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Flashcards in Hospital peds Deck (10):
1

What are the 3 most common causative organisms in empyema?

1. Strep pneumo2. Staph aureus3. GAS

2

What are the stages of empyema development?

1. Stage 1: moderate-large exudative parapneumonic effusion2. Loculation3. Fibrinous peel

3

What are 3 findings on exam of a pleural effusion?

1. Decreased breath sounds2. Decreased chest expansion3. Dullness to percussion

4

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

5

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

6

When should you consider early procedural intervention for a patient with a pleural effusion?

If the patient is in moderate to severe resp distress

7

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)

8

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

9

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)

10

In a patient who has been treated for empyema, does a repeat CXR need to be done?

Yes - child should be followed as outpt until they have clinically recovered and their CXR has returned to near normal (may take several months)-repeat CXR at 2-3 months