Logic

conditional_ID logic
32470 If patient presents with Heart Failure Then a thorough history and physical examination should be obtained/performed
32471 If patients with idiopathic dilated cardiomyopathy Then a 3-generational family history should be obtained
32472 If at each patient encounter Then assess volume status AND assess vital signs AND serial assessment of weight AND estimate jugular venous pressure AND assess the presence of peripheral edema or orthopnea
32473 If ambulatory or hospitalized patients with HF. Then obtain validated multivariable risk scores
32474 If Initial laboratory evaluation of patients presenting with HF Then perform complete blood cell count, AND perform urinalysis AND perform measurement of serum electrolytes (including calcium and magnesium), AND perform measurement of blood urea nitrogen AND perform measurement of serum creatinine AND perform measurement of glucose, AND perform measurement of thyroid-stimulating hormone AND perform a fasting lipid profile test AND perform liver function tests
32475 If Serial monitoring indicated Then include serum electrolyte levels and renal function
32476 If patients presenting with HF Then initially perform 12-lead electrocardiogram
32477 If selected patients who present with HF Then screen for hemochromatosis OR screen for HIV
32478 If patients presenting with HF in whom there is a clinical suspicion of rheumatological diseases, amyloidosis, or pheochromocytoma Then perform diagnostic tests for rheumatological diseases OR perform diagnostic tests for amyloidosis OR perform diagnostic tests for pheochromocytoma
32479 If patients at risk of developing HF Then perform natriuretic peptide biomarker–based screening AND perform team-based care, including a cardiovascular specialist optimizing GDMT
32480 If patients presenting with dyspnea Then perform measurement of natriuretic peptide biomarkers
32481 If patient has chronic HF Then perform measurement of BNP or NT-proBNP
32482 If admission to the hospital Then perform measurement of baseline levels of natriuretic peptide biomarkers and/or cardiac troponin
32483 If during a HF hospitalization Then perform a measurement of predischarge natriuretic peptide level
32484 If patients with chronic HF Then perform measurement of clinically available tests, such as biomarkers of myocardial injury or fibrosis
32485 If Patients with suspected or new-onset HF OR patients presenting with acute decompensated HF Then undergo a chest x-ray
32486 If initial evaluation of patients presenting with HF Then perform a 2-dimensional echocardiogram with Doppler
32487 If patients with HF AND ( who have had a significant change in clinical status OR who have experienced or recovered from a clinical event OR who have received treatment, including GDMT, that might have had a significant effect on cardiac function OR who may be candidates for device therapy) Then perform repeat measurement of EF AND perform measurement of the severity of structural remodeling
32488 If patients presents with de novo HF AND who have known CAD AND no angina AND NOT the patient who is not eligible for revascularization of any kind. Then
32489 If select situations when planning revascularization in HF patients with CAD. Then perform viability assessment
32490 If echocardiography is inadequate Then perform radionuclide ventriculography OR perform magnetic resonance imaging
32491 If assessing myocardial infiltrative processes OR assessing scar burden Then perform magnetic resonance imaging
32492 If absence of clinical status change OR absence of treatment interventions Then DO NOT perform routine repeat measurement of LV function assessment
32493 If patients who have respiratory distress OR patients with clinical evidence of impaired perfusion in whom the adequacy or excess of intracardiac filling pressures cannot be determined from clinical assessment Then perform invasive hemodynamic monitoring with a pulmonary artery catheter
32494 If carefully selected patients with acute HF AND who have persistent symptoms despite empiric adjustment of standard therapies, AND (Whose fluid status, perfusion, or systemic or pulmonary vascular resistance is uncertain OR Whose systolic pressure remains low, or is associated with symptoms, despite initial therapy; OR Whose renal function is worsening with therapy; OR Who require parenteral vasoactive agents; or OR Who may need consideration for mechanical circulatory support or transplantation) Then perform invasive hemodynamic monitoring
32495 If patients eligible for revascularization AND ischemia may be contributing to HF Then perform coronary arteriography
32496 If patients presenting with HF AND when a specific diagnosis is suspected that would influence therapy Then perform endomyocardial biopsy
32497 If normotensive patients with acute decompensated HF AND congestion with symptomatic response to diuretics and vasodilators Then DO NOT perform routine use of invasive hemodynamic monitoring
32498 If routine evaluation of patients with HF Then DO NOT perform endomyocardial biopsy
32499 If lowering the risk of HF Then control hypertension AND control lipid disorders
32500 If patient has (obesity OR diabetes mellitus OR tobacco use OR known cardiotoxic agents) Then control condition OR avoid condition
32501 If patients with (a recent or remote history of MI OR acute coronary syndrome) AND reduced EF) Then use angiotensin-converting enzyme inhibitors
32502 If patients with (a recent or remote history of MI OR acute coronary syndrome) AND reduced EF AND patients intolerant of ACE inhibitors Then angiotensin-receptor blockers are appropriate unless contraindicated
32503 If patients with ( a recent or remote history of MI OR acute coronary syndrome) AND reduced EF Then use evidence-based beta blockers
32504 If patients with a recent or remote history of MI OR acute coronary syndrome Then use statins
32505 If patients with structural cardiac abnormalities, including LV hypertrophy AND the absence of a history of MI or ACS Then control blood pressure
32506 If patients with a reduced EF Then use ACE inhibitors
32507 If patients with a reduced EF Then use beta blockers
32508 If patients with asymptomatic ischemic cardiomyopathy who are ?40 days post-MI AND have an LVEF of ?30%, AND are on appropriate medical therapy AND have a reasonable expectation of survival with a good functional status for >1 year. Then placement of an implantable cardioverterdefibrillator (ICD) is reasonable
32509 If asymptomatic patients with low LVEF AND no symptoms of HF after MI Then Nondihydropyridine calcium channel blockers with negative inotropic effects may be harmful
32510 If patients with HF Then educate to facilitate HF self-care
32511 If patients with symptomatic HF Then restrict sodium
32512 If patients with HF AND who are able to participate to improve functional status Then advise to exercise or have regular physical activity
32513 If clinically stable patients with HF Then use cardiac rehabilitation
32514 If patients in stage C Then use same measures listed in Class I recommendations for patients in stages A and B
32515
32516 If patient with Stage C HFrEF AND NYHA class I–IV Then treat with angiotensin-converting enzyme inhibitor or angiotensin receptor-blocker AND GDMT beta blocker AND diuretics as needed
