Mission medicine has taught Medicos that much of American medicine is driven by fear rather than logic. Continuity is dead in the medical school and residencies. Indoctrinated physicians never actually experience any form of longitudinal community medicine, and therefore, the statistical assumptions are skewed in favor of expensive and dramatic interventions which are inaccessible for large parts of the earth.

That child was given IM antibiotics(Ancef 400 mg and Gentamicin 60 mg IM) and seen one day later. As on day one, the child was afebrile. and interacting appropriately. The eye was less swollen and conjugate gaze was documented. The wound was clean and dry. He received a second series of IM antibiotics. Even in native Spanish, the patrimony misunderstood the directions and never gave the Cleocin which was prescribed. They started the Cleocin po day 3 after the twin series of injections. Medicos will take the sutures out at 5 days. Note the photo on day three below. Excellent Yale Observation scale scores and a totally focused mother-father pair.
Eye and scera are now partially visible and seem to be tracking. CT needed? Yes that was periorbital cellulitis, but there were extenuating traumatic circumstances which makes the prognosis less ominous. Cost prevention over $12,000.

One of the advantages of Medicos is the intense level of the procedural skills and that includes office surgery, fractures, and all of the children who cannot asset care anywhere but Medicos. Additionally there is the constant followup on a variety of cases currently not serviceable in residencies or in the hospital-employee practices under which Family Medicine withers.

Ultrasound cases of this week have included over fifty pregnancies but also an omphalocoele, gallstones, AIUGR, and testicular hernia. We follow all GDM with NST, AFI, EFW in the office by our fellows under faculty supervision.

Medicos physicians are unified in the concept of Family Medicine-OB-ER, but we have maintained the liberty of running these activities within one family medicine group. Medicos is now doing over 30 deliveries a month in Memphis with excellent backup. Additionally the fellows scrub another 15-20 Cesareans monthly from spare physicians. Medicos physicians should understand basic surgical principles.

REPLY #1:
I guess Ill take a crack at it:
Go to Hospital, go directly to hospital for IV abx for peri-orbital celullitis maybe removing a few sutures. Got some necrosis (hopefully superficial) . They feasibly flushed the hell out of it, yet on the face I cant see how they didnt send him out with Abx but I havent spent ED work for a while and I know dog bites are supposed to be pretty clean (compared to humans and cat punctures).

Can the kid see out of that left eye?

reply #2:
My first thought was: Can the kid move the eye?
If he can, then periorbital cellulits is a apt diagnosis. Oral antibiotics are probably OK, may just give the kid a loading dose of something IM, identical Rocephin, next go ahead with po antibiotics. But in this case some imaging would be warranted because of the bite, a CT scan is the usual, maybe a ultrasound could be buttoned up instead, not unqualified.
Crave to rule out an abscess. Releasing a few sutures may be just the ticket. Close follow up is a must on that case.
If the kid cannot move the eye, it is orbital cellulitis, needs to go to the ER emergently. Ophthalmological consultation becomes a must for orbital cellulitis.
-JP
REPLY #3:
Augmentin, standard dose, at the very least, plus/minus 50mg/kg ceftriaxone, possibly relieve any pressure by removing a suture or two.

Shoot the dog.
WRG

REPLY #4:

Is hospitalization an option? culture the wound, and IV Unasyn, if no PCN allg.

Or are you asking b/c that is not an option....

thanks for sending these to a larger group. I have learned from ALL your emails!

-SUE MAGEE
Director Maternal Child Health Fellowship
Brown University/Alpert Medical School

REPLY #5:
Option 1. Rocephin and recheck closely 12-24 hours.
Option 2. Back to the hospital for IV therapy and consultation with surgeon or EENT.
Civilization the Dogs mouth?

REPLY#6:
1. Admit the patient
2. IV antibiotics broad spectrum (Ampicillin-sulbactam)
3. CT Head/looking for orbital/preseptal cellulitis??
4. Get Surgery involved

J.Macias
REPLY #7:
Bill
I would be concerned about the presence of a preseptal infection and would proceed as if it were present. Imaging should be obtained and AB therapy instituted and carried forward until all cleared. C S of any exudate/drainage would be ultimate important to me as well.
Skip Felmar MD
REPLY #8
Sadly when you have results like this, many (paranoid) mainline thinkers only allow you to be not bully or better than average. They think of you as a risk-taker, cavalier or ignorant of all the bad things that could have happened had things not gone so well. At times, I grow weary in the battle, until I remember these words, And let us not be weary in well doing: for in due season we shall reap, if we faint not.

