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Thursday, January 31, 2013

There is Still Plenty of Change Needed

It's been a few days since I have made an entry.  In South Louisiana we tend to fluctuate in extreme temperatures this time of year.  This equates to sick children.  Last week it was Conner with gastroenteritis and this week it is Matthew with croup.  Both had visits at separate times with their pediatrician's office.  Due to scheduling we were unable to see our normal pediatrician. 

Even after all of the education, advocacy, and pleading to make sure EVERY medical assistant in the office knows that blood pressure MUST be included in vitals, we had a new MA that failed to take his bp until I asked for it.  Now mind you, their office has made the dreaded change to electronic medical records which clearly asks for a bp reading.  It was manually over rode.  After a brief explanation she clearly understood the importance of a bp reading not only to me but to every child that comes in.

Now, this week as soon as Matthew started coughing off we went to the doctor.  Same as last week we happened to need an appt. on the day their regular doctor was off.  We were lucky enough to schedule with one of the other pediatrician's that we are quite fond of.  He has always had an interest in Matthew's history and happens to know his nephrologists in NOLA due to the fact he did some of his training there before going into private practice.  We discussed the pros and cons of oral steroids as opposed to an inhaler.  We don't like to put anything on board that will make the kidneys unhappy.  Matthew's visit was different than Conners in the fact that the medical assistant took his bp without being prompted.  A plus in my book!  When she took it the reading was 100/80.  This seemed like an odd reading for what his pressures run even when he doesn't feel good.  I mentioned it to the doctor and he glanced at the computer and said he only looked at the systolic and saw a great number so didn't even look at the bottom number.  He agreed that it was a different spread and called her back in to repeat it.  Again on the right arm and got the exact same reading. She took it on the left arm and this time got 101/82.  Diastolic was even higher. 

The doctor was being as helpful as possible and fully knows that we try to stay on top of bp topics as it pertains to children.  He suggested the elevation could be from him being sick.  This is totally possible and probably accounts for the high reading. He suggested that we just "stop by" a Walgreens or Walmart and retake it in a few days on one of the machines in the pharmacy.  HUH?????  Are you kidding me?  No child should ever, ever put their arm into one of those machines.  First the cuffs are sized for adults.  Secondly, how often are they calibrated?  I don't even recommend for the adults I know to use those unless it is absolutely necessary. 

I allowed him to finish and then said, um no thank you!  He will not be using one of those machines and before I could finish he said that as soon as the words came out of his mouth he realized he should not have recommended that.  He did say that he has recommended older, larger children to give a quick  check using them but realized that in Matthew's case or that of smaller children they should not use them. 

All was well and resolved before we left.  But this just affirmed to me that there are still many, many pediatricians that still need extra knowledge on bp and how it pertains to kids.  After all, this should be one of the main vitals.  They should all be versed on the importance to the safety and lives of their patients to know what is a good number, what is not, when to recheck, what methods should be used to do a recheck, and when to say something is not right. 

Until then, I will continue my endless quest to tell anyone that will listen how important this is.  Until we have all practitioners on the same page parents must also be educated and know what to ask and when to question. 

Now, if you are a physician please, please make sure you first and foremost have a bp done for every child.  Second, look at the numbers.  And look at them close!  Know when to recheck and what is OK.  Please don't ever dismiss an elevated reading to white coat hypertension without a recheck.  Third, never ever tell a parent to bring their child to Walgreens or Walmart to use one of the stationary bp machines that are designed for adults. 


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