32517 If patient is NYHA class II–IV AND provided est. CrCl >30 mL/min AND K+ <5.0 mEq/L Then implement aldosterone antagonist
32518 If NYHA class II–III HF AND Adequate blood pressure on angiotensin-converting enzyme inhibitor or angiotensin receptor-blocker AND No contraindication to angiotensin receptor-blocker or sacubitril Then Discontinue ACEI or ARB AND initiate ARNI
32519 If NYHA class III–IV AND in black patients Then implement Hydral-Nitrates
32520 If NYHA class II–III AND left ventricular ejection fraction ?35% AND (caveat: >1 y survival, >40 d post MI) Then implement implantable cardioverter defibrillator
32521 If NYHA class II–IV AND left ventricular ejection fraction ?35% AND normal sinus rhythm and QRS ?150 ms with left bundle-branch block pattern Then implement cardiac resynchronization therapy OR implement cardiac resynchronization therapy–device
32522 If NYHA class II–III AND normal sinus rhythm AND heart rate ?70 bpm on maximally tolerated dose beta blocker Then implement Ivabradine
32523 If patients are Stage D refractory NYHA class III-IV Then consider additional therapy of palliative care (COR I) OR consider additional therapy of transplant (COR I) OR consider additional therapy of left ventricular assist device (COR IIa) OR consider investigational studies
32524 If patients with HFrEF with fluid retention Then use diuretics
32525 If patients with HFrEF Then use ACE inhibitors
32526 If patients with HFrEF AND who are ACE inhibitor–intolerant Then use ARB's
32527 If patient with HFrEF AND first-line therapy Then use ARBs OR ACE inhibitors
32528 If persistently symptomatic patients with HFrEF on GDMT Then add an ARB
32529 If patients with HFrEF Then Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful
32530 If stable patients Then use of 1 of the 3 beta blockers proven to reduce mortality
32531 If patients with NYHA class II–IV HF AND who have LVEF ?35% Then use aldosterone receptor antagonists
32532 If patient has had an acute MI AND who has LVEF ?40% AND (who develop symptoms of HF OR who has a history of diabetes mellitus) Then use aldosterone receptor antagonists
32533 If (male and serum creatinine is >2.5 mg/dL) OR (female and >2.0 mg/dL) OR estimated glomerular filtration rate <30 mL/min/1.73 m2 or potassium >5.0 mEq/L. Then use of aldosterone receptor antagonists is potentially harmful
32534 If African Americans with NYHA class III–IV HFrEF on GDMT Then combination of hydralazine and isosorbide dinitrate is recommended
32535 If patients with HFrEF AND who cannot be given ACE inhibitors or ARBs Then A combination of hydralazine and isosorbide dinitrate can be useful
32536 If patients with HFrEF Then use of Digoxin can be beneficial
32537 If Patients with chronic HF AND with permanent/persistent/paroxysmal AF AND an additional risk factor for cardioembolic stroke AND absence of contraindications to anticoagulation Then treat with chronic anticoagulant therapy
32538 If permanent AF OR persistent AF OR paroxysmal AF Then individualize the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban)
32539 If patients with chronic HF AND who have (permanent AF OR persistent AF OR paroxysmal AF) AND are without an additional risk factor for cardioembolic stroke AND in the absence of contraindications to anticoagulation Then use of Chronic anticoagulation is reasonable
32540 If patients with chronic HFrEF without AF OR a prior thromboembolic event OR a cardioembolic source Then do not use anticoagulation
32541 If prescribed solely for HF Then Statins are NOT beneficial as adjunctive therapy
32542 If HFrEF patients OR HFpEF patients Then use Omega-3 PUFA supplementation as adjunctive therapy
32543 If patients with current or prior symptoms of HFrEF Then do not treat with nutritional supplements
32544 If patient with HFrEF Then do not use hormonal therapies other than to correct deficiencies
32545 If patients with current or prior symptoms of HFrEF Then avoid use of most antiarrhythmic drugs AND most calcium channel–blocking drugs [except amlodipine] AND nonsteroidal anti-inflammatory drugs AND thiazolidinediones
32546 If patients with HFrEF Then long-term use of infused positive inotropic drugs is potentially harmful
32547 If patient with HFrEF Then do not treat with calcium channel-blocking drugs as routine treatment
32548 If patients with chronic HFrEF Then perform the clinical strategy of (inhibition of the renin-angiotensin system with ACE inhibitors OR ARBs in conjunction with evidence-based beta blockers) AND aldosterone antagonists in selected patients
32549 If patients with chronic HFrEF Then perform the clinical strategy of inhibition of the renin-angiotensin system with ARNI in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients
32550 If patients with prior or current symptoms of chronic HFrEF Then use ACE inhibitors
32551 If patients with prior or current symptoms of chronic HFrEF AND who are intolerant to ACE inhibitors because of cough or angioedema Then use ARBs to reduce morbidity and mortality
32552 If patients with chronic symptomatic HFrEF NYHA class II or III AND who tolerate an ACE inhibitor or ARB Then replace with an angiotensin receptor-neprilysin inhibitor to further reduce morbidity and mortality.
32553 If patients with HFrEF Then do not administer Angiotensin receptor-neprilysin inhibitor concomitantly with ACE inhibitors or within 36 hours of the last dose of an ACE inhibitor
32554 If patients with a history of angioedema Then do not administer Angiotensin receptor-neprilysin inhibitor
32555 If patients with symptomatic (NYHA class II-III) stable chronic HFrEF (LVEF ?35%) AND who are receiving GDEM, including a beta blocker at maximum tolerated dose, AND who are in sinus rhythm with a heart rate of ?70 bpm at rest. Then use Ivabradine to reduce HF hospitalization
32556 If patients with HFrEF AND who have evidence of fluid retention AND not contraindicated Then use diuretics
32557 If patients with HFrEF and current or prior symptoms, AND not contraindicated Then use ACE inhibitors
32558 If patients with HFrEF with current or prior symptoms AND who are ACE inhibitor–intolerant AND not contraindicated Then use ARBs
32559 If first-line therapy for patients with HFrEF AND patients already taking ARBs for other indications AND not contraindicated Then use ARBs as alternatives to ACE inhibitors
32560 If persistently symptomatic patients with HFrEF AND who are already being treated with an ACE inhibitor and a beta blocker i AND an aldosterone antagonist is not indicated or tolerated. Then add an ARB
32561 If patients with HFrEF Then Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful
32562 If for all patients with current or prior symptoms of HFrEF AND not contraindicated Then Use of 1 of the 3 beta blockers proven to reduce mortality (ie, bisoprolol, carvedilol, and sustained-release metoprolol succinate)
32563 If patients with NYHA class II–IV AND who have LVEF of ?35% AND NOT contraindicated AND Patients with NYHA class II with a history of prior cardiovascular hospitalization or elevated plasma natriuretic peptide levels AND Creatinine levels ?2.5 mg/dL in men or ?2.0 mg/dL in women (or estimated glomerular filtration rate >30 mL/min/1.73 m2) 2) AND potassium levels should be <5.0 mEq/L. Then use aldosterone receptor antagonists (or mineralocorticoid receptor antagonists) AND Carefully monitor potassium levels, renal function, and diuretic dosing at initiation and closely follow thereafter
