The Clinical Problem Solvers Episode 423 – RLR – Neutrophilia s/p CABG
Oct 7, 2025
A post‑CABG fever case centered on neutrophilic leukocytosis and risk assessment for mediastinal infection. They weigh urgency, imaging choices, and when to start broad antibiotics versus observe. New urine findings and Pseudomonas culture shift management toward targeted therapy. Practical lessons on balancing diagnostic certainty, patient safety, and hidden‑space thinking.
AI Snips
Chapters
Transcript
Episode notes
Balance Urgency With Patient Stability
- Do balance urgency with patient stability when evaluating in-hospital fever and neutrophilia.
- If the patient is stable and communicative, prioritize targeted testing (viral swabs, UA, CXR, cultures) before reflexively treating with broad empiric antibiotics.
Hidden Spaces Hide Big Infections
- Hidden anatomical spaces like the mediastinum and pelvis can harbor large, clinically silent infections.
- After CABG the sternotomy creates a direct pathway to mediastinal infection, so mediastinitis may present subtly with minimal surface findings.
Decide How Much Certainty You Need
- Do decide early how much diagnostic certainty you need and let that guide actions like imaging or empiric treatment.
- Use patient preference, team input, and resource considerations to choose immediate imaging versus observation and reassessment.