CCS- How to manage TB? - mykawaiigirl

[ArchivalUser]

if its office visit...patient should be admitted and isolated on floor untill TB is rules out.. This is one the diseases partient should not be allowed to leave the hospital even if they are competent preventing transmission to others...if needed patient should be detained

[ArchivalUser]

will you start him on meds AFTER 3 AFB positive............and then send him home

[ArchivalUser]

this is a healthy young man u are just suspecting,not even confirmed and u say detain him? i dont think so.

[ArchivalUser]

Thanks everyone for the input. I should say that this is a patient with no past medical history who came in with fever, night sweats, cough, weight loss, anorexia, fatigue
I was managing this patient like this:
First I will do a complete physical exam.
from the Physical exam, i found patient to have crackles in lung field, cervical lymphadenopathy.
and suspect that he has TB.
i will transfer patient to ER. for further workup.
In ER, I will order:
oxygen, o2 sat, BP , nss
IVA, CBC, BMP, LFT, PT/PTT, U/A, Urine culture, Blood
culture, HIV test, PPD test, Chest X-ray,
acid fast stain sputum- stat and every 24hours(for 2 more days),
mycobacterial culture, sputum, Sputum for PCR tuberculosis.
Respiratory isolation
admit patient to respiratory isolation.
Lab result : Sputum for AFB positive
Order: INH, Rifampin, Ethambutol, Pyrazinamide oral, continuous
Consult: Pulmonary, Infectious Dz, Notify public health department
move clock to next day.
end case with RATED SEX

[ArchivalUser]

Remember to give Vit B6

[ArchivalUser]

@ mykawaiigirl....... Can you please elaborate what does RATED SEX stands for? I have just started preparing for CCS. Thanx and good luck

[ArchivalUser]

refer to the public health people, they'll do the rest

[ArchivalUser]

if it's at night and they are not around
say this is actual hospital

do tests, take a chest x-ray, if a cavity is there admit the patient and isolate and get routine tests for tb. If no cavity patient can be sent home with advice and folow up with routine tb tests

also test for immunocompromised state, young healthy person with Tb, Hiv could tip the balance off and bring forth opportunistic infection

but if its daytime you can always refer them to public health, or tell the patient to come in the morning, by then you are not working that time

[ArchivalUser]

now if you happen to be the public health, call the intern or resident who admitted the case and tell him off for not having complete tests done

start the patient on treatment as per protocol with inh, pyrazinamide and all such medicine, mind their side effect have tests as baseline to likely side effect and treat prophylactically such as pyridoxine.

isolate patient till sputum has no bacilli there, usually after two weeks of medication, kick the patient home we need the beds and follow up the case with meds for duration of months its supposed to be.

now if he has hiv, call in the internist for comanagement,

[ArchivalUser]

you not done yet as public health, contact tracing if hiv and tests and treat close contact of patient

(if he is from overseas then report to immigration to deport him - and get the doctor who falsify his medical report, make sure he doesn't sit usmle)