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References 34, 35, 36, Page 43 Reasons for starting insulin therapy Due to the progressive nature of type 2 diabetes between 70 80% of all type 2 patients will require insulin therapy 7 10 years after diagnosis UKPDS, 1998a, b, c ; Who needs insulin? Patients with type 2 diabetes on maximum OHA's with inadequate glycaemic control and a HbA1c 7.5% despite lifestyle interventions or for whom OHA's are contraindicated Drucquer & McNally, 1998 ; Benefits for starting insulin in GP Practice Help improve the patient experience Reduce the need for referral to secondary care services and outpatient waiting times Recommended insulin regimens See insulin flow chart page 31 ; Insulin Check List The information & topics listed on the insulin checklist see Diabetes Care Plan Starting Insulin on page 56 ; will need to be covered with the patient prior to insulin initiation. Professional Issues, Training & Diabetes Courses No healthcare professional should consider initiating insulin therapy unless they have sufficient knowledge of diabetes and have had the appropriate training in insulin initiation. The following courses can be undertaken to help you develop your diabetes knowledge, skills & expertise: Certificate in Diabetes Care Course University of Warwick Diabetes Management in Primary Care Diploma University of Bradford Warwick Diabetes Modules Available via Diabetes Centre, NPH Education, training and supervision by the DSN team Insulin for Life insulin training programme ; Advanced Approach to Multi-Professional Care in Diabetes Thames Valley University, for example, lasix drug.
Pre-steady-state burst is done to determine whether, like a natural nucleotide, the rate-limiting step follows chemistry Fig. 4A ; . A set of single-turnover experiments were then done at varying nucleotide concentrations to determine the observed rate Fig. 4B ; , and the observed rates were then plotted against nucleotide concentration and fit to a hyperbolic curve to determine the Kd and kpol Fig. 4C ; . In general, the kpol values for different mutants were all equal to or faster than those obtained for RTWT incorporation of dGMP; however, the Kd values varied markedly between different mutants and substrates Fig. 5A, summarized in Table II ; . Comparing the efficiencies of incorporation kpol Kd ; showed that all mutants had similar efficiencies during DNA-directed polymerization except for RTQ151M, which showed a 2-fold higher efficiency Table II ; . During RNA-directed polymerization, RTL74V, RTY115F, and RTCBVR all showed significantly lower efficiencies of incorporation due to weak binding of dGTP reflected by an increase in the Kd ; at their active sites. RTM184V and RTQ151M showed similar efficiencies of incorporation to RTWT. In contrast to dGMP incorporation, all mutants during DNAand RNA-directed CBVMP incorporation showed a decrease in kpol relative to values obtained with RTWT Fig. 5B; summarized in Table II ; . The slowest kpol values were obtained with RTCBVR and RTQ151M 10-fold less than those observed with RTWT ; . Kd values for CBVTP binding varied unpredictably in response to mutation during both DNA- and RNA-directed.
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Mrs. Freda Jones is a 52-year-old female who was recently diagnosed with congestive heart failure. Her husband, Frank, accompanied her to an appointment with Dr. Woodsby on Nov. 26. Dr. Woodsby made arrangements for her to be admitted to the hospital Nov.27th for further assessment and treatment. Mrs. Jones has had hypertension for at least 10 years. She has received the influenza immunization the past two years in October. Last year she received the Pneumovax vaccination at the same time. Mrs. Jones' social life has been curtailed over the past few years because of her illness; she is a friendly, outgoing person who misses her former active lifestyle. Mrs. Jones' husband is out of town for a few days every month and is to be away next week for five days. Her son and daughter live out of province. Mrs. Jones is concerned about the length of stay for this admission. This admission is 10 days before a family reunion and she has been looking forward to seeing her son and daughter and grandchildren. Medical Orders Nov. 27 02 1000 Hb, urinalysis, CBC, serum electrolytes, chest x-ray, chest physio bid & hs Dalmane 15 mg po hs prn Give Lqsix 20 mg stat then Lzsix 40 mg po OD K-Lor 20 mg po OD Ampicillin 250 mg QID ASA 325 mg q4h prn Low Na diet, restrict fluids to 1000 mls per 24 hr Have dietician see re dietary restrictions O2 3 litres per nasal prongs prn Nov. 30 02 0830 Repeat electrolytes and chest x-ray Discontinue K-Lor 20mg po OD K-Lor 20 mg po bid and lisinopril.
