First full patient workup today. I learned that gathering information is easier if I know what I’m looking for . There are many sources of information, so it’s a good idea to prioritize my needs so that I don’t run out of time looking through different sources. It became a much more fulfilling experience as I gathered more information and was able to form a bigger picture of the patient.
Discussion topic: Pneumonia ( extra info)
- PSI is validated, CURB-65 is not
- blood cultures are more useful when: pt is alocholic, increase risk of non std bug suspected, low WBC
- atypicals and anaerobic bacterias don’t grow in cultures
- Atypical: Legionnella, K pneumoniae, C. pneumoniae, RSV (virus)
- pneum vaccine repeat needed after age 65, or a 2nd dose may be required at least 5 years afterewards if first vaccination after 65 years of age
- aspirational pneumonia likely in pt with: poor swallowing reflex, seizure, intubation, collapse
- Antipseudomonas FQ: cipro, levo
- moxi –> PO/IV, high bioavaliability
- differential diagnosis: VQ scan ( pulmonary embolism), COPD, CHF
Bacterias that cause pneumonia: S. pneumo, M. Pneumo, C. pneumo, staph aureus, pseudomonas, viral, H. influenza, Legionnella
Atypicals that cause pneumonia: Legionnella, M. pneumo, C. pneumo, RSV
Bacterias that cause pneumonia in ICU patients: gram negatives, pseudomonas, MRSA,
Useful Pneumonia references:
- IDSA/ American Thoracic Society Consensus Guidelines on the Management of Community Acquired Pneumonia in Adults. CID 2007;44 (Suppl 2).
- Respiratory Tract Infections. In: Koda-Kimble MA, editor. 8th ed. Applied Therapeutics: Baltimore, Maryland: Lippincott, Williams & Wilkins; 2005. Pp. 60-4 to 60-15.
- Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. CID 2000;31:383-421.
- Halm EA, Teirstein AS. Management of Community-Acquired Pneumonia. N Engl J Med 2002;347:2039-44.
- Gin AS, Tailor SAN. Community Acquired Pneumonia. Can J Hosp Pharm 2001;54(Suppl 1): CE Insert. Pp.1-16.
- LGH CAP Pre-printed order
FMI:
- gastroparesis: delayed gastric emptying// can be caused by anticholingergic, narcotics, anorexia nervosa, blemia or gerd// S/S: increase or decrease in blood glucose, nausea, early feeling of fullness, lack of appetite// treatment: metoclopramide, erythromycin, domperidone
Cephalosporin ORAL/IV generations
1st gen
- cefazolin (IV)
- Cefadroxil (PO)
- cephalexin ( PO)
2nd gen
- cefotetan (IV)
- cefoxitin (IV)
- cefuroxime (PO/IV)
- cefaclor( PO)
- cefprozil (PO)
3rd gen
- cefotaxime (IV)
- ceftizoxime(IV)
- ceftriaxone(IV)
- ceftobiprole(IV)
- ceftazidime(IV)
- cefepime(IV)
- cefixime (PO)
- ceftiuten (po)
- Cefpodox/cefdinir/cefditoren (PO)
ANTIPSEUDOMONAL ANTIBIOTICS:
- pip/taz
- imipenem
- meropenem
- ciprofloxacin
- aztreonam
- ceftazidime
- Cefepime
- ceftobiprole
- amg
ENTEROCOCCUS SUSCEPTIBLE ANTIBIOTICS:
- amox/clav
- pip/taz
- ceftobiprole
- tigecycline
- nitrofurantoin
- linezolid
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