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Flashcards in CPS Hospital pediatrics Deck (10)
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1
Q

What are the 3 most common causative organisms in empyema?

A
  1. Strep pneumo
  2. Staph aureus
  3. GAS
2
Q

What are the stages of empyema development?

A
  1. Stage 1: moderate-large exudative parapneumonic effusion
  2. Loculation
  3. Fibrinous peel
3
Q

What are 3 findings on exam of a pleural effusion?

A
  1. Decreased breath sounds
  2. Decreased chest expansion
  3. Dullness to percussion
4
Q

What is the utility of repeating CXRs on a daily basis to evaluate the status of a pleural effusion or empyema?

A

Not necessary unless clinical deterioation is evident

5
Q

In what percentage of empyema cases will the blood culture be positive?

A

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
Q

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

A

If the patient is in moderate to severe resp distress

7
Q

What is the usual empiric antibiotic choice for a child with empyema?

  • what about for severe suspected MRSA pneumonia?
  • duration of treatment?
A

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
Q

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?

A

No change = common for children with empyemas to have fevers > 72 hrs
-only worry if there is no clinical improvement otherwise

9
Q

What are the options of procedural interventions for empyema and which is the most cost-effective?
-what is the dose of fibrinolytic agent used?

A
  1. VATS
  2. Early thoractomy
  3. 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
Q

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

A

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