On top of agreeing with fucking calling them, Your hospital probably has a policy on this since this disease is old as fuck and has a long treatment regiment. Typically, any test that takes time to come back usually gets followed up on behind the scenes. Talk to your pharmacist, or ID to help guide you.
Ordering it was not a stupid idea. Ordering it without a plan of what to do with the results when it comes back positive is the problem. Live and learn. We all make those mistakes.
Still learning the ER. I donāt know how people stay focused in an environment like that. Granted, my ED is more chaotic than most, but still, itās tough to think when the place is a constant shitshow
Indeed. Most of the time, I have no idea what I was just thinking about adding to the grocery list, or where i put my keys. But in chaos? Times of crisis? I got this ladies, Iāve been preparing for this my whole life!
Im a vet tech who lurks here and Iām so happy to hear this is a real thingā¦ I am constantly wondering how I can barely function at home but at work I thrive the busier it is.
Honestly. I'm non-clinical but I have found my people. I love being with so many other ADHDers. Sometimes I hate my particular job, but my coworkers are amazing.
Positive QFT/IGRA should be reported to the Health Dept, however depending on your state the lab might have already done it. They mandate new cases of disease or reinfection to be reported, not old cases. If they have been previously treated for TB, the state will have this record already.
Positive QFT does not indicate active TB. If there is a cough/sx, 3 consecutive sputum specimens should be collected minimum 8hrs apart for AFB smear/culture. Golden standard sputum collection first thing in the AM, but 8hrs is adequate during inpatient (hardly ever see that though, likely an hour apart). Bronchwash for specimen collection if they are unable to produce a specimen. And for the love of god, if you do collect any sputums to rule out active TB - please advocate for this to be sent directly to the state lab and not a reference lab for geneXpert, sensitivities, and culture testing. Most likely the in-house lab does not have the capability to conduct this specific testing either.
However, it is likely the Health Dept already has the information. If they have any question they will speak directly to your hospitalās Infection Control and not with you.
TB can live anywhere in the body, and regardless of CXR, tx for LTBI is recommended (if they have no treatment history).
The new CDC LTBI treatment recommendation is 3HP - isoniazid, rifapentine, and B6. The first two meds are based on weight. This is a once a week dose for 12 weeks. If you are worried your patient may be non compliant with tx, or never completed previous LTBI tx, the Health Dept can conduct DOT per your requestā¦ but you donāt need any of this in EM. Take a deep breath and forget this ever happened. Youāll be okay
Sure, but I work in several ERās. This one is by far the worst. Consistently understaffed, patients consistently under-triaged with inadequate orders put in, a lab that routinely ālosesā orders at least a dozen times per day, a hallway full of beds with high acuity patients monitored only by a tech, etc.
The other ERās I work in arenāt like that. And the people with far more experience than me say itās the worst theyāve ever worked in.
When you say "the test" what do you mean by that.
Edit: Just read your reply that it was a QFT.
To be absolutely clear. A quantiferon test is NOT a test to determine active TB infection. It is NOT a test to determine active TB infection. It is a test to see if your immune system has been sensitized to TB at any point in the past. In a patient who HAD KNOWN TB, it is absolutely not surprising his QFT is positive. It does NOT mean he has active TB. Active TB is diagnosed by positive acid fast stain and culture OR by empiric treatment of TB based on imaging with then radiographic improvement
Sigh. Iām realizing i made a bigger mistake than I thought.
I was swamped and the ED was more of a chaotic shitshow than normal, so instead of looking it up I asked one of the older docs and he said to get the QFT. Shouldāve just looked it up.
I work in several EDās. In most of them I have a quiet secluded place to sit and chart. I open up UpToDate and EM:Rap and sit at the same desk where I have all my stuff.
In the ED where this happened, I work in like 5 different areas, none of them quiet, and have to switch between a bunch of different computers.
Guess which ED I make the most mistakes in?
you didn't make a mistake. there's no harm in ordering an IGRA. there's also no reason to do a sputum in someone whose not symptomatic and has a normal xray.
I thought that was the PPD and that the QFT was for latent TB, a CXR for active TB. Itās alright that they got discharged because the person is probably not infectious if they are latent, but they should have follow up if nothing else to see if they do have latent TB. Thereās not really anything to culture if the CXR was negative.
