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Osteomyelitis

  • Admission orders

    • Admit: Floor
    • Diagnosis: Osteomyelitis
    • Condition: Stable
    • Vital Signs: Routine
    • Allergies:
    • Nursing:
    • Diet: Regular, NPO if planned operation
    • Activity: Up as Tolerated, with Assistance
    • Labs:
      • CBC, Chem qday
      • ESR
      • CRP qday x 3 days
      • blood cultures x 2 (biopsy if inconclusive)
      • UA and culture
      • Imaging:
        • Xray
        • MRI if diabetic foot, vertebral osteomyelitis
        • CT if Xray inconclusive
    • IV: None if tolerating PO
    • Special:
      • ID consult
      • Orthopedics consult if bone biopsy or debridement
      • Vascular surgery consult if diabetic or vascular ulcer
    • Medications:
      • Acetaminophen 650 mg PO q 6 hours prn pain or fever
      • Acetaminophen with codeine 1-2 tablets PO q 4 hours prn pain
      • Heparin 5000 units SQ q 8 hours
      • Antibiotics after sensitivities come back
      • Empiric antibiotics:
        • Nafcillin, clindamycin, or cefazolin for MSSA
        • Vancomycin for MRSA (IV drug use, hospital)
        • Levofloxacin for enteric aerobic gram neg rods (UTI, sickle cell, IV drug use)
    • Call HO: Call for temperature > 38.5 C, SBP < 100, HR > 110
  • Discharge

    • education: PICC care, side effects, return if worsening symptoms
    • meds: PICC line for outpatient IV antibiotic course
    • f/u weekly CBC, chem

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