Question for Healthcare pro's (doctors, nurses, ER staff)

[glocke12]

If you had a 74 year old woman come into your ER who has a history of heart disease, who a week earlier had a cardiac catherization performed, and was now complaining of pain at the site of the cathater entry, and had a fever of 101.1 dg F. Would it be S.O.P. to have a blood culture performed?

Im asking because this is the situation of my Mother. Last weds. she went into the ER as stated above, they performed no blood work, than on friday (less than 48 hours later), she went to the ER again very ill...She was diagnosed with bacteremia, sepsis, a UTI, and a possible vegetative spot on her heart, and she has lost all mental faculties.

 

[Xfujinon]

I answer "yes" hesitantly.

In all likelihood, they would have performed the culture based on the close proximity of the recent cath, and the fact that elevated temperature is at least a decent indication of potential infection (once again, think of the cath).

I am very sorry to hear about your mother. Sepsis can set in very quickly, and its effects can be devastating.

I wish her a complete recovery, and I hope you are holding up okay too.

Never hesitate to ask questions of the ER docs, the staff, or anyone else. It is your right, be persistent yet polite.

 

[glocke12]

Thank you.

I doubt that she will survive. An echocardiogram indicates a possible bacterial colony on the heart. I have my doubts that she will survive. I just had her transfered to a much better hospital.

The first hospital did no blood work the first time...on Friday when she went in to the ER the second time for vomiting blood, she was lucid, rational, knew her name, etc...from friday to last night I saw a steady, rapid decline in her mental state. the hospital staff did not notice this. amazing. Her nurse actually called me and indicated to me she was having problems and might be getting inadeqaute care. They did not even bother to do a CAT scan to verify that her mental decline was not caused by a stroke until late last night after my brothers and I demanded it...I know that sepsis can cause mental problems, but I would think a CAT scan would be routine of someone like her to rule out a stroke.

Last week she was as normal, rational, active, and lucid as any 74 y/o woman can be....

 

[todd11231]

I actually have 5 years of ER experience, and depending on my evaluation of the access site and symptoms I probably would not have ordered blood cultures. Now when the labs came back and she had elevated WBC's , yeah blood cultures may have been called for.

That opinion is most likely scewed by the fact that for the past 3 years I have been working in a cath lab. In my three years and , for the labs 12 years before I arrived we have never had an infected access site. All cath labs have diffrent SOP as far as sterility with some considering the procedure a "clean" procedure. (not sterile).

In my non expert opinion I would say that she definitely caught some kind of nasty bug that probably found its way into her system through the sheath in the cath. That really suck I hope every thing works out for the best.

By the way credentials I hold: RN, EMT, RCIS so as I stated before I have an idea of what I'm talking about but I do not consider myself an expert, especially on the immune system.

 

[todd11231]

Thank you.

I doubt that she will survive. An echocardiogram indicates a possible bacterial colony on the heart. I have my doubts that she will survive. I just had her transfered to a much better hospital.

The first hospital did no blood work the first time...on Friday when she went in to the ER the second time for vomiting blood, she was lucid, rational, knew her name, etc...from friday to last night I saw a steady, rapid decline in her mental state. the hospital staff did not notice this. amazing. Her nurse actually called me and indicated to me she was having problems and might be getting inadeqaute care. They did not even bother to do a CAT scan to verify that her mental decline was not caused by a stroke until late last night after my brothers and I demanded it...I know that sepsis can cause mental problems, but I would think a CAT scan would be routine of someone like her to rule out a stroke.

Last week she was as normal, rational, active, and lucid as any 74 y/o woman can be....

Sepsis could cause mental status changes, however if she has vegetation on her heart a CT scan would be in order, anything leaving the heart at that juncture has a wide open highway straight to the brain. I truly hope that it is just the septic state that she is in that is causing her mental status change. You would be amazed at what good antibiotics can do.

 

[glocke12]

they are doing a transesophogeal endocardiogram tomorrow to further examing the stuff on the heart...

I do understand that sepsis causes mental changes....BUt....at the first hospital she arrived lucid and rational...two days later she didnt know who she was, who I was...and they were asking me if she was always like this and if this was her baseline....her mental change went unnoticed..a CAT scan sounds like it would have been called for to rule out a stroke, and they didnt bother to do that until we raised hell...