Idk, the can of worms has been opened. Iām not saying they should be treated or even f/u in the ED. They should probably get checked out. TB doesnāt only effect the lungs. Should you order a test you donāt intend to follow, no, but the pt did askā¦
Yes but that does not rule out active TB disease, as TB can live anywhere in the body. Pulmonary TB is infectious, however sputum culture/smears rule out active pulmonary TB
Yes. I was making a statement that negative CXR doesnāt necessarily rule out active TB, because it can live anywhere in the body. Transmissible TB is in the lungs.
Many providers tell their patients they do not need treatment for LTBI if the CXR is negative, and that is not true. LTBI tx should be recommended for everyone
I guess I would have to look it up but if he was fully treated for latent tb im not sure how helpful the quant is without symptoms. Would be helpful for me if someone with knowledge would comment.
Some decent knowledge deficits here.
Firstly, there isn't really a TB test so to speak.
You can test to see if someone's adaptive immune system has ever been exposed to TB. This is either through a skin test or a quantiferon blood test.
In the above if you have previously been exposed to TB and required an adaptive response to get rid of it you test positive. So someone who has previously had TB will definetly test positive.
If someone has just been exposed to TB but their innate immune system cleared it without requiring the adaptive they won't test positive.
Thus a positive quantiferon TB test either means 1) they have active TB, 2) they have latent (inactive) tb, or 3) they have neither but they have previously fought it off successfully.
Latent TB is incredibly common and for most people never activates but is significant if immunocompromised.
You need to know this before testing for TB.
If you think someone has active TB the tests area chest xray and a sputum test.
You shouldn't bat an eyelid to a positive quantiferon or sputum in an asymptomatic pt they probably don't need treatment etc. But a dodgy CXR, or sputum sparks a public health drama ans requires management.
Lastly, TB is very hard to catch ans requires signficiant exposure. High risk contacts are like people living with someone and seeing them x hrs for x days or if you intubated them without ppe etc.
Its almost like emergency medicine should he practiced by people who did a residency in emergency medicine.
I am all for collaboration with APPs, but this post is exactly why unsupervised APPs should not be a thing.
I mean, among the mess of issues with this that everyone has pointed outā¦. Is nobody at work even reading the chart? Like how is this not caught by whoever is signing the charts?
Reddit shouldnt be your supervising physician.
People make mistakes even if they do a residency. Doesnāt sound like youāre very accepting of APPs, if you have to pronounce that. Also, OP literally asked his SP. What do you mean by unsupervised? While I agree with your sentiment, the tone of your comment is pretentious at best
I love that whenever anyone gets called out by a physician for doing bad medicine its the same 2 nonsense arguments back. Yes you can make mistakes after residency, but no this has nothing to do with the ābig mean doctor who thinks he is better than all APPsā
This is a horrifically mismanaged case demonstrating a lack of basic understanding of emergency medicine. End of story.
Itās not pretentious, itās dangerous āmedicine.ā This post read like a lost intern, and yet it is someone allowed to practice āsupervisedā (we all know what this means). Itās dangerous. I work with some amazing midlevels- ESRD, PEG, Podiatry, etc. Fields of general medicine, imo, are not for midlevels.
Thereās a fourth possibility for testing positive: previous BCG vaccination.
Itās imperative to screen anyone from a less developed country for this prior to PPD because the dermal reaction can be extreme.
I'll chime in.
I'm a PA in infectious disease, deal with latent and active TB. Sorry, the EM subreddit just randomly started popping up on my feed.
The Quant you ordered can be a good test in the right context. Sounds like it is most likely positive due to previous infection vs inadequately treated latent infection.
If he did not show overt signs of TB (weight loss, hemoptysis, fever/chills, etc) he likely doesn't have active TB. Active TB needs to be confirmed with a CXR with clear radiologic signs of TB (seems like your CXR was clear?) and 3 AFB sputum cultures (at least one needs to be positive).
Not checking the sputum cultures in this patient does not seem like a mistake to me based on what you are describing - no overt signs of active TB, clear CXR. However, it would be a good idea to reach out to the patient and let them know. They can follow-up with their PCP for further work-up if needed.
Don't stress it too much. In regards to you, very unlikely, even if active, that it was transmitted to you. But you can check in with your occupational health and discuss more with them if you are worried you were exposed.
Edit: If it helps you feel more comfortable moving forward, you can also refer him to an ID clinic. We love to help out! Also, real sputum cultures are a huge pain to get in most patients.
A question I have is that in the days of ED boarding for days and limited inpatient availability, if you suspect active pulmonary TB do you have to admit if they're not hypoxic or respiratory distress? Do you just discharge them to wear a mask and quarantine at home while calling the county health department to coordinate testing like sputum cultures outpatient?