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PHYSICAL HANDICAP AND REHABILITATION Bromley, I. Pendleton, H Hugh Schultz-Krohn, W. PRIMARY HEALTH CARE Brown, A. Ellis, P. Gear, S. Hampson, G. Phillips, A. Stephenson, Anne PUBLIC HEALTH National Institute for Health and Brief interventions and referral for smoking cessation in primary Clinical Excellence care and other settings. Quick reference guide National Institute for Health and Four commonly used methods to increase physical activity: brief Clinical Excellence interventions in primary care, exercise referral schemes, pedometers and community-based exercise programmes for walking and cycling. Quick reference guide South East Public Health Choosing health in the South East: smoking Observatory South East Public Health A framework for action on tobacco control in the South East Observatory including the regional "Choosing health" white paper action plan for tobacco control RADIOLOGY Eng, P., Chea, F. RESEARCH Cormack, D.F.S. Moore, A., McQuay, H. Royal College of Nursing Roberts, P. RESPIRATORY SYSTEM Cotes, J.E., Chinn, D.J. Miller, M.R. Currie, G.P. National Collaborating Centre for Chronic Conditions Ward, J.P.T. et al. SEXUAL HEALTH Tomlinson, J.M. SURGERY Davey, A., Ince, C. S. Ellis, H., Calne, R., Watson, C. Halim, I., Lammin, K., Cook, L. Kauvar, A.N.B., Hruza, G.J. Kirk, R.M. Lammin, K. Fundamentals of operating department practice Lecture notes: general surgery Intercollegiate MRCS: single best answer practice papers Principles and practices in cutaneous laser surgery General surgical operations Intercollegiate MRCS: EMQ practice papers 2000 2006 ABC of sexual health 2004 2nd ed Lung function: physiology, measurement and application in medicine ABC of COPD Tuberculosis: clinical diagnosis and management of tuberculosis and measures for its prevention and control The respiratory system at a glance 2006 ed 6th ed The research process in nursing Bandolier's little book of making sense of the medical evidence Reflexivity in research 2000 2006 2003 ed Interpreting chest x-rays: illustrated with 100 cases 2005 2006 The practice manager's law handbook: a ready reference to the law for managers of medical general practices MRCGP multiple choice revision book The complete MRCGP study guide Practice nurse handbook The business planning toolkit: a workbook for the primary care team A textbook of general practice 2000 2002 2006 Tetraplegia and paraplegia: a guide for physiotherapists Pedretti's occupational therapy: practice skills for physical dysfunction 2006 6th ed 6th ed and meridia.
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Director, Pharmacoeconomics group 1995-2000 ; and Statistical Manager, Phase IV Research group 19921995 ; , Research Statistician, Department of Biostatistics 1998-1992 ; at Schering-Plough Corporation. [DEGREES] Ph.D., 1988, Statistics, SUNY Buffalo, New York, USA. [PUBLICATIONS] Over 10 statistical and applied papers in peer-reviewed journals including Annals of Statistics, Annals of the Institute of Statistical Mathematics, Statistics in Medicine, Journal of Biopharmaceutical Statistics, Communications in Statistics - Theory and Methods, American Journal of Gastroenterology. [FIELD OF MAJOR STATISTICAL ACTIVITIES] Dr. Weng's research interests include clinical trial methodology and Health-related Quality of Life. [ICSA ACTIVITIES AND OFFICES HELD] Member of ICSA [PROFESSIONAL ACTIVITIES] Dr. Weng is a member of ASA and International Society of Quality of Life and was a member of the Executive Committee, ASA Biopharmaceutical Section 1993-1994 and mesterolone.
