Flashcards in Hospital peds Deck (10):
What are the 3 most common causative organisms in empyema?
1. Strep pneumo2. Staph aureus3. GAS
What are the stages of empyema development?
1. Stage 1: moderate-large exudative parapneumonic effusion2. Loculation3. Fibrinous peel
What are 3 findings on exam of a pleural effusion?
1. Decreased breath sounds2. Decreased chest expansion3. Dullness to percussion
What is the utility of repeating CXRs on a daily basis to evaluate the status of a pleural effusion or empyema?
Not necessary unless clinical deterioation is evident
In what percentage of empyema cases will the blood culture be positive?
10%-but should still collect before abx to potentially guide choice of abx for children who are ill enough to be hospitalized for pneumonia
When should you consider early procedural intervention for a patient with a pleural effusion?
If the patient is in moderate to severe resp distress
What is the usual empiric antibiotic choice for a child with empyema?-what about for severe suspected MRSA pneumonia?-duration of treatment?
Ceftriaxone or cefotaxime +/- clindamycin to cover anaerobic infection or community acquired MRSA --> when improved, can switch to PO amoxi-clav-severe MRSA: consider adding vancomycin or linezolid -duration of treatment: no evidence exists for the recommended duration but usually requires total of 3-4 wks (IV, then switch to PO when afebrile, drainage of effusion is complete, clinically improved and off O2)
What is the management of a child with empyema on appropriate IV abx who continues to have fevers past 72 hrs of abx despite clinical improvement?
No change = common for children with empyemas to have fevers > 72 hrs-only worry if there is no clinical improvement otherwise
What are the options of procedural interventions for empyema and which is the most cost-effective?-what is the dose of fibrinolytic agent used?
1. VATS2. Early thoractomy3. Chest tube placement with instillation of fibrinolytics (CTWF) = most cost effective-dose of TPA (tissue plasminogen activator): 4 mg in 50 ml NS daily x 3 d)