case should cause everyone to revisit the issue and the standard of withholding --is it right?</p>
<p>Re: testing</p>
<p>There are several rapid Ag tests that can be done on spinal fluid samples - tests for antigens from different types of bacteria that commonly cause meningitis. These would be done in addition to the glucosw, protein, culture, etc.</p>
<p>As a medical professional, I just shake my heads over many of these posts. Yes, a mistake may well have been made, but we don't know, and the news/internet report is not an accurate source of information. Posts like Sonnecty are particularlay hurtful, they plant fear and prejudice that makes the already difficulat job of ER staff even more difficult.</p>
<p>Think about this scenario - patient comes in complaining of "headache" and fever, she has a runny nose and a slightly elevated white count. She has not actually taken her temperature back at the dorm, and now it is normal. She's close to her period and often has headaches at this time, but this one seems a little worse. Her neck is a little stiff, but flexes without an increase in pain, light bothers her eyes. OK, do she get an LP or not??? If she gets one, do you LP every teen with a headache? What is a stiff neck, What is a headache? What is pain? LPs aren't fun, and have their own risks, so an MD wants to be sure that the patient's symptoms and non-invasive signs are appropriate.</p>
<p>Mistakes are made, this could be something as simple and tragic as a tube labelled with the wrong name. It could also be that her infection was subclinical, or as Roberth said, she had a viral infection and then developed meningitis.</p>
<p>Take home messages for me as a Mom.</p>
<p>
[quote]
as a matter of fact, I believe she would have insisted on not leaving!
[/quote]
Right, because 18 year olds don't ever feel that they're immortal.
Because 18 year olds always do what they're told to do.
Because 18 year olds aren't stubborn.
Because 18 year olds never know better than anyone else.</p>
<p>Continuing coverage in the Daily Pennsylvanian.</p>
<p>Attorney: Ryan was Wrongly Diagnosed
<a href="http://media.www.dailypennsylvanian.com/media/storage/paper882/news/2007/10/04/News/Student.Death.Attorney.Ryan.Was.Wrongly.Diagnosed-3011169.shtml%5B/url%5D">http://media.www.dailypennsylvanian.com/media/storage/paper882/news/2007/10/04/News/Student.Death.Attorney.Ryan.Was.Wrongly.Diagnosed-3011169.shtml</a></p>
<p>"But fear of antibiotics --even in extreme and risky cases like this-- has become overblown in medicine today." </p>
<p>I don't think so. Thousands of people are dying (including young women!) are dying from C. difficile colitis related to use of broad spectrum cephalosporins which is what she would have been treated with. <a href="https://content.nejm.org/cgi/content/full/353/23/2442%5B/url%5D">https://content.nejm.org/cgi/content/full/353/23/2442</a>
So if she had received the antibiotic ceftriaxone and it had just been a viral infection but she developed c.difficile, then what? Another lawsuit?</p>
<p>Meanwhile the massive increased use of antibiotics is leading to virulent, resistant deadly staph infections <a href="http://www.gaaap.org/AAU.htm%5B/url%5D">http://www.gaaap.org/AAU.htm</a></p>
<p>I must agree with others however that we probably don't really have enough information (exact lab tests, physical exam) to judge whether she received proper treatment.</p>
<p>
[quote]
Withholding that abx may be considered the standard of care in many cases --that argument CAN be made-- but the standard may be reactionary, and look at the result.
[/quote]
This may be one result. Can you really judge whether the protocol is right or wrong based on one tragic case? Every medical protocol is imperfect. Sometimes even good protocol can lead to death. (Not saying that was the case here.)</p>
<p>Got interrupted.</p>
<p>Mom messages:
Teach your child to use a thermometer, and get them used to expressing in exact degrees - someone who has taken their temp 2-3 times, and recorded that, makes a better story of fever, even if the temp is down when they get to the ER - it is important information.
When you get worse, go back again, be somewhat forceful - I was here, I had an LP, now I'm worse, my temp has been X, my headache is worse...
Take mes judiciously. One scenario I can see in this - child goes back to the dorm, takes a couple of Tylenol, goes to sleep, wakes up dying. It can happen with this disease. If you have symptoms that led to an LP, you should monitor your condition carefully (or you keep calling the kid, they are 18 years old as referenced above), over the next several hours, and go back if you feel any worse.</p>
<p>This is a BAD disease. A BAD disease that harkens back to the bad old days before antibiotics. Despite what the attorney would like you to believe, it is possible that no power on earth would have saved this child, the disease is that bad. It is not all about the antibiotics, either, many, maybe most, victims die of the body's immune reaction to the bug, not hte infection itself. I've seen 3-4 deaths, including the step-daughter of a surgical oncologist, it is a bad thing, that medicine can't always "fix".</p>
<p>
[quote]
Withholding that abx may be considered the standard of care in many cases --that argument CAN be made--
[/quote]
</p>
<p>Yes, that argument CAN be made. Other arguments can ALSO be made, running contrary. That's what keeps the legal system in business - the "battle of the experts" and tailoring arguments to whichever side you're on - not lying, just advocating.</p>
<p>That's why I caution that if statements are made by a plaintiff's lawyer, or a defendant's lawyer, they need to be taken with a pile of salt.</p>
<p>It is interesting to note that in today's daily pennsylvanian story it mentions that Ryan's attorney has not even had access to the medical records as of yet...</p>
<p>1) It is a well known fact that college students are prone to becoming ill with meningitis, especially those living in dorms.</p>
<p>a) Isn't that why the colleges insist that students receive a vaccination?</p>
<p>2) With the knowledge that Ms. Ryan fit the profile stated in #1, above, would it not make sense to be ESPECIALLY careful with her diagnosis, treatment, and FOLLOW-UP?</p>
<p>3) With the possible fatal outcome regarding the chance that it was not a viral infection and indeed meningitis, would it not have been PRUDENT to call Ms. Ryan to check up on her?</p>
<p>4) By not taking care of Ms. Ryan appropriately, other students were in danger of becoming infected also. Therefore, if the lack of proper treatment took place, we are talking about more than just one person being affected here.</p>
<p>Where did you get your medical degree, sonssecty?
She didn't live in a dorm.
Wait for the facts- not an attorney trying to make his case before he even has seen the medical records.</p>
<p>To MomofWildChild: It is a fact that college students often times spend excessive time in the dorms of their friends. I think this counts. I never said that she definitely lived in a dorm. She was still physically located amongst a susceptible population.</p>
<p>One does not need a medical degree to draw reasonable conclusions about circumstances.</p>
<p>
[quote]
One does not need a medical degree to draw reasonable conclusions about circumstances.
[/quote]
Actually, all you've shown is that one does not need a medical degree to JUMP to conclusions without all the facts.</p>
<p>Chedva: This is a forum meant for discussion. I have voiced my opinion just as you and MomofWildChild have done on many occasions.</p>
<p>Sorry, I wasn't trying to cut off discussion. Please continue. Just don't be surprised if others don't think that your conclusions are as "reasonable" as you do.</p>