How hard can I hit the liver?

[Blueorchid, ASN, RN]

Didn't really know where to put this since its trauma related. But!

Had a patient a few days ago with a Grade III liver injury, MVC that was ped struck and her organs took a hit from the aftermath. She was suspected of having heparin induced thrombocytopenia and was started on Argatroban by the chief of basically the whole hospital. Said lady had a fever which wasn't really high grade but was enough that I wanted to get it under control. She had a bunch of ortho traumas, on the vent, figure the last thing she needed was something growing to give her an infection. And I was with a brand new preceptor (I needed to do an extra day) who was vehemently against me giving Tylenol. Her rationale of course was the Grade III liver.

Now I get that Tylenol is metabolized through the liver so I understand why, but Argatroban is too. I wasn't on rounds when it was chosen as the HIT drug of choice (because looking at this I wonder if we could have used a different one) but if she was on Argatroban would it really be that much more damaging to bring her fever down with Tylenol?

For the record I hate thinking of things in hindsight...my goal one day is to be able to pipe up with this during the actual rounds but Im getting there

[tahoe77]

I dont have anything on this. Anyone?

[XingtheBBB, BSN, RN]

risk vs benefit, I guess. (Operative word here is guess. I'm not involved in trauma often) HIT is ugly, and potentially fatal. Getting it under control is imperitive. A fever? "not high grade"? R/t trauma or r/t infection. If infection treat with abx. If it's a general stress reaction, not terribly high or uncomfortable... let it ride. If she's vented, is she sedated? Don't rush to manage a symptom like fever, it might be your best sign of something going on, worsening, or improving.

[Biffbradford]

Agree with BBB. You don't say just how high it was so under the circumstances, you'd be better off monitoring it. In a complex case like this, a quick inquiry with the attending would probably be best. Wouldn't necessarily have to be a 'stat' phone call, but if someone else is calling him/her, then run it by. "you know, Mrs X is running a fever of _____, do you want us to treat it? or let it run until ____?" Word it so you can get a standing order so night shift doesn't have to call at 2am.