Worried about my clinical exam. Did I kill my patient?

I had a clinical exam. The patient came into hospital with a case of severe cellulitis. I wrote the correct antibiotic treatment according to local guidelines, but I have this horrible feeling I wrote oral route instead of I.V 😱

On a scale of 1-10 how bad is this answer? Will I risk killing my patient??!

Reply 1

Lovelemonade

Hey I was wondering if this was possible. I think I wrote this in my exam instead of IV antibiotic. How serious is this?

Reply 2

MonteCristo

If a question specifies "severe cellulitis" then "IV antibiotics" is almost always the correct answer and "oral antibiotics" incorrect.

Reply 3

girl_in_black

Considering this was in an exam, I suspect no patient has been harmed by your answer :smile:

On a more serious note, IV antibiotics are what you should be giving to someone with sepsis, however in exceptional circumstances (i.e. when the patient has very difficult IV access and there is no one who is able to get a cannula in) oral antibiotics can be given as a temporary measure.

Reply 4

belis

Depends on how severe the severe is. If they were septic and about to expire the PO route will not cut it. If they had localized cellulitis you could argue for trying oral first like many GPs would probably do in practice before sending them in for IVs.

Reply 5

LetoKynes

I think the most you'd lose is a mark - was this a completely written station?

Reply 6

nexttime

Define 'serious'. Unless overly septic/?nec fasc or ?osteomyelitis most cases of cellulitis would be started on oral first by their GP, yes.

Reply 7

nexttime

Original post by girl_in_black

That is not a good reason. You can always get iv access if you need it, even if that is carotid or IO access. Giving oral dose is too slow and prevents you from then giving the iv dose. I've never seen that done.

Reply 8

girl_in_black

Original post by nexttime

I have heard of this happening only a couple of times on medical nights when no one, including the anaesthetics SHO with an ultrasound machine, could get a cannula. The patients were pretty stable though. I have never seen IO access used outside of A+E

Reply 9

Etomidate

IO is really under-used, especially in this context. They're licensed to stay in situ for 72 hours and you can get some damn good flow rates in the proximal humerus. The only issue is that infusion can be quite painful in a conscious patient, especially initially (and you need a pressure bag)

(edited 7 years ago)

Reply 10

nexttime

Original post by girl_in_black

Then perhaps they had an infection, as opposed to sepsis?

You also see it where its like '48 hours of IV abx' then their cannula goes at 24 and its really difficult and they're well. Again, clinical decision as to whether orals are then appropriate.

But I think the evidence is pretty clear that in new diagnosis sepsis time to IV antibiotic is a significant predictor of mortality. If you feel a patient meets the criteria for sepsis then they need IV antibiotics, or they need palliating. Those are the two options. You can always put in a central line (or, yes, IO access on the ward, although I've never seen it either!).