Quote:
Originally Posted by PedOncoDoc
I'd be worred that ceftriaxone doesn't cover strep viridans groups and MRSA which both can cause a nasty osteomyelitis, but you have to choose from what's available.
I would be monitoring him closely during and after the first dose of antibiotics in case he goes septic from endotoxin/toxic shock - would have IV fluids ready to run open wide for pressure support and be checking blood pressure and extremity perfusion frequently. I've seen several patients crash within 1-2 hours of the first antibiotic dose (typically gram negative bugs in those cases).
For pain control I would hold off on systemic treatment for now - motrin can affect platelet adhesion and if he starts to head down the line towards DIC I don't want to contribute to bleeding issues. For the concern of shock above I would prefer not to administer narcotics as well so I can keep an eye on mental status.
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My thought is that MRSA is a lower risk given our proposed mechanism, so I wouldn't make MRSA coverage my treatment priority. Agree that a good portion of Strep Viridans is resistant to Rocephin, so it might not be an ideal agent... I'm just running over in my mind what a medic is likely to have. Someone with more current knowledge of what is in an 18D's aid bag than myself would be better to answer this definitively.
Fair call on the pain control.