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23 Cards in this Set
- Front
- Back
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initial managemet of a bite?
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gram stain and culture for both aerobes and anaerobes, clean and irrigate, debride, elevate if extremity, evaluate wound, tetanus prophylaxis if indicated, rabies prophylaxis if indicated
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who needs infection prophylaxis in a bite?
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moderate to severe bite, hand or joint, immunocompromised, if in doubt, prophylax
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recommended antibiotic regimens for bite.
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augmentin (amoxil/clavulanate) or unasyn (amp/sulbactam), cefoxitin, quinolone + clindamycin, penicillin + 1st generation cephalosporin
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how long should you treat if no infection develops?
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3 to 5 days
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T/F pneumonia is lung inflammation and can be acute or chronic and infectious or non-infectious.
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TRUE
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sx to suspect pneumonia?
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cough, dyspnea, chest pain, fever, altered mental status
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classic criteria for dx?
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new/progressive infiltrate on CXR and fever, leukocytosis, and cough with purulent sputum
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who gets a CXR?
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cough and fever, cough and dyspnea, cough and abnormal lung PE
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PE specifications?
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look for resp distress like sternal retraction, use of accessory muscles, nasal flaring. Listen to breath sounds and percuss chest
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lab tests?
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out patient there is no consensus on what to order, if any at all. For patients sick enough to admit, 2 sets of bacterial blood cultures, CBC, pulse ox or arterial blood gas, arterial blood gas if CO2 retention is possible (will see altered mental status, resp distress and probable underlying lung disease)... consider sputum gram stain and culture, urine Ag for pneumococcus, urine Ag for legionella
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signs to admit to the hospital?
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resp rate 30 or over, pulse over 125, systolic BP les than 90, PO2 less than 60 or Sat O2 less than 88%, PCO2>50, altered mental status, no responsible care giver at home
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signs to admit to the ICU?
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PO2 less than 60 or Sat O2 less than 88% on 50% mask O2, PCO2 over 55, needs a vent, needs vasopressors to maintain systolic BP over 90
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describe treatment of pneumococcal pneumonia and pneumococcal meningitis.
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pen and ceftriaxone combos have been good for pen resistant pneumonia but not for pen resistant meningitis, probly due to BBB effects
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penicillin seems to treat pen resistant pneumoccal pneumonia, what about macrolide for macrolide resistant pneumococcus?
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no dice
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facts about pneumococcal pneumonia.
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most common cause of serious community acquired pneumonia, can kill previously health ppl, treatment can change outcome but it must be quick thus use empiric treatment until specefic diagnosis is known
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empiric pneumonia treatments for out patients.
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macrolide (z pac) or doxycycline
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empiric pneumonia treatments for general med ward patients?
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cefotaxime or ceftriaxone with a macrolide (z pack) OR moxifloxacin or gemifloxacin alone
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empiric pneumonia Rx for ICU pts
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macrolide (esp azithro), moxifloxacin or gemifloxacin plus cefotasime, ceftriaxone, or a B lactam Blactamse inhibitor combination
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empiric treatment for pneumonia in pen allergic patients
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moxifloxacin or gemifloxacin + aztreonam
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what bugs usually are nosocomial pneumonia infections?
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enteric gram neg rods like klebsiella, pseudomonas aeruginosa, or staph aureus
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empiric treatment for nosocomial pneumonia?
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anti pseudomonal B lactam and cipro, levoflaxin, or an aminoglycoside. Antipseudomonal B lactams include imipenem or meropenem, timentin or zosyn, ceftazidime or cefoperazone
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describe the bugs and empiric treatments for pneumonia in AIDS patients
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pneumocystis carinii, pneumococcus, and hemophilus. Bactrim or trimethoprim plus dapsone
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except for what kind of pneumonia, anaerobes are not common causes? Empiric treatment?
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aspiration pneumonia, FQ + B lactam/B lactamse inhibitor or metronidazole or clindamycin
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