Fluocinonide Lidex ; Cream, topical: 0.05% Gel, topical: 0.05% Ointment, topical: 0.05% Solution, topical: 0.05% Fluorescein Sodium Injection: 10% Strip, ophthalmic: 1 mg Fluoxetine Prozac ; Capsule: 10 mg, 20 mg Liquid, oral: 20 mg 5 mL Tablet: 10 mg, 20 mg Fluphenazine Prolixin ; Concentrate: 5 mg mL with 14% alcohol Elixir: 2.5 mg 5 mL with 14% alcohol Injection, as decanoate: 25 mg mL Injection, as hydrochloride: 2.5 mg mL Tablet: 1 mg, 2.5 mg, 5 mg, 10 mg Fluticasone Flonase, Flovent ; Aerosol, inhalation, oral: 44 mcg actuation, 110 mcg actuation, 220 mcg actuation Inhalation, nasal: 50 mcg actuation Fluvastatin Lescol ; Capsule: 20 mg, 40 mg Fluvoxamine Luvox ; Tablet: 25 mg, 50 mg, 100 mg Folic Acid Folvite ; Tablet: 0.4 mg, 0.8 mg, 1 mg Fosphenytoin Cerebyx ; Injection: 100 Phenytoin Equivalents [PE] 2 mL, 500 PE 10 mL Furosemide Kasix ; Injection: 10 mg mL Solution, oral: 10 mg mL, 40 mg 5 mL Tablet: 20 mg, 40 mg, 80 mg Gabapentin Neurontin ; Capsule: 100 mg, 300 mg, 400 mg Tablet: 600 mg, 800 mg.
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Consider NG tube Medication-assisted intubation CCPs & RNs ONLY ; " " " Etomidate 0.3 mg kg or, if contraindicated, Midazolam 0.1mg kg IVP Apply cricoid pressure if patient vomits, release cricoid pressure and suction as needed ; Intubate Confirm tube placement and document per policy If unsuccessful Ventilate using BVM and high flow oxygen Repeat etomidate 0.3 mg kg x 1 or midazolam x 1 to maximum of 10mg or move directly to paralysis Paralysis Atropine 0.01mg kg IVP minimum 0.1mg, maximum 0.5mg ; Vecuronium 0.4mg kg IVP if contraindicated, use succinylcholine 1.5mg kg ; Maintain cricoid pressure Intubate after fasciculation's cease approx. 30 seconds ; If succinylcholine used and inadequate relaxation is present or if paralysis wears off early, the succinylcholine dose may be repeated once. Bradycardia in any airway-compromised patient must be assumed to anoxic in origin until proven otherwise If bradycardia occurs, ventilate using BVM and high flow oxygen and give 0.01mg kg of atropine IVP minimum 0.1mg, maximum 0.5mg and naprosyn.
It is especially important to check with your doctor before combining naproxen with the following: ace inhibitors such as the blood-pressure drug zestril aspirin beta blockers such as the blood-pressure drug tenormin blood-thinning drugs such as coumadin furosemide pasix ; lithium eskalith, lithobid ; methotrexate naproxen sodium aleve, anaprox ; oral diabetes drugs such as diabinese and micronase phenytoin dilantin ; probenecid benemid ; sulfa drugs such as the antibiotics bactrim and septra ec-naproxen should not be used with antacids, h 2 blockers such as tagamet, or sucralfate carafate.
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Ballance et al. Ch. 7, 1992 ; state that the Ministry of Health and Welfare began to remove entry restrictions in the 1980s. By 1990, foreign multinationals had a 15% share of the domestic market. Japanese firms had relied on licensing agreements to sell their products abroad, but are now beginning to invest abroad. FDI has been growing at 10% annually since 1989 Scrip Yearbook, 1995 ; . In 1992, Takeda's export sales were 10%, and Sankyo's were 8% of their total sales and phentermine.
