ha mrsa

.:Elijah Gabriel Smith:.

My mom just came in and told me that my nephew has MRSA (an anti-biotic resistant staph infection) now, and he might be going back into surgery in a few hours. While I am not religious, my family is and my mom has asked if you guys can pray or at least send positive thoughts his way. I would greatly appreciate it if you would do so.

Thank you.

EDIT: You are free to reblog if you think spreading will somehow help. I’m not going to turn down whatever might possibly help him.

independent.co.uk
Antibiotics will soon 'stop working'
Urgent action is needed to control the use of antibiotics before they cease to work, leaving a number of major conditions untreatable and causing “terrible human and economic cost”, a major study has warned.

Resistance to antibiotics is growing at such an alarming rate that they risk losing effectiveness entirely meaning medical procedures such as caesarean sections, joint replacements and chemotherapy could soon become too dangerous to perform. Unless urgent action is taken, drug resistant infections will kill 10 million people a year by 2050, more than cancer kills currently, the report’s authors warn.

Drug resistant infections are thought to be growing due to over-use of medicine such as antibiotics and anti-fungus treatments to treat minor conditions such as the common cold. With over-use, resistance to the drugs builds up meaning some conditions become incurable and so-called ‘superbugs’ such as MRSA develop.

Research has also suggested that antibiotic use in pig farming is common as poor living conditions mean such treatment is necessary to prevent infections spreading between livestock and that this passes down to humans through pork consumption, increasing resistance levels further. In the UK, 45 per cent of all antibiotics are given to livestock.

The report is the result of a two year long review of the use of antibiotics undertaken by economist and former Goldman Sachs Asset Management chairman Lord Jim O’Neill. The review was commissioned by the Government amid growing concerns about the use of the medicines in the UK.

One of those days where patients haunt my dreams...

Started out the weekend right with 11 patients new to me on my rounding list. I’m working 12 hour shifts now so I figure I’ll be done with notes and rounding at 5pm or 6 at the latest.

First patient I kind of know from seeing a few weeks ago. Type 1 diabetic vasculopath with probable early dementia just hanging out for placement after losing his leg. I see the blood sugars are insane. Low of 36 overnight, above 300 sometimes… I look and see the diabetes specialist signed off 5 days ago. Nursing tells me he’s eating Halloween candy and no regular meals. I try and talk to the patient about it, try my hand at some motivational interviewing. Nope, he’s not having it. He yells at me, then apologizes. I say we’ll talk more tomorrow and peace out.

Second is an older lady with bilateral DVTs who had been scraping along at home by herself for a tad too long. I can smell her yeastiness from outside the door, poor lady. She is very nice but her memory is not great, I find she also has a MRSA UTI and her already bad renal function is worsening. I call nephrology to take a look at her and ask pharmacy to renally dose vancomycin.

Third is a post-op urology consult who developed an ileus. Now passing gas and eating like a champ. My healthiest patient of the day I would later find out. Unfortunately he and his wife are in the class I would call “speculators.” They will tell you in long, slow, endless descriptions all of his flatus and bowel habits and about every little twinge he has experienced, whilst nervously asking “that’s normal, right?”

I’m about to see my planned fourth patient, when I get a call from one of the MDs. “So and so was in dialysis and they think she had a stroke, can you go see her?” We realize the MD forgot to assign me to the patient, so now I have 12, so I quickly look her up and go through her stuff. She was just admitted last night. Missed dialysis for a week, was visiting family out of town. Family dropped her off in ED and left. She was confused already, couldn’t give much history. Initial head CT negative. I see ?stroke and ?cardiac disease on her problem list. Oh brother. I go see the patient. She smiles blankly and can’t participate in a neurologic exam. I find her daughter’s number and call her. The daughter seems to be high or intoxicated while driving in a wind tunnel on speaker phone. Apparently she is also in town but does not feel she needs to be at her sick mother’s bedside. Bottom line, unhelpful, but she does tell me she wants “FULL RESUSCITATION AND BREATHING TUBES” if her mom goes downhill. I order more brain irradiation for the poor lady along with a bunch of stat labs and an EKG.

It is past noon already. Oh dear. I grab some lunch and hurriedly start typing notes on my upcoming patients.

Patients 5, 6, 7, 8, 9, and 10 are a mishmash of orthopedic post-op consults, detoxing alcoholics with incidentalomas on their CT scans, pneumonias, and a sad guy who is chronically aspirating and thinking about hospice. I tell a lot of people that I just met that they may have cancer and need GI follow up. In prettier words than that. 

I review the CT scan on the confused lady. No acute changes. I call my attending and she wants a brain MRI. I order that.

Patient 11 is a nonverbal cognitively impaired group home resident coming in with vomiting and PEG tube problems. It seemed like a silly admission but digging further into his history I realize there are some unaddressed issues, in particular a bunch of WEIRD CRAP on his admission CT that could be CANCER that no one mentioned in their note. Make it end!! To make matters worse, I had planned to see him earlier and start his tube feeds but got tied up in calling consults, getting paged for positive blood cultures, and going back to see the confused lady, and so I don’t start his feeds until the end of the day. I also realize he was not getting IV fluids while not eating or drinking. I feel like a total failure and want to report myself to someone. In reality, there were several physicians who saw the patient before me as well as a ton of nurses, and all of us should have realized this sooner. Thankfully, the patient seems unharmed and happy and labs are normal.

I sink down to finish my day and type some notes. One of the attendings walks in and I start to give her a report on her patients. And promptly realize I forgot about patient #12. I freak out, run downstairs, see him VERY late in the day, and everything’s fine. Just an ortho post-op consult and ortho had seen him earlier already. Nonetheless I feel even crappier…

5 minutes before the official end of my on call time, and 2 hours later than I thought I’d be at the hospital, I get a frantic call from nursing saying the bilateral DVT lady with the MRSA is wheezing and sweating after the vancomycin was started. I hold the infusion, order Benadryl and nebs, and call pharmacy, who confirms my suspicion that this is not the typical presentation of a vanc allergy. I ask them to renally dose linezolid instead. I write a few notes. Brain MRI on confused lady is back, vague reading by radiology but seems nothing acute so I page the attending with the results. I fight every urge to stay longer and figure out what is going on with the wheezing lady and ask for the night hospitalist to come see her if she does not improve, as it’s now long past my call time.

I go home, still frazzled. I get in the bath and log in to the EMR on my computer because I’m still nervous. No news. And I sit and try to take a deep breath from this crazy day.

I love my job, but if every day was like this I would never have a good night’s sleep…

MRSA...eww

It amazes me how people can take one small thing a doctor says and hold onto it so tight. For example, my brother has had MRSA infections in the past and about once or twice a year he gets really bad knots usually on his arms(armpits) . The most recent one he had to go to a surgeon to cut open the infection on his bicep. Well my family physician told my mom during a visit that sometimes a person can get a staph infection from spider bites. So, unfortunately my brother has no health insurance and developed a knot on his forearm. My mom says to me, “how does he always get bit by these spiders that cause this MRSA?” -_-

Does anyone have any info on MRSA in general and if you can ever get rid of it and what he should do.. He’s thinking about going to the er, but with no insurance, I don’t know what most er docs will do?