32564 If following an acute MI in patients AND who have LVEF of ?40% AND who develop symptoms of HF OR who have a history of diabetes mellitus AND not contraindicated Then use aldosterone receptor antagonists
32565 If patients with HFrEF AND (serum creatinine is >2.5 mg/dL in men OR >2.0 mg/dL in women) OR estimated glomerular filtration rate <30 mL/min/1.73 m2 OR potassium >5.0 mEq/L Then Inappropriate use of aldosterone receptor antagonists is potentially harmful
32566 If patients self-described as African Americans with NYHA class III–IV HFrEF AND receiving optimal therapy with ACE inhibitors and beta blockers AND NOT contraindicated Then use a combination of hydralazine and isosorbide dinitrate
32567 If patients with current or prior symptomatic HFrEF AND who cannot be given an ACE inhibitor or ARB because of drug intolerance, hypotension, or renal insufficiency, AND NOT contraindicated Then use a combination of hydralazine and isosorbide dinitrate
32568 If patients with HFrEF AND NOT contraindicated Then use digoxin
32569 If Patients with chronic HF AND with permanent OR persistent OR paroxysmal AF AND an additional risk factor for cardioembolic stroke (history of hypertension, diabetes mellitus, previous stroke or transient ischemic attack, or ?75 years of age) AND NO contraindications to anticoagulation Then treat with chronic anticoagulant therapy
32570 If on the basis of risk factors OR cost OR tolerability OR patient preference OR potential for drug interactions OR other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin Then individualize the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal AF
32571 If patients with chronic HF AND (who have permanent OR persistent OR paroxysmal AF) AND without an additional risk factor for cardioembolic stroke AND NOT contraindications to anticoagulation Then use chronic anticoagulation
32572 If patients with chronic HFrEF without AF OR a prior thromboembolic event OR a cardioembolic source Then DO NOT use anticoagulation
32573 If statins are prescribed solely for the diagnosis of HF in the absence of other indications for their use Then Statins are NOT beneficial as adjunctive therapy
32574 If patients with NYHA class II–IV symptoms AND (HFrEF OR HFpEF) AND not contraindicated, Then supplement with Omega-3 polyunsaturated fatty acid as adjunctive therapy
32575 If patients with current or prior symptoms of HFrEF Then DO NOT treat with nutritional supplements
32576 If patients with current or prior symptoms of HFrEF Then do not use hormonal therapies to treat other than to correct deficiencies
32577 If patients with current or prior symptoms of HFrEF Then avoid prescibing drugs known to adversely affect clinical status or withdraw whenever possible
32578 If patients with HFrEF Then Long-term use of infused positive inotropic drugs is potentially harmful except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment
32579 If patients with HFrEF Then DO NOT treat with Calcium channel–blocking drugs as routine treatment
32580 If patients with HFpEF Then control systolic and diastolic blood pressure
32581 If patients with HFpEF Then use diuretics for relief of symptoms due to volume overload
32582 If patient with CAD AND (symptoms (angina) OR demonstrable myocardial ischemia) is having an adverse effect on symptomatic HFpEF despite GDMT Then Coronary revascularization is reasonable
32583 If patients with HFpEF Then Manage AF according to published clinical practice guidelines
32584 If patients with hypertension AND with HFpEF Then use beta-blocking agents OR use ACE inhibitors OR use ARBs
32585 If In appropriately selected patients (with EF ?45% AND (elevated BNP levels OR or HF admission within 1 year) AND estimated glomerular filtration rate >30 mL/min AND creatinine <2.5 mg/dL, potassium <5.0 mEq/L)) Then use aldosterone receptor antagonists
32586 If patients with HFpEF Then use ARBs to decrease hospitalizations
32587 If patients with HFpEF Then Routine use of nitrates or phosphodiesterase-5 inhibitors to increase activity or QoL is ineffective
32588 If patients with HFpEF Then DO NOT routinely use nutritional supplements
32589 If selected patients with (nonischemic DCM OR ischemic heart disease ?40 days) AND post-MI AND with LVEF of ?35% AND NYHA class II or III symptoms AND on chronic GDMT AND who have a reasonable expectation of meaningful survival for >1 year Then ICD therapy is recommended for primary prevention of sudden cardiac death to reduce total mortality
32590 If patients who have LVEF of 35% or less AND sinus rhythm AND left bundle-branch block with a QRS duration of 150 ms or greater AND NYHA class II, III, or ambulatory class IV symptoms AND on GDMT Then Cardiac resynchronization therapy
32591 If selected patients at least 40 days post-MI AND with LVEF of 30% or less AND NYHA class I symptoms while receiving GDMT AND who have a reasonable expectation of meaningful survival for more than 1 year Then ICD therapy
32592 If patients who have LVEF of ?35% AND sinus rhythm AND a non-LBBB pattern with a QRS duration of ?150 ms AND NYHA class III/ambulatory class IV symptoms on GDMT Then use CRT
32593 If patients who have LVEF of ?35% AND sinus rhythm AND LBBB with a QRS duration of 120–149 ms AND NYHA class II, III, or ambulatory class IV symptoms on GDMT Then use CRT
32594 If patients with AF and LVEF of ?35% on GDMT AND patient requires ventricular pacing or otherwise meets CRT criteria AND atrioventricular nodal ablation or pharmacological rate control will allow near 100% ventricular pacing with CRT Then use CRT
32595 If patients on GDMT AND who have LVEF of ?35% AND undergoing placement of a new or replacement device with anticipated requirement for significant (>40%) ventricular pacing. Then use CRT
32596 If patients with a high risk of nonsudden death as predicted by frequent hospitalizations, advanced frailty, or comorbidities such as systemic malignancy or severe renal dysfunction. Then The usefulness of implantation of an ICD is of uncertain benefit to prolong meaningful survival
32597 If patients who have LVEF of ?35% AND sinus rhythm AND a non-LBBB pattern with a QRS duration of 120–149 ms AND NYHA class III/ambulatory class IV on GDMT Then use CRT
32598 If patients who have LVEF of ?35% AND sinus rhythm AND a non-LBBB pattern with a QRS duration of ?150 ms AND NYHA class II symptoms on GDMT Then use CRT
32599 If patients who have LVEF of ?30% AND ischemic etiology of HF AND sinus rhythm AND LBBB with a QRS duration of ?150 ms AND NYHA class I symptoms on GDMT Then use CRT
32600 If patients with NYHA class I or II symptoms AND non-LBBB pattern with a QRS duration of <150 ms Then CRT is NOT recommended
32601 If patients whose comorbidities and/or frailty limit survival with good functional capacity to <1 year Then CRT is NOT indicated
32602 If patients with hyponatremia AND in stage D Then Fluid restriction (1.5–2 L/d) is reasonable to reduce congestive symptoms
32603 If patients with cardiogenic shock AND NOT definitive therapy (eg, coronary revascularization, MCS, heart transplantation) AND NOT resolution of the acute precipitating problem Then provide temporary intravenous inotropic support
