Possible MMI Scenario?

[MiamiBoyy]

So Im wrapping up a quite eventful night shift in the ER (Im a scribe). A few hours ago, a month old baby came in with a 102.5 F fever. The poor baby also had a recent liver infection for which he stayed 10 days in the NICU. Pediatrician that took care of him during that time is concerned for meningitis and wants the baby transferred to another hospital with a Peds ER. Doc from transfer center wants a lumbar puncture to confirm meningitis before accepting the patient. Parents don't want the LP because they believe the baby has been through enough trauma. As the ER physician you are responsible for the patient while he is in your hospital. I guess the question is, as the ER doc how would you approach the situation?

---

Members don't see this ad.

 

[Bumblenest]

Would explain risks of lp, but also why it is important, to try to see if they are okay w it. If parents ultimately still don't want it I would not give lp. See if there are other ways to test for meningitis, and closely monitor for other symptoms that could confirm. Continue to treat baby.

 

[peridotthecat]

This seems too clinically detailed for an MMI scenario. At least at the MMI I went to, the admissions folks said the questions were designed so someone without medical knowledge could answer them. The underlying idea (parents' wishes vs. best interest of the child) is good though! It would just likely be presented in more simple terms.

 

[MiamiBoyy]

This seems too clinically detailed for an MMI scenario. At least at the MMI I went to, the admissions folks said the questions were designed so someone without medical knowledge could answer them. The underlying idea (parents' wishes vs. best interest of the child) is good though! It would just likely be presented in more simple terms.

Yeah youre right I guess it can be reworded a little to make it simpler but yeah that was the underlying idea. @Bumblenest good answer! However a detail that should have been mentioned is that an LP is the most definitive way to diagnose meningitis aside from cultures which would take a couple of days. Anyways I think this goes back to @peridotthecat s point about it being to clinical.

 

[CliveStaples]

I agree that at this point the case is too medical for a medical school interview.

The fact of the matter is that in a 30 day old with a fever and suspicion for meningitis vs. some other source for sepsis (also keep in mind this infant is a NICU graduate) the standard of care is going to be to perform a lumbar puncture, among a whole host of other tests. The best solution is to convey the gravity of the situation to the parents - it sounds like they didn't believe that the child was really sick and that the LP would be unnecessary. A physician's job is also to educate and proper education of the parents will likely solve this situation.

That said, if they continue to refuse and you believe that this puts the infant at risk of harm, this is what a call to CPS is for. Oftentimes a visit from CPS will get the parent's consent without necessarily resorting to going to the courts.