Today was the last of my 5 day evening shifts in the Emergency Department (I've got the next two days off - yippie!). A relatively quiet night - I was working in the acute area, and there was never any point in the evening when there were more than two slots filled in the "to-be-seen" box. This was, of course, in stark contrast to a few days ago, when the patients were spilling out into the corridors and chairs.
There was a five year old kid today who came in with a headache and fever. The headache had started this morning, while he was at school, sitting down having morning tea. The pain was global (not localised anywhere on his head), sharp and throbbing. His pain built up to severe and was settled, but not completely relieved, with acetaminophen (tylenol/panadol). He had been well the past week although he had been in hospital one week ago for an operation to his penis to enlarge his urethral orifice as it had become stenosed (again) secondary to an operation there some time ago to correct congenital hypospadias. He had been on Keflex (cephalexin) for an infection of the wound on his penis and for a cough.
At triage, he had a temperature of 37.9 degrees Centigrade and was given some more paracetamol. When I saw this kid, he was lethargic and sleepy but rousable. He had no neck stiffness, no photophobia and no other neurological deficits. His chest was clear and his abdomen was soft. There were some slightly enlarged tonsils in his mouth and two 1cm swollen and firm lymph nodes on either side of his neck. His eardrums were not visible due to wax in his external ear canal. There were no rashes of any sort anywhere on his body. There was no signs of trauma anywhere on his head.
A chest X-ray of this boy turned out to show no abnormalities. Blood tests only showed a slightly raised white cell count, mostly neutrophils. The decision was made to lumbar puncture him to exclude a meningitis.
My shift ended at 12 midnight and the decision to LP him was only made at 11:45pm (the bloods were inconclusive and he had not improved on paracetamol and ibuprofen, his temperature had climbed to 38.4 C and he looked no better than when he arrived). I did have to reinsert an IV cannula into his arm as the previous one had kinked and was not working.
I will have to remember to check this kids records later when I go back to work in a couple of days to find out whether or not he had any meningitis as I didn't stay for his LP.
A short financial update:
The Dow Jones Industrial Average does not look like it has any good support at this level. The 9500 level was cut through like a hot knife through butter. hmm...
On a technical scale, there is some minor support near the 9000 mark, but the major support level would be closer to the 1998 low of 7000. Sheesh. Ouch.
Anyone long or holding on to stocks "for the long term" had better hope these levels hold. ... or that you don't really need your money for the next ... lots of years ...