1 Misceleneus ID

patients with recurrent or persistent bacteremia without an alternative source who have pacemaker- what should be done
For patients with recurrent or persistent Staphylococcus aureus bacteremia without an alternative source, we suggest the system be explanted even in the absence of evidence of pocket infection or device-related endocarditis (Grade 2B). For patients with bacteremia due to any pathogen that persists or recurs without an alternative source despite appropriate antibiotic therapy, we suggest the device be explanted even in the absence of evidence of pocket infection or device-related endocarditis
Generator pocket infection
remove and continue Abx for 14 more days
sycope w/u- how long the tele?
24-48 h
Urinary retention as outpatient- how many days keep the foley before TOV
in 1 study starting alfa blocker and TOV after 2-3 days per AAFP article

Uptodate: We generally have patients attempt a TWOC one to two weeks after the catheter is placed. While a second TWOC for patients who fail the initial trial has a lower rate of success than the initial TWOC, for patients who fail the initial TWOC, we suggest a second trial of TWOC after an additional two weeks with the catheter
NSAID and urinary retention?!!
yes=> decreases prostaglandin production ==> decreases detresurcontraction=> Urinary retention
can we give finasteride in acute urinary retention?!
usage of it for longe term > 3-4 years can prevent urinary retention.
uptodate: 5-alpha reductase inhibitors (eg, finasteride and dutasteride) decrease the incidence of AUR in men with BPH but do not reduce the early recurrence of AUR [46-48]. Patients need to be treated for more than one year to prevent AUR and reduce the need for surgery.
causes of Urinary retention?
obstruction : in F: uretrocel/rectocele/cystocele, fecal impaction
Neurologic: cord compression
Infeciton/inflmation: Urethritis, vaginitis, cystitis/acute prostetitis
When to call urology for urinary retention...
If the etiology for AUR is not found on initial evaluation, patients should be referred to a urologist to evaluate for less common anatomic etiologies (eg, urethral stricture or urethral diverticulum) and/or for possible bladder function testing. Urodynamic studies should be performed by a urologist with experience in functional bladder disorders.
What if patient develops postobstructive diuresis
Any patient with urinary retention can develop postobstructive diuresis. Many patients can manage the increase in urine output by increasing oral fluid intake. In patients who are unable to do so or have severe postobstructive diuresis, we measure the urine output and replace one-half the urine volume with one-half isotonic saline.
Alaris pump
IV pump
Follow-up blood cultures within one to two days of initiating antimicrobial therapy should be obtained in the following circumstances:
●Bacteremia due to Staphylococcus aureus (see "Clinical approach to Staphylococcus aureus bacteremia in adults")
●Known or suspected endocarditis (see "Clinical manifestations and evaluation of adults with suspected native valve endocarditis")
●Presence of fever, leukocytosis, or other signs of infection more than 72 hours following initiation of antimicrobial therapy
●Known or suspected site of infection with limited antimicrobial penetration (such as an abscess or joint space infection)
●Presumed source of infection in abdomen or central nervous system
●Presence of prosthetic vascular grafts, intravascular lines, or cardiac pacemakers
●Presence of pathogens that are known or suspected to be multiply resistant to standard antibacterial agents
●Unknown source for initial bacteremia