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US Census Bureau: United States Census 2000. [ : census.gov main www cen2000 ]. Electronic Citation 2000 ; Prince A, Bernard AL, Esdall AP: A descriptive analysis of fibromyalgia from the patient's perspective. John of Musculoskeletal Pain 2000, 8: 35-47. Patucchi E, Fatati G, Puxeddu A, Coaccioli S: Prevalence of fibromyalgia in diabetes mellitus and obesity. Recenti Prog Med 2003, 94: 163-165. Yunus MB, Arslan S, Aldag JC: Relationship between body mass index and fibromyalgia features. Scand J Rheumatol 2002, 31: 27-31. Mengshoel AM, Haugen M: Health status in fibromyalgia a followup study. J Rheumatol 2001, 28: 2085-2089. Shapiro JR, Anderson DA, noff-Burg S: A pilot study of the effects of behavioral weight loss treatment on fibromyalgia symptoms. J Psychosom Res 2005, 59: 275-282. White KP, Nielson WR, Harth M, Ostbye T, Speechley M: Does the label "fibromyalgia" alter health status, function, and health service utilization? A prospective, within-group comparison in a community cohort of adults with chronic widespread pain. Arthritis Rheum 2002, 47: 260-265. Yazici Y, Pincus T, Kautiainen H, Sokka T: Morning stiffness in patients with early rheumatoid arthritis is associated more strongly with functional disability than with joint swelling and erythrocyte sedimentation rate. J Rheumatol 2004, 31: 1723-1726. Salvarani C, Cantini F, Boiardi L, Hunder GG: Polymyalgia rheumatica. Best Pract Res Clin Rheumatol 2004, 18: 705-722. Grnblad M, Nyk: anen J, Konttinen Y, J: arvinen E, Helve T: Effect of zopiclone on sleep quality, morning stiffness, widespread tenderness and pain and general discomfort in primary fibromyalgia patients. A double-blind randomized trial. Clin Rheumatol 1993, 12: 186-191. Russell IJ, Michalek JE, Kang YK, Richards AB: Reduction of morning stiffness and improvement in physical function in fibromyalgia syndrome patients treated sublingually with low doses of human interferon-alpha. J Interferon Cytokine Res 1999, 19: 961-968. Lineker S, Badley E, Charles C, Hart L, Streiner D: Defining morning stiffness in rheumatoid arthritis. J Rheumatol 1999, 26: 1052-1057. Engstrom-Laurent A, Hallgren R: Circulating hyaluronic acid levels vary with physical activity in healthy subjects and in rheumatoid arthritis patients. Relationship to synovitis mass and morning stiffness. Arthritis Rheum 1987, 30: 1333-1338. Yaron I, Buskila D, Shirazi I, Neumann L, Elkayam O, Paran D, Yaron M: Elevated levels of hyaluronic acid in the sera of women with fibromyalgia. J Rheumatol 1997, 24: 2221-2224. Werle E, Jakel HP, Muller A, Fischer H, Fiehn W, Eich W: Serum hyaluronic acid levels are elevated in arthritis patients, but normal and not associated with clinical data in patients with fibromyalgia syndrome. Clin Lab 2005, 51: 11-19. Bliddal H, Moller HJ, Schaadt M, Danneskiold-Samsoe B: Patients with fibromyalgia have normal serum levels of hyaluronic acid. J Rheumatol 2000, 27: 2658-2659. Barkhuizen A, Bennett RM: Elevated levels of hyaluronic acid in the sera of women with fibromyalgia. J Rheumatol 1999, 26: 2063-2064. Lapossy E, Maleitzke R, Hrycaj P, Mennet W, Muller W: The frequency of transition of chronic low back pain to fibromyalgia. Scand J Rheumatol 1995, 24: 29-33. Giesecke T, Gracely RH, Grant MA, Nachemson A, Petzke F, Williams DA, Clauw DJ: Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis Rheum 2004, 50: 613-623. Kivimaki M, Leino-Arjas P, Virtanen M, Elovainio M, KeltikangasJarvinen L, Puttonen S, Vartia M, Brunner E, Vahtera J: Work stress and incidence of newly diagnosed fibromyalgia: prospective cohort study. J Psychosom Res 2004, 57: 417-422. Amir M, Kaplan Z, Neumann L, Sharabani R, Shani N, Buskila D: Posttraumatic stress disorder, tenderness and fibromyalgia. J Psychosom Res 1997, 42: 607-613. Van Houdenhove B, Neerinckx E, Onghena P, Vingerhoets A, Lysens R, Vertommen H: Daily hassles reported by chronic fatigue syndrome and fibromyalgia patients in tertiary care: a con.
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Because both the mosquito and parasite are now extremely resistant to the insecticides designed to kill them, governments are now trying to teach people to take antimalarial drugs as a preventive medicine and avoid being bitten by mosquitoes.
