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Flashcards in Hospital peds Deck (10)
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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)


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