Several nights back I admitted a patient that had a temp of 105. Blood cultures were drawn and they were positive. The patient was put on IV vanc. They also removed his port-cath two days ago because it was infected. The patient had been plodding along doing relatively well. No more high temps, white count 12. Last night his temp shot up to 103. This occurred around 4 am. I treated the fever with Tylenol and it was down to 99 by 6 am.
The doctor was furious enough with me for not calling that he went to the nursing director. I had to explain to her my rationale for not calling which was blood cultures had already been drawn and he's been on vanc. I'm not sure what else would have been done at this point. She told me to always call the doctor in a situation like that. But this wasn't a new thing. He came in with very high fever. I feel like if I had called at 4 am the doctor would have said, "He's been on vanc and we've already done cultures. Why are you calling and waking me up with this?"
Is my like of thinking wrong? I feel like I am never for sure when to call in situations like this is the middle of the night.
Also, I forgot to mention. This am his white count had jumped from 12 to 16. However, that info wasn't available to me on my shift. Labs came in right at the tail end.