John Spencer MD
A Side Note:
A child who continues to receive immune competent mothers milk even at this age, will also be less inclined to have infections of all types, especially those involving mucous membranes. Both pictures show the use of the bottle which is associated with boost likelihood of cutaneous infections. We could speculate that had this child still been receiving his mothers milk he may not have had the infection in the first position. We could also speculate that had his mother been nursing her prolactin levels would have been higher and she would have passй more protective and the dog bite may not have occurred. Realistically speaking and sadly so, many humans dont want to hear that.
Sadly when you have results like this, many (paranoid) mainline thinkers only allow you to be not good or better than average. They think of you as a risk-taker, cavalier or ignorant of all the bad things that could have happened had things not gone so well. At times, I grow weary in the battle, until I remember these words, And let us not be weary in well doing: for in due season we shall reap, if we faint not.

Similar posts: cleocin and nursing

Pharmacy 50th Anniversary- To celebrate their 50th Anniversary Paramores Pharmacy would like to invite you to their Open House from 9am-5pm Thursday Friday. Anyone who has been an employee of Paramores Pharmacy is invited for a special reunion Friday afternoon at 5pm.
Friday, November 7, 2008
Laurence S. Pender, Principal of Sneads High School would like to cordially invite all graduates of Sneads High School and Grand Ridge School to attend an alumni reception at ten oclock in the morning. The reception will be held in the foyer of the school and guests are invited to view the collection of alumni photographs at this time.
Friday-Saturday, November 7-8, 2008
7th Annual Veterans Day Poker Run hosted by Pony Soldier and Cookie. FREE Tent/RV Camping, Live Band Friday and Saturday Nights, Food and Vendors, Saturday Poker Run starts and ends at The River Lounge Hwy 92, Clayhatchee, AL. FBO: 1200 hrs/ LBI 1700 hrs. Best/worst hand- Door Prizes, 50/50 Drawing. All proceeds support ANG Family Readiness Program. $10 per hand Free Run Patch. For more information call Pony at 334-692-9933.
10 Mile Long Yard Sale off Hwy 69 N. in Grand Ridge on Sand Ridge Rd. or Butler Rd. Plenty of signs will be showing the way as well. Yard sale begins at 7 a.m. Come for a day of fun. For more information call Sue Rudd at 592-1260.
Saturday, November 8, 2008
Rocky Creek Baptist Church Fall Festival- Pastor Charles Williams and the entire Rocky Creek Baptist Church family invite you to join them at their Fall Festival from 3pm-7pm on the church grounds. There will be food, music, games and lots of fun and fellowship for everyone. This exciting event is being given as a gift of love- no charge. Dont miss out on a great time! The church is located just south of I-10, exit 142. Highway 71 S one mile, left on Rocky Creek Road, approximately 3 miles on the left. For more information, call 850-569-2591.
First United Methodist Church of Cottondale is having a huge Yard Sale from 7am-11am. The sale will be inside the Fellowship Hall as well as on the sidewalk outside! For more information call Sandra Tice 352-4732.
Gallery Talk hosted by The Artists Guild of Northwest Florida during their monthly meeting at Chipola Arts Center at Chipola College in Marianna, Florida. The public is invited and encouraged to attend this meeting featuring talks by local and regional artists regarding their work on exhibit at the Arts Center. Event will begin at 9 a.m. and continue until noon.
Sunday, November 9, 2008
Harvest Day at First Baptist Church of Campbellton services start at 10:30am. Rev. Luther Pumphrey welcomes all! Gateway Messengers in Concert. Guest speaker is Rev. Ronnie Wright. Join them for a day of worship, music and fellowship. A covered dish lunch will be served following the service. Come and bring family friends.
Gospel Sing at the Lighthouse Community Church - The feature group will be the Walkers from Perry Fl. The sing will begin at 6 P.M. Everyone is invited. For more information please call 526-7763.
Sunday- Wednesday, November 9-12, 2008
First Baptist Church of Bascom welcomes Pastor Jack Daniels. Come hear the amazing story of Gods Grace of salvation that took him from the bottle to the Bible. Sunday morning services begin at 11 a.m. with nightly services beginning at 6:30 p.m. The church is located at 4951 Basswood Rd.
Monday, November 10, 2008
Veterans Day Parade Hosted by the Ted Walt VFW Post 12046, Marianna, Florida. VFW Post #12046 and Ladies Auxiliary of Marianna will host a parade honoring veterans past and present, Line up will be at 2PM on Daniels St. at the old Marianna High School. No Entry Fee to participate. Please call 526-1880 before November 3rd for sign up information.
Thursday, November 13, 2008
Jackson County Habitat Auction Smoked Steak Dinner will be held at Jackson County Agricultural Conference Center, 2741 Pennsylvania Avenue, Marianna, FL. Tickets are $25 in advance, $30 at the door, $5 for Auction only. Smoked Steak Dinner and Silent Auction @ 5:00pm. (Bidding on Silent Auction items can begin at 3:00pm) Live Auction @ 6:30pm. Volunteers Needed. Donated Items Accepted. For more information call Leslie Fuqua 4822187. Tickets can be purchased at the Thrift store, Melvin Eng., Georges Glass Tinting, Jackson County Vault Monument, or the Habitat Office.