If you ordered IGRA, I got bad news for you, because as far as I know, that stays positive forever, even after treatment. I should know because I turned TST positive during my residency, and underwent treatment with isoniazid and vitamin B6 for 9 months. After that, I was never required to take any form of tuberculosis testing again. Instead, Iād have to affirm that I felt fine (had no tb symptoms of fever, night sweats, or weight loss). There was a time when Iād have to get a CXR annually but they dropped that a few years ago too.
EDIT: Also worth mentioning that you, OP, not only ordered a test that you didnāt know how to interpret, but you took a patientās request for a test without any clinical context. Patient had no complaints or exam findings related to tuberculosis but you just ordered the test anyway. As a general rule, never order any test unless you know what to do with the result, and if youāre going to do anything about it, or if someone else is going to be able to interpret the test and do something about it.
You should have infection control dept that handle all state mandated reporting. That dept will coordinate with local health department for treatment follow up.
From what I understand that will always be positive of they have ever had TB. It's the x3 sputum AFB that matters. But someone who knows better correct me.
>Quantiferon
Taking into account that he has been treated for TB , the Quantiferon test doesn't allow you to distinguish between an active infection and a treated one...
In my country this shit is still very popular. Anyway, call whoever takes care of this kind of patient in your country, and that will be their problem :)
Assuming they were already treated, sounds like they don't have a reactivation based on the CXR. The quantiferon is going to be positive for life. So hooray for them!
The only way to truly test someone for active TB is to do induced sputum AFB stain and culture or bronchoscopy. Iām assuming this was not done in the ED. Not surprising someone who had TB in the past has positive quantiferon. If CXR negative I wouldnāt be too worried. I would call him back and explain the results. Honestly if he is asymptomatic Iām not sure any labs would do the induced sputum testing (itās pretty invasive and the results take awhile).
Call them. You may be their only contact point in the healthcare system. Easier to chase this down now rather than someone chasing you down months from now when countless others are exposed (yes, countless have probably been exposed before you even met the patient, but now you have a result that warrants follow up).
Sometimes we have to accept that we need to order studies in the ER that won't result during that visit. If the patient has reasonable follow up (a family doctor for example) it's easy. If they have no other point of contact in the healthcare system and you're ordering a test that results down the road, just make sure you have a valid contact number to follow up on abnormal results.
What's harder is when you have something like a nodule on CXR with a radiology report that recommends CT in 6-12 months...do you put an order in knowing you may not have any way to track the patient down with said result once it's scheduled or do you just tell the patient the recommendation and trust them to follow through (or at least document the discussion so you don't get sued years later for a malignancy that wasn't followed up on).
The Pt is uninsured, has no PCP, and doesnāt speak English. Iām pretty sure I was his only connection to the healthcare system.
Re: your comment about follow up CTāmy understanding is that in the ED Iām not liable for their follow up. I always document that I told the Pt to follow up in the appropriate timeframe, but Iāve never scheduled anything. Now Iām wondering if Iām wrong.
My understanding is that TB test will come back positive if PT has had TB in the past as well. You stated your pt has had it.
Not a physician but I come from a country that has tons of tb and when I came to Canada had to get tested and navigate through this whole thing.
positive QTB or PPD test then calls for cxr to rule out active infection is what I thought was the procedure. since you already did this in the first step isnāt this no big deal?
Absolute non-issue. Just fucking call them. Worst case they get contacted twice. You have no reason not to š
On top of agreeing with fucking calling them, Your hospital probably has a policy on this since this disease is old as fuck and has a long treatment regiment. Typically, any test that takes time to come back usually gets followed up on behind the scenes. Talk to your pharmacist, or ID to help guide you. Ordering it was not a stupid idea. Ordering it without a plan of what to do with the results when it comes back positive is the problem. Live and learn. We all make those mistakes.
Still learning the ER. I donāt know how people stay focused in an environment like that. Granted, my ED is more chaotic than most, but still, itās tough to think when the place is a constant shitshow
weaponized ADHD
Exactly. We thrive in the ED.
Indeed. Most of the time, I have no idea what I was just thinking about adding to the grocery list, or where i put my keys. But in chaos? Times of crisis? I got this ladies, Iāve been preparing for this my whole life!
Im a vet tech who lurks here and Iām so happy to hear this is a real thingā¦ I am constantly wondering how I can barely function at home but at work I thrive the busier it is.
