10-09-2007, 01:07 PM
A 23-year-old woman comes to the emergency department because of fever. She was diagnosed with acute lymphoblastic leukemia 2 weeks ago, and chemotherapy was initiated 3 days later. She has received all of the chemotherapy as an outpatient. Several hours prior to admission she developed a single episode of shaking chills, which spontaneously resolved. Vital signs are temperature 38.4°C (101.1°F), pulse 108/min, respirations 16/min, and blood pressure 120/80 mm Hg. She is in mild distress. Partial alopecia is noted, and a Hickman catheter is in place. Results of stat complete blood count are obtained and shown:
Blood
Hemoglobin
8.5 g/dL
WBC
950/mm3
Platelet count
80,000/mm3
Urinalysis shows no abnormalities. Two sets of blood cultures are obtained. Which of the following is the most appropriate next step?
A
) Administer a single dose of antibiotics and discharge with oral antibiotics
B
) Admit her to the hospital
C
) Discharge her on G-CSF (filgrastim)
D
) Monitor vital signs in the emergency department
E
) Remove the Hickman catheter and discharge with oral antibiotics
B
Blood
Hemoglobin
8.5 g/dL
WBC
950/mm3
Platelet count
80,000/mm3
Urinalysis shows no abnormalities. Two sets of blood cultures are obtained. Which of the following is the most appropriate next step?
A
) Administer a single dose of antibiotics and discharge with oral antibiotics
B
) Admit her to the hospital
C
) Discharge her on G-CSF (filgrastim)
D
) Monitor vital signs in the emergency department
E
) Remove the Hickman catheter and discharge with oral antibiotics
B