Emerald Coast Hospice Chaplain/Social Worker To present "Grief and the Holidays" Gino Mayo, Chaplain and Bereavement Coordinator, and Sherri Stone, Social Worker for Emerald Coast Hospice in Marianna will present the program "Grief and the Holidays" at the Marianna Health and Rehabilitation Center on Thursday, November 13th, 1:30 pm. The experience of grief can be overwhelming during the holidays when the loss of a loved one is felt more intensely. Holiday time can be very difficult for those still mourning the loss of a loved one. This program will assist you in celebrating the holidays and provide tips to assist you in effectively managing your grief. Come spend an hour with us and learn how to make the holidays a special time for you and your family. Call Gino Mayo, hospice chaplain, at 850-526-3577 for more information and directions.
Friday, November 14, 2008
Jims Buffet and Grill is hosting a Dance at 5:30 p.m. Tickets are $6 per person. Dinner from the buffet or from menu as priced. All proceeds will be donated. Come have fun. For more information call 526-4561.
Saturday, November 15, 2008
Malone Pecan Festival Friday the 14th of November there will be a pecan pie contest; all entries will need to be at the Malone Town Hall before 12, so they can be judged. Saturday morning there will be a pecan pancake breakfast starting at 6:00am and the parade will start at ten. Entertainment will be the Thompsons and BlueGrass Pure Simple with Travis Perry from Dothan. The line up will be at the Malone High School. There will also be an art contest. Parade contacts: Dorothy Mathis 5692986, or Sallie Gibson 5692980 or 5692771. There is no fee for parade entries. Booth contacts: Flora or Ken Beard 5695644. Booths with electricity will be $35.00, without $30.00. Pecan pies will be for sale. For fun there will be pony rides and slides for the kids. They will have a pecan house owned by Gayle Hart and her son Jessie. They buy and sell pecans. Come out and enjoy the day!! 1st, 2nd, and 3rd place winners for best float will receive trophies. Pecan Festival sponsored by Optimist Club of Malone and Jackson County Tourist Council of Marianna.
Campbellton Senior Citizens are reminded to call in to Campbellton Town Hall and get on the list for the Thanksgiving Luncheon on November 15--this is an event which the Town of Campbellton does once a year for the seniors.
Tag a Live Christmas tree from 8am -5pm. Maphis Tree Farm is having a Fall sale on plants and other items at the Nursery and Gift Shop. Many items reduced. Bring the family and tag your Christmas tree. Fruit and Citrus trees, shrubs, hanging baskets, fall decorations, wreaths, silk arrangements, etc. Located at 814 Rattlebox Road Chipley, Florida. For more information call 638-8243.
Last day to submit the names of needy families for the Buffalo Soldiers of Marianna Thanksgiving food drive.
The North East Jackson County Optimist Club announces its Annual Childrens Christmas Fundraiser. Members of the club will sell BBQ plates during the Malone Pecan Festival. The plates which will consist of a shredded BBQ Boston Butt Sandwich, coleslaw, baked beans, bread and a drink will go on sale at 10:30 a.m. All proceeds from this event will be used to purchase Christmas gifts for area children. For more information, contact Lisa Floyd at 850-573-7696.
Saturday-Sunday, November 15-16, 2008
Caverns Road Church of Christ will be hosting a Saturday Vacation Bible School. It will be more Christian fun than you can imagine in a half day! Festivities will include: Bible stories, singing, crafts, hay rides, horse rides, animals to visit with, snacks and lunch! Its free for all children ages 1-12 [6th grade].
St. James A.M.E Church located at 2391 Orange St. in Marianna will be celebrating "Membership Day Weekend." On Saturday the weekend celebration will kick off with a "March of the 50 States Program" in the lower auditorium beginning at 6:00 p.m. The celebration will conclude on Sunday with the 11:00 a.m. Worship Service. All are cordially invited to attend. For further information you may call 850-536-3440.
Sunday, November 16, 2008
Fine Arts Series presents FSU Baroque Ensemble- Cello, Violin, and Flute, with Ryan A. Kasten on Harpsichord. 4:00pm at St. Lukes Episcopal Church in Marianna. Meet the Artists Reception follows this concert. Donations accepted for the Fine Arts Series.
Compass Lake in the Hills Fire Dept. hosting a spaghetti dinner from 1-5 p.m. on Nortek Blvd. Adults are $6.00 and children under 10 are $3.00. Take Out available. For information or tickets call 579-430 or Arty Penello at 579-5183 or 557-3554.
Monday, November 17, 2008
Jackson Hospital Finance Committee will have their Finance meeting at 5:30pm in the Community Room of the Hudnall Building.
Chipola Chapter, NSDAR will meet at Caverns Road Church of Christ, located one block north of the Jefferson Kelson intersection in Marianna. Social time begins at 11:10 with the opening ritual at 11:30 a.m. Debra Bush will bring the Native American program, "Living in Two Worlds." The Dutch Treat luncheon is $11 and reservations are needed so that caterer Brenda Shiver will know the amount of chicken casserole, etc. to prepare. For reservations please call Dorcas Jackson at 579-2103 or send an email to snoopyxii60@hotmail.com.
Cottondale Alford. For further information, you may call 579-4194 or 526-1951.
Monday-Friday, November 17-21, 2008
Salem Free Will Baptist Church will be hosting the Salem Association Area Wide Crusade. Services will begin each night at 7:00 p.m. The evangelist will be the Rev. Tim York, who pastors Woodbine Free Will Baptist Church in Nashville, Tennessee. There will be special singing nightly. Salem church is located at 2555 Kynesville Highway, just off Highway 231, between Cottondale and Alford. For more information call 579-4194 or 536-1951.
Wednesday, November 19, 2008
Jackson Hospital Board of Trustees will have their board meeting at 5:30pm in the Community Room of the Hudnall Building.