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In view of the high pathogenicity of E. multilocularis to humans, special safety precautions should be observed if dogs or cats ; , infected with E. multilocularis, have to be treated by application of an anthelmintic 8, 9 ; Chapter 3 ; . a ; Animals should only be treated under supervision of a veterinarian by informed and trained personnel. b ; Treatment should be performed under biohazard precautions in a veterinary clinic or under conditions where faecal material excreted after treatment can be collected and disinfected by heat or can be incinerated. Disinfection of kennels for example by heat 80C ; , the ground, equipment, etc. possibly contaminated with E. multilocularis should be feasible Table 7.2. ; . c ; After treatment the animals should be shampooed and bathed in warm water in order to remove Echinococcus eggs adhering to the coat. d ; The result of treatment should be checked by repeated examination of faecal samples for taeniid eggs and for Echinococcus-specific coproantigen and or DNA Chapter 3 ; . e ; Persons who had contact to a definitive host infected with E. multilocularis, should receive serological screening for serum antibodies using a highly specific and sensitive test for example Em2 plus-ELISA, [17] ; beginning about 4 weeks after suspected exposure and 6, 12 and 24 months later Chapter 2 ; . f ; These measures have to be adequately adapted to the situation of the individual case by the supervising veterinarian and levitra.
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ANESTHESIOLOGY Anesthesiology Clinical Conference Weekly, Tuesdays, 7: 00 a.m. Room G-200 1 AMA PRA Category 1 Credit TM 202 ; 877-7500 CARDIOLOGY CARDIOVASCULAR Cardiac Catheterization Conference Weekly, Wednesdays, 7: 30 a.m. True Auditorium 1 AMA PRA Category 1 Credit TM 202 ; 877-8574 Updates in Cardiovascular Medicine Lecture Series Biweekly, Tuesdays, 6: 30 p.m. District of Columbia, Maryland and Virginia Area Restaurants 1 AMA PRA Category 1 Credit TM 202 ; 877-2992 Echocardiography Conference Weekly, Thursdays, 7: 45 a.m. Cath Lab Conference Room 5th Flr ; 1 AMA PRA Category 1 Credit TM 202 ; 877-7853 EMERGENCY MEDICINE Emergency Medicine Grand Rounds Monthly, 3rd Thursdays, 7: 00 a.m. Emergency Department Conf. Rm. 1 AMA PRA Category 1 Credit TM 202 ; 877-9191 American Board of Emergency Medicine ABEM ; Literature Review Monthly, 1st Friday, 7: 30 a.m. Emergency Department Conf. Rm. 1 AMA PRA Category 1 Credit TM 202 ; 877-9393 MEDICINE GRAND ROUNDS Weekly, Wednesdays, 12: 30 p.m. True Auditorium 1 AMA PRA Category 1 Credit TM 202 ; 877-3109 or 202 ; 877-6749 NRH Medical Grand Rounds Weekly, Fridays, Noon NRH Auditorium 1 AMA PRA Category 1 Credit TM 202 ; 877-1660 NEONATOLOGY Visiting Lecturer Series in Perinatal Pediatrics Twice Monthly, 1st & 2nd Tuesdays 12: 30 p.m. 5B3 Conference Room 1 AMA PRA Category 1 Credit TM 202 ; 877-6527 NEUROLOGY Cerebrovascular Case Conference Biweekly, Wednesdays, 8: 00 a.m. Various locations 1 AMA PRA Category 1 Credit TM 202 ; 877-3154.
A Never Performed. You have never performed the stated task and have no experience with this type of skill. Name B Familiar with. You are familiar with the stated task; but you would need more experience and practice to feel comfortable and proficient in this type of skill. Signature C Experienced in. You have performed this task several times; you feel moderately comfortable functioning independently, but you would require a resource person to be nearby. Please select the column that most accurately describes your proficiency level. D Expert. You have a performed this task frequently; you feel comfortable and proficient in this skill; you would not require supervision or practice. SKILL CARE OF PATIENT WITH: Acute MI Aneurysm Angina Cardiac arrest CHF Myocarditis Aspiration COPD Hemopneumothorax Laryngospasm Pneumonia Pneumothorax Pulmonary edema Pulmonary emboli Tension pneumothorax Skull fracture Closed head injury CVA DT's Overdose Encephalitis Meningitis Neuromuscular disease Seizures Asthma Spinal cord injuries Open fractures Closed fractures A B C SKILL CARE OF PATIENT WITH: CONTINUED ; Immobilizer Casts GI bleed Abdominal trauma Bowel obstruction Hepatitis Hepatic failure Renal failure UTI Diabetic ketoacidosis Diabetic coma Hyperthryoidism Hypothyroidism Hypothermia Hypothermia Penetrating eye injury Chemical exposure Nose bleed TRAUMA CARE: Anaphylactic shock Cardiogenic shock Hypovolemic shock Neurogenic shock Septic shock Human bites Animal bites Venomous bites First degree burns A B C SKILL NEUROLOGICAL: