L*****r
发帖数: 722 | 1 Dr. Aplusplus (Hakuna Matata)：Good decision-making comes from experience,
and experience comes from bad decision-making.
Dr. Lexian (蒙古大夫)：ideally, get your experience from OTHER'S bad
decision making :-)
1. When you order cultures, please write “before antibiotics are given”;
while order starting antibiotics, please write “after blood and urine
cultures are collected” . 因为用抗生素会显著影响细菌培养的结果；
注意有些特殊情况，尤其要考虑先取材培养，再上抗生素。
（1）怀疑骨髓炎，应该先probe the bone to get deep tissue culture, since
superficial culture of an infected wound is useless --- all contaminations.
（2）怀疑脑膜炎，一定争取先腰穿。
（3）血培养阳性，尤其是1/2, 一定先重复血培养，然后再上抗生素，因为极大的可能
是污染。
2. For anemia patients, write"please collect blood samples before
transfusion" ，especially anemia workup, 因为输血会显著影响检查结果--你查的
是病人和输血者的混合结果了；
3. Holding parameters for antihypertensive medications: 一般人的写法是：hold
metoprolol, lisinopril, clonidine and HCTZ if SBP<100. 但是这样的话，很可能
患者的血压就会飙到天上去。所以最好的写法是加上一句 call MD，你去看了病人，再
相应的给药。
4。stat as stat: intern 刚开始，会经常忘记加 stat,结果是检查就可能给约到第二
天或是第三天。如果是CT-angio for PE, 或是lipase R/O pancreatitis 一类, 阳性结果就
是延误诊断了。
5。写医嘱一定要具体，因为护士忙起来常常顾不上动脑子替你着想。譬如 "EKG+
cardiac ensymeX3 Q6h"，开了多半等于没开，因为护士不会去给你计算6小时之后会是
几点钟。必须写清楚：“EKG+cardiac ensymeX3 Q6h， stat now, 10pm and 4am ”
先想到这么多，请大家补充。 | t*********m
发帖数: 360 | 2 be careful for meningitis. it is medical emergency.
usually, abx soon after lp asap. but, if you want to send pt for CT before
LP, give abx first, as consequence is grave if treatment delayed.
or ask your attending/ or ed attending, if you can't decide. it can be just
a judgement call. | A*******s
发帖数: 9638 | 3 A great post.
For 4 and 5, I would talk to the nurse IN PERSON about the orders. | m*********6
发帖数: 609 | 4 Thanks a lot.
【在 L*****r 的大作中提到】
: Dr. Aplusplus (Hakuna Matata)：Good decision-making comes from experience,
: and experience comes from bad decision-making.
: Dr. Lexian (蒙古大夫)：ideally, get your experience from OTHER'S bad
: decision making :-)
: 1. When you order cultures, please write “before antibiotics are given”;
: while order starting antibiotics, please write “after blood and urine
: cultures are collected” . 因为用抗生素会显著影响细菌培养的结果；
: 注意有些特殊情况，尤其要考虑先取材培养，再上抗生素。
: （1）怀疑骨髓炎，应该先probe the bone to get deep tissue culture, since
: superficial culture of an infected wound is useless --- all contaminations.
| s********e
发帖数: 1596 | 5 for meningitis, always abx first! No delay!
【在 L*****r 的大作中提到】
: Dr. Aplusplus (Hakuna Matata)：Good decision-making comes from experience,
: and experience comes from bad decision-making.
: Dr. Lexian (蒙古大夫)：ideally, get your experience from OTHER'S bad
: decision making :-)
: 1. When you order cultures, please write “before antibiotics are given”;
: while order starting antibiotics, please write “after blood and urine
: cultures are collected” . 因为用抗生素会显著影响细菌培养的结果；
: 注意有些特殊情况，尤其要考虑先取材培养，再上抗生素。
: （1）怀疑骨髓炎，应该先probe the bone to get deep tissue culture, since
: superficial culture of an infected wound is useless --- all contaminations.
| A*******s
发帖数: 9638 | 6 LP, 5 mins; preparation of ABX, 10 mins. It should work out. :)
【在 s********e 的大作中提到】
: for meningitis, always abx first! No delay!
| t*********m
发帖数: 360 | 7 you are talking about IM intern or Dr. Lexian? *_*
【在 A*******s 的大作中提到】
: LP, 5 mins; preparation of ABX, 10 mins. It should work out. :)
| s********e
发帖数: 1596 | 8 well, you can always start ABX in 10 minutes, but not always get LP done in
5-10 minutes:)
What I am saying is that ABX should never be held because of LP.
【在 A*******s 的大作中提到】
: LP, 5 mins; preparation of ABX, 10 mins. It should work out. :)
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