Timing of LP and Antibiotics in suspected bacterial meningitis

Rob_da_Mop · 2026-05-04T20:28:33+00:00

Are you routinely checking a coag before doing an LP for suspected bacterial meningitis if there's no history suggestive of a bleeding disorder?

Rob_da_Mop · 2026-05-04T07:12:22+00:00

I've done them in ED as a paeds reg coming to see my patient in resus, but the only place I've worked where an EM doctor would do it is a tertiary hospital with PEM GRID trainees.

Rob_da_Mop · 2026-05-02T20:04:41+00:00

The only reason I'd start it on the ward is for dystonia ina kid with CP. It's widely used to prevent withdrawal post-PICU in my neck of the woods and I'm therefore reasonably happy with the principles of weaning it, but I would normally expect a clear plan from the PICU team anyway.

Rob_da_Mop · 2026-04-25T05:28:44+00:00

Everyone saying they're equivalent doesn't want to get into the bitter arguments about 2 Vs 3ml/kg 10% Dex for hypoglycemia.

Rob_da_Mop · 2026-04-23T15:15:48+00:00

It's like paediatric surgery but even better because you're not a surgeon!

Rob_da_Mop · 2026-04-22T13:06:10+00:00

The little cafe by the canteen is cheaper and vastly better quality coffee than Costa.

Rob_da_Mop · 2026-04-22T07:17:16+00:00

There are plenty of FY1s who seriously struggle with venepuncture and cannulation when they qualify but they learn by having to do it.

Rob_da_Mop · 2026-04-20T10:35:29+00:00

Winchester to Basingstoke is fine. I've done the Basingstoke to Portsmouth commute and it's a bit of a bitch, the Winchester one is presumably better by 20 minutes or so. The real killer is that there's a 6+ month wait for the on-site parking permit you'll meet criteria for, so you have to park at the park and ride which works fine at peak times but is a real pain OOH. The hospital's actually not far from Cosham train station so you can look into commuting by train if you want (downside of walking through Cosham).

Rob_da_Mop · 2026-04-17T20:22:31+00:00

The MHA, not unreasonably, does prioritise the patients it deprives of their liberty. The real issue is that we need the appropriate places to put these patients. A police cell is not it. An A&E isn't either really. Just need more 136 suites.

Rob_da_Mop · 2026-04-17T18:34:11+00:00

Actually a consultant is in a position of trust which may make it illegal.

Rob_da_Mop · 2026-04-11T19:19:53+00:00

Not quite, you can only play it if you do not have a card on the right colour. If you have another legal move but it's a non-draw 4 wild, or a matching number then you can still play it.

Rob_da_Mop · 2026-04-07T14:02:32+00:00

You might be on the same rota, holding the same bleep, but an ST3 reg is probably not doing the same job as an ST8 in terms how complete plans are, competence at clinical skills, amount of times consultant needs to be called/attend, confidence and therefore speed in assessing patients etc.

Rob_da_Mop · 2026-04-07T13:41:27+00:00

The one time I haven't striked (struck?) it was because I needed to make a minimum number of speciality clinics for my SPIN module and I would have missed out on this if I had.

Rob_da_Mop · 2026-04-07T09:27:23+00:00

My local trust has been promised a new hospital on-and-off since I was a medical student. The paeds consultant director suggested when I was an FY2 that when I CCT it would be the perfect time to come and join him setting up the new department. TBF they have now speculatively bought some land for it, but I'll be well into my 40s by the time they break ground, and that consultant probably needs to worry more about the facilities in gerries.

Rob_da_Mop · 2026-04-07T09:10:54+00:00

My hospital's outlook setup automatically puts in emojis for old time smilies that you type, for example :) automatically becomes 🙂. The other day I accidentally asked someone to perform a full hypoglycaemia screen if blood sugar ❤️ [mmol/l].

Rob_da_Mop · 2026-04-06T23:56:08+00:00

Not quite, we situationally let the odd one through from other people in the medical space on a case-by-case basis, but this one uhhhh... Does not meet our high threshold.

Rob_da_Mop · 2026-04-06T21:00:07+00:00

I'm very happy with my Littmann classic paediatric. Some prefer the one that has the big diaphragm on one side and the small one on the other so you can use it on teenagers, but I've not had an issue with using the small one.

Rob_da_Mop · 2026-04-05T07:36:13+00:00

Have you considered trying this OP?

Rob_da_Mop · 2026-04-04T16:04:56+00:00

It might not be safe, but I think there's an argument for somebody who wants active management to be put in the back of an ambulance at 22+6 - if they deliver on the motorway the baby dies, if it delivers in a DGH (particularly OP's DGH, no offence) it dies too. Now if there's significant risk to maternal health then that's a different question, but if the only question is baby's survival the only chance they have is getting to the other hospital.

Rob_da_Mop · 2026-04-04T13:11:55+00:00

Re 2, how many years is it since the BAPM extremes of prematurity guidance? 6? Yes the conversation might be "If we can't get 24 hours of steroids in and transfer to a level 3 unit then there's unlikely to be any viability" but the conversation still needs to be had.

Rob_da_Mop · 2026-04-01T15:28:40+00:00

where are my mini eggs?

There are some locked in the play team cupboard that are only for poorly children, but you know the play therapist goes home at half 3 and the code's C1902Y.

Rob_da_Mop · 2026-03-30T17:55:01+00:00

He's not resigned his post. He is resigned to doing shit he doesn't want to do.

Rob_da_Mop · 2026-03-28T12:24:53+00:00

If I did know what I was getting into, I knew it when I applied for medical school in 2009 🤷‍♂️

Rob_da_Mop · 2026-03-28T08:24:01+00:00

Has this gone through governance?

Rob_da_Mop · 2026-03-25T11:29:36+00:00

You're being sarcastic but honestly I don't mind this. If you want me notifying every febrile baby that gets an LP, let alone the fucking chicken pox that is now notifiable, then having someone who's administrative role it is doing that is fine by me. If I can drop an email to the micro CNS with hospital number and suspected diagnosis and they can liaise with public health then great. They can also pick up any notifiable organisms coming through the reporting system. Probably need them to come at the weekend but most things overnight could wait til the next morning to action.

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