We can provide much better patient care if you take the time to prepare before calling the consult.
Not so great “blurb”:
“We have this guy, he has diabetes and just had a foot debridement and is in the PACU, his old wound cultures are growing Staph, and we put him on vanc and Zosyn, can you come and help us with antibiotics?”
“This is a 50 yo man with poorly controlled diabetes and we are calling for assistance with management of left foot osteomyelits. He has a A1c 12, with no prior foot infections, who picked a callous on the lateral side of his foot in early July. He was seen in Z hospital and on exam had a black eschar, which was not debrieded. He had no fever or leukocytosis at that time. Instead he was given ciprofloxacin. He represented last Thursday with fevers, chills, redness and swelling of the lateral side of the foot. At Z hospital, he was found to be febrile to 102 degrees and had leukocytosis of 15 with a left shift. He had blood cultures drawn before antibiotics, and was found to be bacteremic with MSSA and was started on cefazolin. His bacteremia cleared right away. He had a superficial wound swab sent from the lateral of the foot which grew MSSA and Proteus and he was transferred here for surgery. I emailed you a photo of the foot before we took him to surgery. Today he went to the OR for a soft tissue debridement on the lateral side of his foot, all the necrotic tissue was debrieded and the bone margins were sent for pathology and culture and a wound vac was placed. His vascular supply to the foot is good. He is on vancomycin and piperacillin-tazobactam now to cover MRSA, just in case, and gram negatives, because the foot looked so bad, and we would like help managing his antibiotics, we think he needs a prolonged course. We hope to take him back to the OR in 4 or 5 days for placement of a skin graft.”