Surgeon 2: She's on zosyn. Can she breast feed? Is that safe?
S1: I don't know.
S3: Let's ask ID.
S1: We're not consulting ID for such a simple question.
S2: We'll curbside them.
S1: Ok, call them after rounds.
Me: The WHO says it's safe. (Micromedex)
S1: The staph culture is pan-sensitive.
S2: Give her augmentin.
S3: She has a PCN allergy - anaphylaxis.
S1: I don't give keflex to anaphylactic reactions to PCN.
S3: We can't use levaquin or bactrim because she's on coumadin especially because this will be long term.
S1: So what do we use?
S2: Let's ask ID.
S1: Ok, I'll call ID today.
Me: You can use doxycycline - no listed interactions with warfarin (Micromedex)
S1: Okay, but make sure you follow her INRs closely.
S1: Her ostomy output is through the roof.
S2: We can't keep up with it. Replacing her cc per cc with IV fluids.
S3: Maybe it's the daptomycin. Is dapto like erythro? Does it give you diarrhea?
S2: I don't know.
Me: 6-12% have diarrhea. (Micromedex)
S1: 6-12% days of the week I have diarrhea too. Keep her on the dapto.
EM residents are already valued on off-service rotations for their superhuman abilities to insert IVs and use ultrasound machines. Now, we can facilitate morning rounds with our smart phones too.
This is a 3-part guest series by Dr. Timothy Peck, who is launching his own blog at ModernEM.blogspot.com. Check it out!