32604 If patients with stage D HF AND refractory to GDMT and device therapy AND who are eligible for and awaiting MCS or cardiac transplantation. Then Continuous intravenous inotropic support is reasonable as “bridge therapy”
32605 If hospitalized patients AND presenting with documented severe systolic dysfunction AND who present with low blood pressure AND significantly depressed cardiac output to maintain systemic perfusion and preserve end-organ performance Then Short-term, continuous intravenous inotropic support may be reasonable
32606 If select patients with stage D HF despite optimal GDMT and device therapy AND who are not eligible for either MCS or cardiac transplantation. Then Long-term, continuous intravenous inotropic support may be considered as palliative therapy for symptom control
32607 If patient with HF AND in the absence of specific indications or for reasons other than palliative care Then Long-term use of either continuous or intermittent, intravenous parenteral positive inotropic agents is potentially harmful
32608 If hospitalized patients AND (without documented severe systolic dysfunction OR low blood pressure OR impaired perfusion) AND evidence of significantly depressed cardiac output, with or without congestion Then Use of parenteral inotropic agents is potentially harmful
32609 If carefully selected patients with stage D HFrEF AND in whom definitive management (eg, cardiac transplantation) or cardiac recovery is anticipated or planned Then MCS is beneficial
32610 If carefully selected HFrEF patients AND with acute, profound hemodynamic compromise Then Nondurable MCS, including the use of percutaneous and extracorporeal ventricular assist devices, is reasonable as a “bridge to recovery” or a “bridge to decision”
32611 If carefully selected patients with stage D HFrEF Then Durable MCS is reasonable
32612 If carefully selected patients AND with stage D HF AND GDMT AND device management AND surgical management Then Evaluation for cardiac transplantation is indicated
32613 If patient with ACS precipitating acute HF decompensation Then promptly identify by ECG and serum biomarkers, including cardiac troponin testing AND treated optimally as appropriate to the overall condition and prognosis of the patient
32614 If during initial evaluation Then consider common precipitating factors for acute HF
32615 If In patients with HFrEF AND experiencing a symptomatic exacerbation of HF requiring hospitalization during chronic maintenance treatment with GDMT Then it is recommended that GDMT be continued in the absence of hemodynamic instability or contraindications.
32616 If only in stable patient AND after optimization of volume status AND successful discontinuation of intravenous diuretics AND successful discontinuation of vasodilators AND successful discontinuation of inotropic agents Then Initiation of beta-blocker therapy at a low dose is recommended
32617 If patients who have required inotropes during their hospital course. Then Caution should be used when initiating the use of beta blockers
32618 If Patients with HF AND admitted with evidence of significant fluid overload Then should be promptly treated with intravenous loop diuretics
32619 If patients are receiving loop diuretic therapy Then the initial intravenous dose should equal or exceed their chronic oral daily dose AND should be given as either intermittent boluses or continuous infusion. AND Urine output and signs and symptoms of congestion should be serially assessed, AND the diuretic dose should be adjusted accordingly to relieve symptoms, reduce volume excess, and avoid hypotension.
32620 If patients with HF Then The effect of HF treatment should be monitored with careful measurement of fluid intake and output, vital signs, body weight that is determined at the same time each day, and clinical signs and symptoms of systemic perfusion and congestion AND Daily serum electrolytes, urea nitrogen, and creatinine concentrations should be measured during the use of intravenous diuretics or active titration of HF medications.
32621 If When diuresis is inadequate to relieve symptoms Then it is reasonable to intensify the diuretic regimen using higher doses of intravenous loop diuretics OR it is reasonable to intensify the diuretic regimen using addition of a second (eg, thiazide) diuretic
32622 If to improve diuresis and better preserve renal function and renal blood flow Then Low-dose dopamine infusion may be considered in addition to loop diuretic therapy
32623 If patients with obvious volume overload Then Ultrafiltration may be considered to alleviate congestive symptoms and fluid weight
32624 If patients with refractory congestion not responding to medical therapy Then Ultrafiltration may be considered
32625 If patients admitted with acute decompensated HF AND symptomatic hypotension is absent Then intravenous nitroglycerin, nitroprusside, or nesiritide may be considered as an adjuvant to diuretic therapy for relief of dyspnea
32626 If patient admitted to the hospital with decompensated HF Then should receive venous thromboembolism prophylaxis with an anticoagulant medication
32627 If patients hospitalized with volume overload, including HF AND who have persistent severe hyponatremia AND are at risk for or having active cognitive symptoms despite water restriction and maximization of GDMT Then vasopressin antagonists may be considered in the short term to improve serum sodium concentration in hypervolemic, hyponatremic states with either a V2 receptor–selective or a nonselective vasopressin antagonist
32628 If identifying appropriate HF patients for GDMT OR providing clinicians with useful reminders to advance GDMT OR assessing the clinical response Then use performance improvement systems and/or evidence-based systems of care
32629 If Throughout the hospitalization as appropriate OR before hospital discharge, OR at the first postdischarge visit OR in subsequent follow-up visits Then Initiate GDMT if not previously established and not contraindicated AND Precipite causes of HF, barriers to optimal care transitions, and limitations in postdischarge support AND Assess volume status and supine/upright hypotension with adjustment of HF therapy, as appropriate AND Titration and optimization of chronic oral HF therapy AND Assess renal function and electrolytes, where appropriate AND Assess and manage comorbid conditions AND Reinforce HF education, self-care, emergency plans, and need for adherence AND Consider palliative care or hospice care in selected patients
32630 If patients at high risk for hospital readmission Then use multidisciplinary HF disease-management programs
32631 If patient within 3 days of hospital discharge Then schedule an early follow-up visit (within 7–14 days) and early telephone follow-up
32632 If identifying patients at higher risk for postdischarge clinical events Then use clinical risk-prediction tools and/or biomarkers
32633 If patients with NYHA class II and III HF and iron deficiency (ferritin <100 ng/mL or 100–300 ng/mL if transferrin saturation is <20%) Then use intravenous iron replacement
32634 If patients with HF and anemia Then DO NOT use erythropoietin-stimulating agents to improve morbidity and mortality
32635 If patients at increased risk, stage A HF AND with hypertension Then the optimal blood pressure should be <130/80 mm Hg
32636 If Patients with HFrEF AND hypertension Then prescribe GDMT titrated to attain systolic blood pressure <130 mm Hg
