PMercier

To answer the questions posed by TraumaRUs: "why would you give a script for antibiotics when you don't want the pt to take them unless certain conditions are met?" My medical director insists that an antibiotic Rx is given to the patient. I go to great detail explaining the difference between viral and bacterial illnesses. If a secondary bacterial infection develops in the form of a sinus infection or pneumonia I want the patient to have the antibiotic and hopefully avoid an expensive trip to the ER. Each patient is advised to follow up with their PCP, the physician we refer them to if they do not have a PCP or to return to our facility if they start the antibiotics according to my treatment plan.

Took 6 years of full time practice in a busy ER before I could honestly say that I was comfortable practicing.

Dear Colleagues, My name is Paul Mercier. I am a FNP with nine years experience working in ERs and Urgent Care facilities. I am writing to request a peer critique of a treatment plan that I have been personally using as well as offering to my patients who are diagnosed with an URI or Viral Syndrome. I have recently been admonished by my medical director because of one complaint by a patient who simply wanted antibiotics. Please note that Item #8 of my treatment plan discusses when to take the antibiotics. I send each patient home with a prescription of an antibiotic because my medical director insists. He has two reasons for giving all patients antibiotics, #1 all patients presenting with signs, symptoms and a history consistent with a viral illness have a secondary bacterial infection (I can find no research supporting this) and #2 all patients expect an antibiotic and if they don't receive one they will not return to the clinic because they are unsatisfied. Please share your thoughts. Here is the plan: 1.At the onset of symptoms, irrigate your sinuses with an over-the-counter NETI pot upon waking and before going to bed, and use Zicam Cold Remedy oral mist according to package instructions. 2.Drink plenty of clear liquids. 3.Alternate Tylenol and Motrin every 3 hours for fever and or body aches. 4.Treat runny nose or post nasal drip with Claritin or Benadryl. 5.Take 3-4 grams of Vitamin C daily. 6.Treat sinus &/or chest congestion with Mucinex or Guiafenesin. 7.Treat sinus congestion by: *Wearing a Breathe Right nasal strip while sleeping. *Elevating the head of your bed to promote drainage. *Taking Pseudoephedrine according to package instructions, (Avoid if you have, or are being treated for high blood pressure). Pseudoephedrine is kept behind the counter and you must ask the Pharmacist for it. *Using Afrin nasal spray every 12 hours. Stop using Afrin after three days! 8.Take the antibiotic under the following circumstances: *If you develop a fever of 101 degrees that will not come down after taking Tylenol and Motrin. *If you develop pain in your chest or back when breathing. *If you develop pain in your upper teeth, cheeks or forehead. *If you were prescribed a steroid (Medrol Dosepak or Prednisone). *If you are diabetic, asthmatic or a heavy smoker. If your symptoms are not better after 12 days.

From personal experience as a patient, I know that when promethazine 25 mg/ml is administered undiluted into a peripheral IV site it burns and can cause chemical phlebitis. I am hoping to write my master's thesis on this subject and cannot locate any research data to support my anecdotal finding. If you know of any documentation to support my position, please e-mail it to me. I would also like to hear from anyone who has experienced a similar result from phenergan IVP. Thanks, Paul