Recently did an ED rotation, had a trach pt come in for resp distress with a whiteout lung concerning for pneumonia + large effusion. Vitals entirely WNL but not satting well and imaging concerning. Pt has history of a few diff lung MDROs, last cultures sensitive to avycaz. I recommend we start avycaz and mayyyyybe flagyl if we are seriously concerned she aspirated around her cuffed trach at the NH. Suggest we talk to ID as well since theyre gonna get consulted on admit anyway.
what we do instead is not talk to ID, start vanc, merem, cefepime, flagyl, and azithro. Get a lecture about why these choices. Admit to micu. First thing fellow asks me is why the hell i didnt just start avycaz and why i needed vanc on this aki on ckd mrsa nares negative pt who got decolonized last admit 2 weeks ago.😭
Edit: Wrote this while tired, when I wrote "Vitals entirely WNL but not satting well" I should have written "OTHER vitals wnl but not satting well" or "HDS but hypoxemic." Sorry if there was any confusion.