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IVOST-ing, and Mycoplasma

29 Jun, 14 | by tomfardon

The verbalising of nouns is an insidious threat to modern civilisation, some would have us believe. Things are ‘actioned’, when the already existing verb, ‘to do’, would seem perfectly suitable. Adjectives seem to be replacing adverbs: the triathlon magazines I read each month promise to tell me how to ‘run fast’, or how to descend on the bike “fast”, rather than quickly.

Medicine is the biggest culprit, though. We ‘warfarinise’, and even ‘fragmentise’, our poor unsuspecting patients, unaware that our grammar teachers of old are turning in their graves. To warfarin: I warfarin, you warfarin, he warfarinises, one warfarinises, I have warfarinised, I will warfarinise, I will have had have warfarinised…

The most recent, though, is IVOST. It crept into the “Plan” section of ward rounds notes:

Plan
Wean O2
Stop IV fluids
IVOST

Then it became a question “Can I IVOST them today?”. And now we’re all IVOSTing all over the place. Some more than others. I “IVOST” all the time. I think it’s the main input I have on a daily basis. Modern antibiotics have such high oral bioavailability, if the oral route is available, and an oral preparation exists, there’s little benefit in going down the IV route.

At a ‘board round’ this week, I encouraged the trainees to do some more IVOSTing, but they were reluctant. The acute medicine guidelines on sepsis so clearly say IV antibiotics for suspected sepsis that they are wary of making any changes down the line. One of them piped up: “Makes no difference, though, does it?”. Cue a 5 minute, massively informative, ad hoc ‘teaching session’ on the expense of IV antibiotics, the risks of soft tissue injury from unnecessary cannulas, and the difference in nursing dependency required to make up, check and administer the IV antibiotics, compared with the oral variety. Yes, I know, I must be a marvel at parties.

The protocolisation (there, I can verbalise a noun with the best of them) of everything means that far less thought goes into antibiotic prescribing than I’d like to think we did years ago, when I was a House-man. Or maybe we just missed cases of sepsis, and under treated.

In other news, I’ve seen 3 cases of confirmed mycoplasma pneumonia this past fortnight – reassuringly all in young people, two with a background of asthma, and all with a typical history of dry cough, fever, and not dramatic systemic upset. It continues to perplex me slightly that we give ‘atypical’ cover to older patients (who have a CURB65 score of 1 even when they’re well) when it’s very unlikely hey have an atypical pathogen; yet the younger, fitter, low CURB65 score patients who are more likely to have an atypical pathogen who just get the amoxicillin. It’s all in the history, of course, as always.

I have to admit that I don’t know whether it’s an ‘epidemic’ year for mycoplasma, or a ‘mini-epidemic’ year, but in Dundee, 3 in a fortnight is at least something.

I have 2 weeks off work: the Tour de France starts in only 6 days, in Yorkshire, and I’m marshalling (an actual verb), on stage 1, somewhere a bit north of Skipton. The Summer BTS is in York before that though – I’ll be sending Tweets from the conference, and might fit in a blog at some point. Hopefully I’ll be maximising my VO2Max, and AT in the run-up to both, with some time out on the bike.

If IVOST is now a recognised verb now, how can we get a verb for putting people back on their usual inhalers, and stopping their nebulisers. I’ve proposed NIST – Nebuliser Inhaler Switch Therapy. I NIST, you NIST, I am NISTING, I have NISTED, I was NISTING… It’ll catch on. Or perhaps I’m delerium-ing.

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