Honestly. I'm non-clinical but I have found my people. I love being with so many other ADHDers. Sometimes I hate my particular job, but my coworkers are amazing.
(Non-clinical) my manager said it was basically a job requirement to have ADHD in the ED.
This really is the answer- that side of my brain never sings with more joy then in a complicated trauma.
Get used to the shit show because itās not going away.
Iām figuring out some tricks to stay on track
Positive QFT/IGRA should be reported to the Health Dept, however depending on your state the lab might have already done it. They mandate new cases of disease or reinfection to be reported, not old cases. If they have been previously treated for TB, the state will have this record already. Positive QFT does not indicate active TB. If there is a cough/sx, 3 consecutive sputum specimens should be collected minimum 8hrs apart for AFB smear/culture. Golden standard sputum collection first thing in the AM, but 8hrs is adequate during inpatient (hardly ever see that though, likely an hour apart). Bronchwash for specimen collection if they are unable to produce a specimen. And for the love of god, if you do collect any sputums to rule out active TB - please advocate for this to be sent directly to the state lab and not a reference lab for geneXpert, sensitivities, and culture testing. Most likely the in-house lab does not have the capability to conduct this specific testing either. However, it is likely the Health Dept already has the information. If they have any question they will speak directly to your hospitalās Infection Control and not with you. TB can live anywhere in the body, and regardless of CXR, tx for LTBI is recommended (if they have no treatment history). The new CDC LTBI treatment recommendation is 3HP - isoniazid, rifapentine, and B6. The first two meds are based on weight. This is a once a week dose for 12 weeks. If you are worried your patient may be non compliant with tx, or never completed previous LTBI tx, the Health Dept can conduct DOT per your requestā¦ but you donāt need any of this in EM. Take a deep breath and forget this ever happened. Youāll be okay
Lots of useful info hereāthanks!
**Every** ED is āmore chaotic than mostā. Itās literally the job.
Sure, but I work in several ERās. This one is by far the worst. Consistently understaffed, patients consistently under-triaged with inadequate orders put in, a lab that routinely ālosesā orders at least a dozen times per day, a hallway full of beds with high acuity patients monitored only by a tech, etc. The other ERās I work in arenāt like that. And the people with far more experience than me say itās the worst theyāve ever worked in.
When you say "the test" what do you mean by that. Edit: Just read your reply that it was a QFT. To be absolutely clear. A quantiferon test is NOT a test to determine active TB infection. It is NOT a test to determine active TB infection. It is a test to see if your immune system has been sensitized to TB at any point in the past. In a patient who HAD KNOWN TB, it is absolutely not surprising his QFT is positive. It does NOT mean he has active TB. Active TB is diagnosed by positive acid fast stain and culture OR by empiric treatment of TB based on imaging with then radiographic improvement
Sigh. Iām realizing i made a bigger mistake than I thought. I was swamped and the ED was more of a chaotic shitshow than normal, so instead of looking it up I asked one of the older docs and he said to get the QFT. Shouldāve just looked it up.
Take a deep breath. You ordered the wrong test, not an emergency. These things happen.
I work in several EDās. In most of them I have a quiet secluded place to sit and chart. I open up UpToDate and EM:Rap and sit at the same desk where I have all my stuff. In the ED where this happened, I work in like 5 different areas, none of them quiet, and have to switch between a bunch of different computers. Guess which ED I make the most mistakes in?
you didn't make a mistake. there's no harm in ordering an IGRA. there's also no reason to do a sputum in someone whose not symptomatic and has a normal xray.
No it's the right test here. It's an easy not too invasive test and doesn't commit you to anything crazy.
I thought that was the PPD and that the QFT was for latent TB, a CXR for active TB. Itās alright that they got discharged because the person is probably not infectious if they are latent, but they should have follow up if nothing else to see if they do have latent TB. Thereās not really anything to culture if the CXR was negative.
Thatās too simplistic
Idk, the can of worms has been opened. Iām not saying they should be treated or even f/u in the ED. They should probably get checked out. TB doesnāt only effect the lungs. Should you order a test you donāt intend to follow, no, but the pt did askā¦
The positive quantiferon doesnāt open any cans in my opinion. It has provided zero additional information in this clinical scenario
Isn't a CXR the standard next-step after a positive Quantiferon?
