Post by Bjs04f on Aug 2, 2015 10:08:01 GMT -5
important as I had an arguement with medicine. Dude with lung ca with liver and bone mets comes in temp 100.1, looks like shits low pulse ox, ams. ABX on board immediately, like walked out put in fluids, abx, started O2 treating it like sepsis. Guy was tachy, tachpneic, but no white count or neutropneia. Medicine not impressed, he has no whie count, no true fever, no neutropenia. Again numbers in these pt dont work well, just like the elderly. Treat the pt not the numbers. Guy cxr shows bilateral PNA, still admitted in hospital 4 days later
Malignancy with SIRS
Don't think febrile neutropenia, the patients neither need to be febrile nor neutropenic to warrant empiric antibiotics. A better term (and the name of our internal protocol) is malignancy with SIRS.
UCMC Protocol: www.emergencykt.com/extern/Febrile%20Neutropenia.pdf
Goal time to antibiotic administration is <2 hours.
Start with empiric Gram negative coverage. Add Vancomycin if there is a clinical indication.
Clinical indications for the addition of Vancomycin
Clinically apparent serious catheter related infection
Blood culture positive for gram positive bacteremia
Known colonization with PCN/Cephalosporin resistant pneumococci or MRSA
Hypotension or septic shock
Soft tissue infection
Pneumonia
Goal time to antibiotic administration: <2hours
Empiric Gram negative coverage with Cefepime or Meropenem.
Add Vancomycin if there is a clinical indication.
Malignancy with SIRS
Don't think febrile neutropenia, the patients neither need to be febrile nor neutropenic to warrant empiric antibiotics. A better term (and the name of our internal protocol) is malignancy with SIRS.
UCMC Protocol: www.emergencykt.com/extern/Febrile%20Neutropenia.pdf
Goal time to antibiotic administration is <2 hours.
Start with empiric Gram negative coverage. Add Vancomycin if there is a clinical indication.
Clinical indications for the addition of Vancomycin
Clinically apparent serious catheter related infection
Blood culture positive for gram positive bacteremia
Known colonization with PCN/Cephalosporin resistant pneumococci or MRSA
Hypotension or septic shock
Soft tissue infection
Pneumonia
Goal time to antibiotic administration: <2hours
Empiric Gram negative coverage with Cefepime or Meropenem.
Add Vancomycin if there is a clinical indication.