32637 If Patients with HFpEF AND persistent hypertension after management of volume overload Then prescribe GDMT titrated to attain systolic blood pressure <130 mm Hg
32638 If In patients with NYHA class II–IV HF AND (suspicion of sleep disordered breathing OR excessive daytime sleepiness) Then perform a formal sleep assessment
32639 If In patients with cardiovascular disease AND obstructive sleep apnea Then use continuous positive airway pressure
32640 If In patients with NYHA class II–IV HFrEF AND central sleep apnea Then DO NOT use adaptive servo-ventilation
32641 If patients HF on GDMT AND with angina AND suitable coronary anatomy, especially for a left main stenosis (>50%) or left main–equivalent disease Then Coronary artery revascularization via coronary artery bypass graft OR percutaneous intervention
32642 If patients with mild to moderate LV systolic dysfunction (EF 35%–50%) AND (significant (?70% diameter stenosis) multivessel coronary artery disease OR proximal left anterior descending coronary artery stenosis when viable myocardium is present in the region of intended revascularization) Then perform coronary artery revascularization via coronary artery bypass graft
32643 If patients with severe LV dysfunction (EF <35%) AND heart failure AND significant coronary artery disease Then perform coronary artery bypass graft OR use medical therapy
32644 If patients with critical aortic stenosis AND predicted surgical mortality of <10% Then perform surgical aortic valve replacement
32645 If patients with critical aortic stenosis AND who are deemed inoperable Then perform transcatheter aortic valve replacement after careful candidate consideration
32646 If patients with ischemic heart disease with severe LV systolic dysfunction (EF <35%) AND operable coronary anatomy whether or not viable myocardium is present Then perform coronary artery bypass graft
32647 If after careful candidate selection AND with a background of GDMT Then perform transcatheter mitral valve repair or mitral valve surgery for functional mitral insufficiency
32648 If carefully selected patients with HFrEF for specific indications including intractable HF and ventricular arrhythmias Then perform surgical reverse remodeling OR LV aneurysmectomy
32649 If patient with chronic HF Then Effective systems of care coordination with special attention to care transitions should be deployed
32650 If patient with HF Then should have a clear, detailed, and evidence-based plan of care AND should be updated regularly a AND made readily available to all members of each patient’s healthcare team
32651 If patients with symptomatic advanced HF Then Palliative and supportive care is effective
32652 If patient with HF Then use performance measures based on professionally developed clinical practice guidelines
32653 If improving quality of HF care. Then Participate in quality improvement programs and patient registries based on nationally endorsed, clinical practice guideline–based quality and performance measures
32654 If diagnosing VAP Then perform noninvasive sampling with semiquantitative cultures AND NOT invasive sampling with quantitative cultures AND NOT noninvasive sampling with quantitative cultures
32655 If patients with suspected VAP whose invasive quantitative culture results are below the diagnostic threshold Then withhold antibiotics rather than continuing
32656 If patients with suspected HAP (non-VAP) Then treat according to the results of microbiologic studies performed on respiratory samples obtained noninvasively NOT treat with empiric antibiotic therapy
32657 If For patients with suspected HAP/VAP Then use clinical criteria alone to decide whether or not to initiate antibiotic therapy NOT use serum PCT plus clinical criteria
32658 If patients with suspected HAP/VAP Then using clinical criteria alone to decide whether or not to initiate antibiotic therapy NOT using bronchoalveolar lavage fluid (BALF) sTREM-1 plus clinical criteria
32659 If patients with suspected HAP/VAP Then use clinical criteria alone to decide whether or not to initiate antibiotic therapy NOT use CRP plus clinical criteria,
32660 If patients with suspected HAP/VAP Then use clinical criteria alone to decide whether or not to initiate antibiotic therapy NOT use CPIS plus clinical criteria
32661 If patients with VAT Then do not provide antibiotic therapy
32662 If patients with suspected VAP Then include coverage for S. aureus, Pseudomonas aeruginosa, and other gram-negative bacilli in all empiric regimens
32663 If patients with a risk factor for antimicrobial resistance (Table 2) OR patients being treated in units where >10%–20% of S. aureus isolates are methicillin resistant OR patients in units where the prevalence of MRSA is not known Then include an agent active against MRSA for the empiric treatment of suspected VAP
32664 If patients without risk factors for antimicrobial resistance, who are being treated in ICUs where <10%–20% of S. aureus isolates are methicillin resistant Then include an agent active against methicillinsensitive S. aureus (MSSA) (and not MRSA) for the empiric treatment of suspected VAP
32665 If empiric coverage for MRSA is indicated, Then treat with vancomycin OR treat with linezolid
32666
32667 If treating proven MSSA Then Oxacillin, nafcillin, or cefazolin are preferred agents but are not necessary for the empiric treatment of VAP if one of the above agents is used
32668 If for the empiric treatment of suspected VAP AND (a risk factor for antimicrobial resistance (Table 2) OR patients in units where >10% of gram-negative isolates are resistant to an agent being considered for monotherapy, OR patients in an ICU where local antimicrobial susceptibility rates are not available) Then prescribe 2 antipseudomonal antibiotics from different classes
32669 If suspected VAP AND patients without risk factors for antimicrobial resistance AND patients who are being treated in ICUs where ?10% of gram-negative isolates are resistant to the agent being considered for monotherapy Then prescribe one antibiotic active against P. aeruginosa
32670 If patients with suspected VAP AND alternative agents with adequate gram-negative activity are available Then avoid aminoglycosides
32671 If patients with suspected VAP AND alternative agents with adequate gram-negative activity are available Then avoid colistin
32672 If patients being treated empirically for HAP Then prescribe an antibiotic with activity against S. aureus
32673 If patients with HAP AND who are being treated empirically AND (a risk factor for MRSA infection (ie, prior intravenous antibiotic use within 90 days, hospitalization in a unit where >20% of S. aureus isolates are methicillin resistant, OR the prevalence of MRSA is not known OR who are at high risk for mortality) Then prescribe an antibiotic with activity against MRSA
32674 If patients with HAP AND who require empiric coverage for MRSA, Then treat with vancomycin or linezolid rather than an alternative antibiotic
32675 If patients with HAP AND who are being treated empirically AND have no risk factors for MRSA infection AND are not at high risk of mortality Then prescribe an antibiotic with activity against MSSA
32676 If empiric treatment that includes coverage for MSSA AND not MRSA Then use a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem.