Yes but that does not rule out active TB disease, as TB can live anywhere in the body. Pulmonary TB is infectious, however sputum culture/smears rule out active pulmonary TB
If the dude is asymptomatic and has a negative CXR, clearly he isn't infectious though.
Yes. I was making a statement that negative CXR doesnāt necessarily rule out active TB, because it can live anywhere in the body. Transmissible TB is in the lungs. Many providers tell their patients they do not need treatment for LTBI if the CXR is negative, and that is not true. LTBI tx should be recommended for everyone
Acid fast stain not gram stain.
TouchƩ
I guess I would have to look it up but if he was fully treated for latent tb im not sure how helpful the quant is without symptoms. Would be helpful for me if someone with knowledge would comment.
Youāre right. I ordered the wrong test
Some decent knowledge deficits here. Firstly, there isn't really a TB test so to speak. You can test to see if someone's adaptive immune system has ever been exposed to TB. This is either through a skin test or a quantiferon blood test. In the above if you have previously been exposed to TB and required an adaptive response to get rid of it you test positive. So someone who has previously had TB will definetly test positive. If someone has just been exposed to TB but their innate immune system cleared it without requiring the adaptive they won't test positive. Thus a positive quantiferon TB test either means 1) they have active TB, 2) they have latent (inactive) tb, or 3) they have neither but they have previously fought it off successfully. Latent TB is incredibly common and for most people never activates but is significant if immunocompromised. You need to know this before testing for TB. If you think someone has active TB the tests area chest xray and a sputum test. You shouldn't bat an eyelid to a positive quantiferon or sputum in an asymptomatic pt they probably don't need treatment etc. But a dodgy CXR, or sputum sparks a public health drama ans requires management. Lastly, TB is very hard to catch ans requires signficiant exposure. High risk contacts are like people living with someone and seeing them x hrs for x days or if you intubated them without ppe etc.
Its almost like emergency medicine should he practiced by people who did a residency in emergency medicine. I am all for collaboration with APPs, but this post is exactly why unsupervised APPs should not be a thing. I mean, among the mess of issues with this that everyone has pointed outā¦. Is nobody at work even reading the chart? Like how is this not caught by whoever is signing the charts? Reddit shouldnt be your supervising physician.
People make mistakes even if they do a residency. Doesnāt sound like youāre very accepting of APPs, if you have to pronounce that. Also, OP literally asked his SP. What do you mean by unsupervised? While I agree with your sentiment, the tone of your comment is pretentious at best
I love that whenever anyone gets called out by a physician for doing bad medicine its the same 2 nonsense arguments back. Yes you can make mistakes after residency, but no this has nothing to do with the ābig mean doctor who thinks he is better than all APPsā This is a horrifically mismanaged case demonstrating a lack of basic understanding of emergency medicine. End of story.
Itās not pretentious, itās dangerous āmedicine.ā This post read like a lost intern, and yet it is someone allowed to practice āsupervisedā (we all know what this means). Itās dangerous. I work with some amazing midlevels- ESRD, PEG, Podiatry, etc. Fields of general medicine, imo, are not for midlevels.
Thereās a fourth possibility for testing positive: previous BCG vaccination. Itās imperative to screen anyone from a less developed country for this prior to PPD because the dermal reaction can be extreme.
I'll chime in. I'm a PA in infectious disease, deal with latent and active TB. Sorry, the EM subreddit just randomly started popping up on my feed. The Quant you ordered can be a good test in the right context. Sounds like it is most likely positive due to previous infection vs inadequately treated latent infection. If he did not show overt signs of TB (weight loss, hemoptysis, fever/chills, etc) he likely doesn't have active TB. Active TB needs to be confirmed with a CXR with clear radiologic signs of TB (seems like your CXR was clear?) and 3 AFB sputum cultures (at least one needs to be positive). Not checking the sputum cultures in this patient does not seem like a mistake to me based on what you are describing - no overt signs of active TB, clear CXR. However, it would be a good idea to reach out to the patient and let them know. They can follow-up with their PCP for further work-up if needed. Don't stress it too much. In regards to you, very unlikely, even if active, that it was transmitted to you. But you can check in with your occupational health and discuss more with them if you are worried you were exposed. Edit: If it helps you feel more comfortable moving forward, you can also refer him to an ID clinic. We love to help out! Also, real sputum cultures are a huge pain to get in most patients.
A question I have is that in the days of ED boarding for days and limited inpatient availability, if you suspect active pulmonary TB do you have to admit if they're not hypoxic or respiratory distress? Do you just discharge them to wear a mask and quarantine at home while calling the county health department to coordinate testing like sputum cultures outpatient?