Thursday, November 20, 2008
Emerald Coast Hospice Chaplain/Social Worker To present "Grief and the Holidays" on November 20th Gino Mayo, Chaplain and Bereavement Coordinator, and Sherri Stone, Social Worker for Emerald Coast Hospice in Marianna will present the program "Grief and the Holidays" at the Jackson County Senior Citizens Center on Thursday, November 20th, at 10:00 am. The experience of grief can be overwhelming during the holidays when the loss of a loved one is felt more intensely. Holiday time can be very difficult for those still mourning the loss of a loved one. This program will assist you in celebrating the holidays and provide tips to assist you in effectively managing your grief. Come spend an hour with us and learn how to make the holidays a special time for you and your family. Call Gino Mayo, hospice chaplain, at 850-526-3577 for more information and directions.
Friday, November 21, 2008
Buffalo Soldiers of Marianna will be giving selected needy families the Thanksgiving boxes they have prepared.
Saturday, November 22, 2008
Help the March of Dimes achieve their mission to give babies the chance of a happy, healthy life by attending an elegant cocktail reception to celebrate the Best of Tallahassee winners, wine tasting, music, and a live and silent auction. 6 PM: A variety of wine classes. 7PM: The Grand Wine Tasting Event. At the University Center Club, Florida State University. Tickets are $50 in advance and $75 at the door. For more information contact Eventions at 850 Last day for submissions to be entered for the D.A.R sponsored writing contest. Contest includes the DAR American History Essay Contest for grades 5-8 and the Christopher Columbus Essay for grades 9-12. For more information please contact Chipola Chapter, NSDAR American History Chairman Mary Robbins at snoopyxii60@hotmail.com or 209-4066.
Monday, December 1, 2008
Campbellton Senior Citizens meeting is scheduled at 6 p.m. in the Community Center. Ben Graves from Promised Land Farms will present an informative program on trees. Also, this will be a Christmas Luncheon. Each person is asked to bring a small gift under $10 for exchange along with a covered dish for the evening meal. For other information, call 263-8145.

Similar posts: cleocin and nursing