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Occult scaphoid fracture — RCPSC EM MCQ

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HardMusculoskeletalOccult scaphoid fractureRCPSC EM

A patient receiving chemotherapy has temperature 38.6 °C, ANC 0.2 × 10⁹/L, rigors and BP 94/60 mmHg. What is the most appropriate initial antimicrobial action?

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Correct answer: B — Collect cultures and give IV antipseudomonal antibiotics

The best answer is “Collect cultures and give IV antipseudomonal antibiotics”. This is high-risk febrile neutropenia with hypotension. Fever may be the only sign of invasive infection, so obtain indicated cultures without delaying empiric IV antipseudomonal antibiotics and resuscitate or admit. Observation, outpatient oral therapy, isolated antifungal treatment or antipyretics alone permit rapid progression to sepsis.

Reference: Emergency Care BC: Febrile Neutropenia in Adults: https://emergencycarebc.ca/clinical_resource/clinical-summary/febrile-neutropenia-in-adults/