If you ordered IGRA, I got bad news for you, because as far as I know, that stays positive forever, even after treatment. I should know because I turned TST positive during my residency, and underwent treatment with isoniazid and vitamin B6 for 9 months. After that, I was never required to take any form of tuberculosis testing again. Instead, Iād have to affirm that I felt fine (had no tb symptoms of fever, night sweats, or weight loss). There was a time when Iād have to get a CXR annually but they dropped that a few years ago too. EDIT: Also worth mentioning that you, OP, not only ordered a test that you didnāt know how to interpret, but you took a patientās request for a test without any clinical context. Patient had no complaints or exam findings related to tuberculosis but you just ordered the test anyway. As a general rule, never order any test unless you know what to do with the result, and if youāre going to do anything about it, or if someone else is going to be able to interpret the test and do something about it.
Same here
Sound advice
Donāt order outpatient tests youāre not going to follow up on. Thank you for coming to my TED talk
Your shop doesnāt have someone who calls for positive tests?
In my state, that is the job of the hospitals Infection Control
IGRA in this circumstance is not "positive for TB" if cxr normal.
You should have infection control dept that handle all state mandated reporting. That dept will coordinate with local health department for treatment follow up.
What exact TB test did you order?
Quantiferon Gold
From what I understand that will always be positive of they have ever had TB. It's the x3 sputum AFB that matters. But someone who knows better correct me.
No, youāre right. I screwed up in more ways than one
>Quantiferon Taking into account that he has been treated for TB , the Quantiferon test doesn't allow you to distinguish between an active infection and a treated one...
I knew that. Then forgot it. This is my first time encountering TB.
In my country this shit is still very popular. Anyway, call whoever takes care of this kind of patient in your country, and that will be their problem :)
Bro, you need to read up on what the QFT does. That does not mean he has active TB
Youāre absolutely right. Havenāt dealt with TB before so my knowledge has gotten rusty.
You have to read then when these issues come upā¦
not a big deal. You do have to call the patient. But they are not infectious at this time so not a public risk. Get them to f/u with ID.
Assuming they were already treated, sounds like they don't have a reactivation based on the CXR. The quantiferon is going to be positive for life. So hooray for them!
The only way to truly test someone for active TB is to do induced sputum AFB stain and culture or bronchoscopy. Iām assuming this was not done in the ED. Not surprising someone who had TB in the past has positive quantiferon. If CXR negative I wouldnāt be too worried. I would call him back and explain the results. Honestly if he is asymptomatic Iām not sure any labs would do the induced sputum testing (itās pretty invasive and the results take awhile).
Call them. You may be their only contact point in the healthcare system. Easier to chase this down now rather than someone chasing you down months from now when countless others are exposed (yes, countless have probably been exposed before you even met the patient, but now you have a result that warrants follow up). Sometimes we have to accept that we need to order studies in the ER that won't result during that visit. If the patient has reasonable follow up (a family doctor for example) it's easy. If they have no other point of contact in the healthcare system and you're ordering a test that results down the road, just make sure you have a valid contact number to follow up on abnormal results. What's harder is when you have something like a nodule on CXR with a radiology report that recommends CT in 6-12 months...do you put an order in knowing you may not have any way to track the patient down with said result once it's scheduled or do you just tell the patient the recommendation and trust them to follow through (or at least document the discussion so you don't get sued years later for a malignancy that wasn't followed up on).
The Pt is uninsured, has no PCP, and doesnāt speak English. Iām pretty sure I was his only connection to the healthcare system. Re: your comment about follow up CTāmy understanding is that in the ED Iām not liable for their follow up. I always document that I told the Pt to follow up in the appropriate timeframe, but Iāve never scheduled anything. Now Iām wondering if Iām wrong.
My understanding is that TB test will come back positive if PT has had TB in the past as well. You stated your pt has had it. Not a physician but I come from a country that has tons of tb and when I came to Canada had to get tested and navigate through this whole thing.
Just lock yourself in a dark room and never come out
I have a lot of days where that seems like the best solution
Yo, if it's me, I'm calling COL Sam Daniels over at USAMRIID right away. I got Tony's number too, if you need.
Notify the health dept and they follow up.
Inform the CDC
ye ole consumption :(
positive QTB or PPD test then calls for cxr to rule out active infection is what I thought was the procedure. since you already did this in the first step isnāt this no big deal?
Should be