32677 If patients with HAP who are being treated empirically Then prescribe antibiotics with activity against P. aeruginosa and other gram-negative bacilli
32678 If For patients with HAP who are being treated empirically AND have factors increasing the likelihood for Pseudomonas or other gram-negative infection OR a high risk for mortality Then prescribe antibiotics from 2 different classes with activity against P. aeruginosa
32679 If patients with HAP who are being treated empirically Then do not use an aminoglycoside as the sole antipseudomonal agent
32680 If patients with HAP/VAP Then determine antibiotic dosing using PK/PD data, rather than the manufacturer’s prescribing information
32681 If patients with VAP due to gram-negative bacilli that are susceptible to only aminoglycosides or polymyxins (colistin or polymyxin B), Then use both inhaled and systemic antibiotics, rather than systemic antibiotics alone
32682 If MRSA HAP/VAP Then treat with either vancomycin or linezolid rather than other antibiotics or antibiotic combinations
32683 If patients with HAP/VAP due to P. aeruginosa Then choice of an antibiotic for definitive (not empiric) therapy be based upon the results of antimicrobial susceptibility testing
32684 If patients with HAP/VAP due to P. aeruginosa Then NOT treat with aminoglycoside monotherapy
32685 If For patients with HAP/VAP due to P. aeruginosa, AND not in septic shock AND NOT at a high risk for death AND the results of antibiotic susceptibility testing are known Then treat with monotherapy using an antibiotic to which the isolate is susceptible rather than combination therapy
32686 If patients with HAP/VAP due to P. aeruginosa AND (who remain in septic shock OR at a high risk for death when the results of antibiotic susceptibility testing are known) Then treat with combination therapy using 2 antibiotics to which the isolate is susceptible rather than monotherapy
32687 If patients with HAP/VAP due to P. aeruginosa, Then NOT treat with aminoglycoside monotherapy
32688 If patients with HAP/VAP due to ESBL-producing gramnegative bacilli Then the choice of an antibiotic for definitive (not empiric) therapy be based upon the results of antimicrobial susceptibility testing and patient-specific factors
32689 If patients with HAP/VAP caused by Acinetobacter species AND the isolate is susceptible to carbapenem or ampicillin/sulbactam Then treat with either a carbapenem or ampicillin/sulbactam
32690 If patients with HAP/VAP caused by Acinetobacter species that is sensitive only to polymyxins Then treat with intravenous polymyxin (colistin or polymyxin B)
32691 If patients with HAP/VAP caused by Acinetobacter species that is sensitive only to polymyxins Then treat with adjunctive inhaled colistin
32692 If patients with HAP/VAP caused by Acinetobacter species that is sensitive only to colistin Then do not treat with adjunctive rifampicin
32693 If patients with HAP/VAP caused by Acinetobacter species Then do NOT use tigecycline
32694 If patients with HAP/VAP caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins Then treat with intravenous polymyxins (colistin or polymyxin B)
32695 If patients with HAP/VAP caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins Then treat with adjunctive inhaled colistin
32696 If For patients with VAP Then treat with a 7-day course of antimicrobial therapy rather than a longer duration
32697 If patients with HAP Then treat with a 7-day course of antimicrobial therapy
32698 If patients with HAP/VAP Then antibiotic therapy be de-escalated rather than fixed
32699 If patients with HAP/VAP Then use PCT levels plus clinical criteria to guide the discontinuation of antibiotic therapy, rather than clinical criteria alone
32700 If patients with suspected HAP/VAP Then do not use the CPIS to guide the discontinuation of antibiotic therapy
32701 If patient has impetigo or ecthyma Then use gram stain and culture of the pus or exudates from skin lesions to identify whether Staphylococcus aureus and/or a ?-hemolytic streptococcus is the cause
32702 If patient has impetigo or ecthyma Then it is reasonable in typical cases to treat without identifying whether Staphylococcus aureus and/or a ?-hemolytic streptococcus is the cause
32703 If patient has bullous or nonbullous impetigo Then treatment should be with either mupirocin or retapamulin twice daily for 5 days
32704 If patient has impetigo or ecthyma Then oral therapy should be a 7-day regimen with an agent active against S. aureus OR oral penicillin when cultures yield streptococci alone
32705 If patient has impetigo or ecthyma Then use dicloxacillin OR use cephalexin
32706 If patient has impetigo or ecthyma AND methicillin-resistant Staphylococcus aureus is suspected or confirmed Then use doxycycline OR use clindamycin OR use sulfamethoxazole-trimethoprim
32707 If outbreak of post-streptococcal glomerulonephritis Then systemic antimicrobials should be used for infections to help eliminate nephritogenic strains of Streptococcus pyogenes from the community
32708 If patient has carbuncles and abscesses Then use gram stain and culture of pus OR treatment without these studies is reasonable in typical cases
32709 If inflamed epidermoid cysts Then Gram stain and culture of pus are NOT recommended
32710 If inflamed epidermoid cysts OR carbuncles OR abscesses OR large furuncles Then treat by incision and drainage
32711 If temperature >38°C OR temperature <36°C OR tachypnea >24 breaths/min OR tachycardia >90 beats/min OR white blood cell count >12,000 cells/mm3 OR white blood cell count <4000 cells/mm3 Then administer antibiotics directed against S. aureus as an adjunct to incision and drainage
32712
32713 If A recurrent abscess at a site of previous infection Then search for local causes such as a pilonidal cyst, hidradenitis suppurativa or foreign material
32714 If early in the course of infection Then recurrent abscesses should be drained and cultured
32715 If after obtaining cultures of recurrent abscess, Then treat with a 5- to 10-day course of an antibiotic active against the pathogen isolated
32716 If recurrent S. aureus infection Then Consider a 5-day decolonization regimen of intranasal mupirocin bid, daily chlorhexidine washes, and daily decontamination of personal items such as towels, sheets, and clothes
32717 If recurrent abscesses began in early childhood Then adult patients should be evaluated for neutrophil disorders
32718
32719 If evaluating patient for cellulitis and erysipelas AND (patients with malignancy on chemotherapy OR neutropenia OR severe cell-mediated immunodeficiency OR immersion injuries OR animal bites) Then cultures of blood are recommended
32720 If evaluating patient for cellulitis and erysipelas AND (patients with malignancy on chemotherapy OR neutropenia OR severe cell-mediated immunodeficiency OR immersion injuries OR animal bites) Then obtain cultures of blood OR obtain microscopic examination of cutaneous aspirates OR obtain biopsies OR obtain swabs
32721 If Typical cases of cellulitis AND without systemic signs of infection Then should receive an antimicrobial agent that is active against streptococci
32722 If pateint has cellulitis AND systemic signs of infection Then systemic antibiotics are indicated
32723 If patient has cellulitis associated with penetrating trauma OR evidence of MRSA infection elsewhere OR nasal colonization with MRSA OR injection drug use OR SIRS Then vancomycin or another antimicrobial effective against both MRSA and streptococci is recommended
32724 If In severely compromised patients (patients who have failed oral antibiotic treatment or those with systemic signs of infection (such as temperature >38°C, tachycardia (heart rate >90 beats per minute), tachypnea (respiratory rate >24 breaths per minute) or abnormal white blood cell count (<12 000 or <400 cells/?L), or those who are immunocompromised,or those with clinical signs of deeper infection such as bullae, skin sloughing, hypotension, or evidence of organ dysfunction) Then broad-spectrum antimicrobial coverage may be considered
32725 If treating a patient for cellulitis and erysipelas AND severe infection Then Vancomycin plus either piperacillin-tazobactam or imipenem/meropenem is recommended as a reasonable empiric regimen
32726 If treating a patient for cellulitis and erysipelas AND the infection has not improved within the recommended duration of antimicrobial therapy of 5 days Then treatment should be extended
32727 If treating erysipelas and cellulitis Then Elevate the affected area AND treat predisposing factors, such as edema or underlying cutaneous disorders
32728 If In lower extremity cellulitis Then carefully examine the interdigital toe spaces because treating fissuring, scaling, or maceration may eradicate colonization with pathogens and reduce the incidence of recurrent infection
32729 If patient does not have SIRS OR patient does not have altered mental status OR patient does not have hemodynamic instability Then Outpatient therapy is recommended
32730 If concern for a deeper or necrotizing infection for patients with poor adherence to therapy OR concern for infection in a severely immunocompromised patient OR outpatient treatment is failing Then hospitalization is recommended
32731 If nondiabetic adult patients with cellulitis Then consider systemic corticosteroids (eg, prednisone 40 mg daily for 7 days)
32732 If routine patient care OR during the acute stage of cellulitis Then Identify and treat predisposing conditions such as edema, obesity, eczema, venous insufficiency, and toe web abnormalities.
