Housestaff Survival Guide Crosscover Specialty Procedures + Calcs ...

Home
Sign-out
Crosscover
Specialty
Procedures + Calcs
Electrolytes
Call Survival Tips
Phone Numbers
Specialty
Housestaff
Survival Guide
Housestaff Survival Guide | Specialty | Neutropenic fever
If Temp > 38.1, 38.1 and looks sick, or has any two fevers within one hour,
And ANC 500 or less, or was < 500 within the prior 48h, or pt on chemo and ANC < 1000:
On the phone
- Ask for vital signs. Your goal is to assess if the patient is unstable.
- Neutropenic fever is a MEDICAL EMERGENCY. Antibiotics need to be ordered immediately and running in the next 30 mins
- If the patient is unstable, patient will need ICU evaluation and transfer / pressors / EGDT
Management
- Send BCx s 2, urine Cx, +/- CXR
- Start Abx within 10 minutes:
Cefepime, and gent if renal fxn ok [aztreonam and gent if PCN allergic]
Add VANC for hypotension, sepsis, mucositis, catheter infxn, MRSA
- Examine the patient, assess hemodynamics, look for infection source, write a note
- Make sure the antibiotics start running STAT
If pt cont’ be febrile after 3d (& w/o etiology found)-> consider chest CT, ID consult
“ “ after 5d -> add voriconazol 6mg/kg q12 x 2 doses, then 200mg po q12
“ “ >6d -> consider switching to imipenem/cilastatin
• Antimicrobials
• Vancomycin dosing
• UIH Abx Guidelines
• UIH PNA Guidelines
• UIH VAP Guidelines
Quick Links