Intracranial pressure monitoring ORTHOPEDICS: Circulation checks Gait Range of motion Assist with placement of cast Use of support devices cane, sling, etc. ; GI: Abdominal bowel sounds Fluid balance Nutritional status Interpretation of blood chemistry Placement of nasogastric tubes Salem sump to suction Saline lavage RENAL GU: Assess fluid balance Interpretation of BUN and creatinine Insertion of straight and indwelling catheter Urine specimen collection Interpretation of electrolytes A B C SKILL ENDOCRINOLOGY: Signs and symptoms of diabetic coma Signs and symptoms of insulin reaction Blood glucose monitoring MEDICATIONS: Adenocard Adrenalin Lanoxin Cardizem Dobutamine Dopamine Esmolol Lazix Nitroglycerin Nitroprusside Aminophylline Bronkosol Epinephrine Isuprel Steroids Terbutaline Decadron Dilantin Mannitol Phenobarbital Solu-Medrol Antiemetics Antispasmodic Ipecac Insulin Administration of blood and blood products IV THERAPY: Central line catheter dressing Broviac Groshong PICC A B C Avoid medications for arthritis and pain unless your heart care provider tells you which one s ; are safe for you. Examples are Advil, Celebrex, ibuprofen, Motrin, Naprosyn, Nuprin, and Vioxx. Tylenol or acetaminophen are OK. ; Other medicines to avoid Plan your medication refills to avoid "running out". Keep a copy of your medication list in your purse or wallet. Ask your health care provider if you have a question. Name Date.
Additional history regarding Mr. Ritis' arthritis: He has had classic seropositive RA for 25 years. It has affected the PIP and MCP joints of both hands, elbows, knees, and ankles, resulting in joint deformity. He uses paraffin wax baths daily for his hands and has been instructed to do exercises but is noncompliant because of pain. A.R. did not tolerate ASA due to GI upset, so he was treated with various NSAIDs. About 10 years ago, he was given a trial of gold therapy which was discontinued due to lack of efficacy. After this, he was placed on prednisone and has never been steroid-free despite several attempts to taper off the medication. A.R.'s regimen includes prednisone, naproxen and acetaminophen. Of these drugs, prednisone and naproxen can contribute to CNS toxicity in the elderly. Although almost every currently marketed NSAID has been associated with CNS toxicity, three are particularly prominent: INDOMETHACIN, IBUPROFEN and NAPROXEN. The addition of a NSAID to ASA or other salicylate products has been used to achieve greater anti-inflammatory response than can be obtained with either product alone. However, clinical data supporting this potential synergism are lacking. In general, when patients receive optimal doses of salicylates the addition of NSAIDs renders little, if any, benefit. Additionally, there is increased risk for adverse drug reactions interactions increased risk of GI intolerance, bleeding and nephrotoxicity ; . The elderly are at risk for salicylate intoxication due to age-related pharmacokinetic changes and polypharmacy. In the elderly, no changes in aspirin or salicylate absorption or metabolic pathways have been demonstrated. Aging has been associated with decreases in serum albumin, which may be exaggerated by malnutrition. Reduced serum albumin increases the fraction of unbound active ; salicylate and may predispose the elderly to salicylate toxicity. Age-related reductions in renal function cause decreased elimination of salicylates. Consequently, normal adult doses may result in toxic total and unbound concentrations in the elderly patient. Limiting their use of corticosteroids may be even more important in their elderly RA patient because steroid-related side effects may magnify age-related risks for disease i.e., osteoporosis, cataract formation, increased susceptibility to infections, hyperglycemia and changes in mental status ; . 9: 30-10: 20 Session: Antibiotics Christopher J. Destache, Pharm. D. A 72 inch; 170 lb. ; BM is admitted to the hospital complaining of decreased mental status, productive cough that is blood-streaked, fever to 102.7 F, elevated RR to 40 ; , and signs and symptoms consistent with CHF. His past medical history is positive for coronary artery disease, COPD with bronchitis, and mild CHF controlled with low dose lasix. On admission, his sputum shows many PMNs and no squamous epithelial cells but no organisms on Gram stain. His labs show a WBC 21.4 with 58% segs and 14% bands. Admission creatinine and BUN are 2.2 mg dl and 58 Gm dl, respectively. The intern notices you and asks for assistance with antibiotic selection.
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