32733 If patient has 3-4 episodes of cellulitis per year despite attempts to treat or control predisposing factors Then administer prophylactic antibiotics, such as oral penicillin or erythromycin bid for 4-52 weeks OR intramuscular benzathine penicillin every 2-4 weeks
32734 If predisposing factors persist Then continue to administer prophylactic antibiotics, such as oral penicillin or erythromycin bid for 4-52 weeks, or intramuscular benzathine penicillin every 2-4 weeks
32735 If surgical site infection Then suture removal plus incision and drainage should be performed
32736 If surgical site infections associated with a significant systemic response such as erythema and induration extending >5 cm from the wound edge, temperature >38.5ºC, heart rate >110/min, or WBC count >12,000/mm3 Then Adjunctive systemic antimicrobial therapy is NOT routinely indicated but in conjunction with incision and drainage may be beneficial
32737 If patients with surgical site infections after clean operations on the trunk, head and neck, or extremities that also have systemic signs of infection Then a brief course of systemic antimicrobial therapy is indicated
32738 If risk factors for MRSA are high (nasal colonization, prior MRSA infection, recent hospitalization, recent antibiotics) Then use a first-generation cephalosporin OR use an anti-staphylococcal penicillin for MSSA OR use vancomycin OR use linezolid OR use daptomycin OR use telavancin OR use telavancin
32739 If infections after operations on the axilla OR infections after operations on the gastrointestinal tract OR infections after operations on the perineum OR infections after operations on the female genital tract Then use agents active against Gram-negative bacteria and anaerobes, such as a cephalosporin or fluoroquinolone in combination with metronidazole
32740 If patients with aggressive infections associated with signs of systemic toxicity OR suspicion of necrotizing fasciitis OR gas gangrene Then prompt surgical consultation
32741 If patient has necrotizing fasciitis, including Fournier's gangrene Then empiric antibiotic treatment should be broad (eg, vancomycin or linezolid plus piperacillin-tazobactam or plus a carbapenem; or plus ceftriaxone and metronidazole), since the etiology can be polymicrobial (mixed aerobic-anaerobic microbes) or monomicrobial (Group A streptococcus, community-acquired MRSA)
32742 If treating documented Group A streptococcal necrotizing fasciitis Then use penicillin plus clindamycin
32743 If establishing the diagnosis of pyomyositis. Then use magnetic resonance imaging OR computed tomography scan OR ultrasound studies
32744 If managing pyomyositis Then obtain cultures of blood and abscess material
32745 If initial empiric therapy Then Vancomycin is recommended AND An agent active against enteric Gram-negative bacilli should be added for infection in immunocompromised patients or after open trauma to the muscles
32746 If treating pyomyositis caused by MSSA Then use Cefazolin OR use antistaphylococcal penicillin (eg, nafcillin or oxacillin)
32747 If treating pyomyositis Then early drainage of purulent material should be performed
32748 If patients with persistent bacteremia Then perform repeat imaging studies to identify undrained foci of infection
32749 If treating for pyomyositis Then Initially administer antibiotics intravenously AND once patient is clinically improved and bacteremia has cleared promptly and no evidence of endocarditis Then Treat with oral antibiotics or metastatic abscess
32750 If evaluating and treating clostridial gas gangrene or myonecrosis Then perform urgent surgical exploration of the suspected gas gangrene site AND perform surgical debridement of involved tissue
32751 If In the absence of a definitive etiologic diagnosis, Then broad-spectrum treatment with vancomycin plus either piperacillin/tazobactam, ampicillin/sulbactam or a carbapenem antimicrobial
32752 If treating clostridial myonecrosis Then perform definitive antimicrobial therapy with penicillin and clindamycin
32753 If Treating clostridial gas gangrene or myonecrosis Then do not use hyperbaric oxygen therapy is because it has not been proven as a benefit to patients and may delay resuscitation and surgical debridement
32754 If patient is immunocompromised OR patient is asplenic OR patient has advanced liver disease OR patient has preexisting or resultant edema of the affected area OR pateint has moderate to severe injuries, especially to the hand or face OR patient has injuries that may have penetrated the periosteum or joint capsule Then Preemptive early antimicrobial therapy for 3-5 days
32755 If patient has dog or cat bite Then may indicate postexposure prophylaxis for rabies AND consult with local health officials to determine if vaccination should be initiated
32756 If patient has Infected wounds related to animal bite Then use an antimicrobial agent or agents active against both aerobic and anaerobic bacteria such as amoxicillin-clavulanate
32757 If patient has wound related to animal bite AND patient without toxoid vaccination within 10 years Then Tetanus toxoid should be administered. Tdap is preferred over Td if the former has not been previously given
32758 If patient has an animal bite wound AND NOT to the face Then use copious irrigation AND cautious debridement AND preemptive antibiotics NOT primary wound closure
32759 If other wound Then approximate wound
32760 If naturally acquired cutaneous anthrax Then treat with oral penicillin V 500 mg qid for 7-10 days
32761 If bioterrorism case of cutaneous anthrax Then treat with Ciprofloxacin 500 mg PO bid OR treat with levofloxacin 500 mg IV/PO q24h for 60 days
32762 If Cat Scratch Disease Then treat with Azithromycin Patients >45 kg, 500 mg on day 1 followed by 250 mg for 4 additional days. OR treat with Azithromycin. Patients <45 kg, 10 mg/kg on day 1 and 5 mg/kg for 4 more days
32763 If treating bacillary angiomatosis Then treat with Erythromycin 500 mg qid or doxycycline 100 mg bid for 2 weeks to 2 months
32764 If treating erysipeloid Then treat with Penicillin 500 mg qid or amoxicillin 500 mg tid for 7-10 days
32765 If treating Glanders Then treat with Ceftazidime OR treat with gentamicin OR treat with imipenem OR treat with doxycycline OR treat with ciprofloxacin
32766 If diagnosing Bubonic plague Then perform Gram stain and culture of aspirated material from a suppurative lymph node
32767
32768
32769 If diagnosing tularemia Then use serologic tests
32770 If treating severe cases of tularemia Then use Streptomycin 15 mg/kg q12h IM or gentamicin 1.5 mg/kg q8h IV
32771 If treating mild cases of tularemia Then use tetracycline 500 mg qid or doxycycline 100 mg bid PO is
32772 If tularemia is suspected Then Notify the microbiology laboratory
32773
32774 If assessing skin and soft tissue infections in immunocompromised patients Then Differential diagnosis for infection of skin lesions should include bacterial, fungal, viral and parasitic agents
32775 If assessing skin and soft tissue infections in immunocompromised patients Then implement biopsy or aspiration of the lesion to obtain material for histologic and microbiologic evaluation as an early diagnostic step
