05-04-2007, 02:13 PM
A 57-year old woman comes to the emergency department because of a "very high fever." She has diabetes mellitus and hemodialysis-dependent renal failure. She also has hypertension and is status-post total abdominal hysterectomy. She is frail appearing and diaphoretic. Her blood pressure is 170/90 mm Hg and temperature is 38.3 C (101.0 F). Her neck is supple without any specific meningismus. She has a Tesio catheter in her left subclavian vein. Her lungs are clear and she has no costovertebral angle tenderness. Her laboratory studies show a white blood cell count of 23,000/mm3 and a hematocrit of 31%. Her urinalysis is dipstick negative for white blood cells. The most appropriate next step in management is to
A. begin antibiotic therapy with gentamycin
B. begin antibiotic therapy with vancomycin and gentamycin
C. order urinalysis analysis and culture
D. perform a lumbar puncture and send CSF for analysis and culture
E. schedule emergent surgical removal of her Tesio catheter
A. begin antibiotic therapy with gentamycin
B. begin antibiotic therapy with vancomycin and gentamycin
C. order urinalysis analysis and culture
D. perform a lumbar puncture and send CSF for analysis and culture
E. schedule emergent surgical removal of her Tesio catheter