Before calling that ID consult: a few thoughts

  • I am happy to see the consult
  • I want to make recommendations that are useful to you and the patient
  • It is incredibly helpful if you have a well-defined consult question
  • Antibiotics are a precious resource and should only be given when necessary (easier said than done to determine when that is!)
  • Question medical dogma.  Most of it is wrong.
  • Does the patient have any allergies?
  • Were blood cultures drawn before antibiotics? Are you sure?
  • Antibiotics, including doses and dates (before admission and since admission)
  • What bacteria were the clinicians trying to cover with those antibiotics?
  • Fever curve and WBC trend
  • Have you requested all the patient’s records (especially cultures) from the OSH?
  • What do you think the source of the bacteremia is? Do we have source control?
  • Any hardware or devices or PICC lines or ports in place? When were they inserted?
  • If there was a recent surgery, what happened in the OR? What is the surgical plan?
  • If you can get consent and post a photo of the wound in LMR, that’s very helpful.
  • How was the urine sample collected (clean catch, straight cath, off the foley bag, nephrostomy tube, etc).
  • Has the patient been seen by ID before? If so, when, and why?
  • The very best ID doctors I have worked with always keep asking the question, “why?”
  • “Why does this patient have this infection?”  “Why now?” etc
Screen Shot 2015-02-23 at 8.22.54 PM
with my son. who already knows that germs make us sick.

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