32776 If assessing skin and soft tissue infections in patients with fever and neutropenia Then Determine whether the current presentation of fever and neutropenia is the patient’s initial episode of fever and neutropenia or a persistent unexplained fever from their initial episode (after 4-7 days), or a subsequent episode of fever and neutropenia (recurrent)
32777 If assessing skin and soft tissue infections in immunocompromised patients Then aggressively determine the etiology of the skin and soft tissue infection by aspiration and/or biopsy of skin and soft tissue lesions AND submit these for thorough cytologic/histologic assessments, microbial staining, and cultures
32778 If assessing skin and soft tissue infections in immunocompromised patients Then Risk-stratify patients with fever and neutropenia according to susceptibility to infection: high-risk patients are those with anticipated prolonged (>7 days) and profound neutropenia (ANC <100 cells/?L) or with a Multinational Association for Supportive Care (MASCC) score of <21; low-risk patients are those with anticipated brief (<7 days) periods of neutropenia and few comorbidities or with a MASCC of ?21
32779 If assessing skin and soft tissue infections in immunocompromised patients AND as indicated by clinical signs and symptoms Then Determine the extent of infection through a thorough physical examination AND Determine the extent of infection through blood cultures, AND Determine the extent of infection through chest radiograph AND Determine the extent of infection through additional imaging (including chest CT)
32780 If patient with skin and soft tissue infection during the initial episode of fever and neutropenia Then hospitalize AND perform empiric antibacterial therapy with vancomycin plus antipseudomonal antibiotics such as cefepime, a carbapenem (imipenem-cilastatin or meropenem or doripenem) or piperacillintazobactam
32781 If patient with skin and soft tissue infection during the initial episode of fever and neutropenia AND documented clinical and microbiologic skin and soft tissue infection Then treat based on antimicrobial susceptibilities of isolated organisms
32782 If patient with skin and soft tissue infection during the initial episode of fever and neutropenia Then treatment duration should be 7-14 days
32783 If patient with skin and soft tissue infection during the initial episode of fever and neutropenia Then perform surgical intervention for drainage of soft-tissue abscess after marrow recovery or for a progressive polymicrobial necrotizing fasciitis or myonecrosis
32784 If patient with skin and soft tissue infection during the initial episode of fever and neutropenia Then do not perform adjunct colony-stimulating factor therapy (granulocyte colony-stimulating factor, granulocyte macrophage colony-stimulating factor) OR granulocyte transfusions
32785 If patient with skin and soft tissue infection during the initial episode of fever and neutropenia AND patient is suspected or confirmed to have cutaneous or disseminated herpes simple or varicella zoster virus infection Then administer acyclovir
32786 If patients with skin and soft tissue infections during persistent or recurrent episodes of fever and neutropenia Then add empiric antifungal therapy to the antibacterial regimen
32787 If patients with skin and soft tissue infections during persistent or recurrent episodes of fever and neutropenia AND not already administering vancomycin or other agents with Gram-positive activity Then add empiric administration of vancomycin or other agents with Gram-positive activity (linezolid, daptomycin or ceftaroline)
32788 If Candida species skin and soft tissue infections AND persistent or recurrent episodes of fever and neutropenia Then treated with an echinocandin OR if Candida parapsilosis has been isolated, lipid formulation amphotericin-B
32789 If patients with skin and soft tissue infections during persistent or recurrent episodes of fever and neutropenia AND Candida parapsilosis has been isolated Then treat with fluconazole as an acceptable alternative to lipid formulation amphotericin-B
32790 If Candida species skin and soft tissue infections AND during persistent or recurrent episodes of fever and neutropenia Then treat for 2 weeks after clearance of blood stream infection or resolution of skin lesions
32791 If Aspergillus skin and soft tissue infections AND during persistent or recurrent episodes of fever and neutropenia Then treat with voriconazole
32792 If Aspergillus skin and soft tissue infections AND during persistent or recurrent episodes of fever and neutropenia Then treat with lipid formulations of amphotericin B, posaconazole, or echinocandin for 6-12 weeks
32793 If Mucor/Rhizopus infections AND during persistent or recurrent episodes of fever and neutropenia Then treat with lipid formulation amphotericin B
32794 If Mucor/Rhizopus infections AND during persistent or recurrent episodes of fever and neutropenia Then treat with posaconazole
32795 If Mucor/Rhizopus infections AND treated with lipid formulation amphotericin B or posaconazole AND during persistent or recurrent episodes of fever and neutropenia Then add echinocandin
32796 If Fusarium species skin and soft tissue infections AND during persistent or recurrent episodes of fever and neutropenia Then treat with high-dose IV voriconazole or posaconazole
32797 If patients with skin and soft tissue infections during persistent or recurrent episodes of fever and neutropenia AND patients currently on antibiotics Then begin treatment for antibiotic-resistant bacterial organisms
32798 If during persistent or recurrent episodes of fever and neutropenia AND (suspected or confirmed cutaneous or disseminated herpes simplex virus OR varicella zoster virus infections) Then add intravenous acyclovir to the patient’s antimicrobial regimen
32799 If patients with skin and soft tissue infections during persistent or recurrent episodes of fever and neutropenia Then obtain blood cultures AND aggressively evaluate skin lesions by culture aspiration, biopsy, or surgical excision
32800 If patients with skin and soft tissue infections during persistent or recurrent episodes of fever and neutropenia AND unexplained skin lesions Then use polymerase chain reaction in peripheral blood for herpes simplex virus and varicella zoster virus to establish a diagnosis of disseminated infection
32801 If patients with cellular immune defects Then Consider immediate consultation with a dermatologist familiar with cutaneous manifestations of infection
32802 If patients with cellular immunodeficiency Then consider biopsy AND consider surgical debridement
32803 If patients with cellular immunodeficiency AND life-threatening situation Then use empiric antibiotics, antifungals and/or antivirals
32804 If patients with cellular immunodeficiency Then The use of specific agents should be decided with the input of the primary team, dermatology, infectious disease, and other consulting teams
32805 If patient with a suspected abdominal aortic aneurysm OR patient with known abdominal aortic aneurysm Then perform physical examination that includes an assessment of femoral and popliteal arteries