Peds

Card Set Information

Author:
ch.tyrrell
ID:
175403
Filename:
Peds
Updated:
2012-10-03 22:36:56
Tags:
Peds Serious Infection
Folders:

Description:
Serious Infection
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user ch.tyrrell on FreezingBlue Flashcards. What would you like to do?


  1. What is the pathophysiology of osteomyelitis?
    • 1. hematogenous spread most common in children
    • 2. primarily develops in metaphysis of long bones
    • 3. slowed blood flow predisposes area to bacterial invasion
    • 4. acute infection and inflammation ensue
    • 5. infection can spread and enter joint space
  2. What is the clinical presentation of osteomyelitis in neonates?
    • may exhibit pseudoparalysis or pain with movement
    • half of neonates do not have fever and may not appear ill
  3. What is the clinical presentation of osteomyelitis in older infants and children?
    • more likely to have fever and localize pain
    • localizing signs: edema, erythema and warmth
    • limp or refusal to walk with involvement of lower extremities
  4. How is osteomyelitis diagnosed?
    • clinical
    • white blood cell count (WBC)
    • erythrocyte sedimentation rate (ESR)
    • c-reactive protein (CRP)
    • plain radiographs
    • computed tomography (CT)
    • magneticc resonance imaging (MRI)
  5. What are the causes of osteomyelitis?
    • bacteria = most common pathogens
    • Staphylococcus aureus
    • Group A streptococcus
    • Group B streptococcus and enteric gram-negative bacilli
    • Pseudomonas aeruginosa
    • Salmonella
  6. What are the treatment options for osteomyelitis?
    • empiric antibiotics
    • surgery
  7. What is the duration of therapy for osteomyelitis treatment?
    • minimum of 21 days
    • --> patient shows prompt resolution (within 5-7 days)
    • -->ESR and CRP normalized
    • 4-6 weeks may be required
  8. What is the osteomyelitis empiric antibiotic treatment for neonates?
    • antistaphylococcal penicillin + broad spectrum cephalosporin
    • aminoglycoside may be used instead of a cephalosporin
    • modify antibiotics based on culture results when possible
  9. What is the osteomyelitis empiric antibiotic treatment for infants and children?
    • vancomycin 60 mg/kg/day divided q 6-8h
    • goal trough:
    • modify antibiotics based on culture results when possible
  10. What are the requirements for surgical treatment of osteomyelitis?
    • frank pus from subperiosteal or metaphyseal aspiration
    • penetrating injury
    • retained foreign body is possible
    • infection of hip and/or pelvis
  11. What monitoring is required with osteomyelitis?
    • WBC, ESR, CRP
    • children may need long term follow-up
  12. What is the pathophysiology of meningitis in newborns?
    acquired during birth from contact with maternal genital and GI flora
  13. What is the pathophysiology of meningitis in older infants and children?
    infxn of upper respiratory tract --> invasion of blood --> invasion of CNS --> immunologic cascade --> local tissue damage, edema, increased ICP
  14. What are the classic signs and symptoms (early) of meningitis?
    • fever
    • nuchal rigidity (neck stiffness)
    • altered mental status
    • severe headache
    • photophobia
    • kernig sign (+)
    • brudzinski sign (+)
    • petechial rash (N. meningitidis only)
  15. What are the late signs and symptoms of meningitis?
    • irritability
    • drowsiness
    • seizures
    • coma
  16. How can meningitis be diagnosed?
    • history and physical examination
    • lumbar puncture
    • CSF gram stain and culture
    • latex agglutination
    • polymerase chain reaction (PCR)
    • CT scan
  17. How does opening pressure present for normal, bacterial and viral meningitis?
    • Normal: 75 - 175 mm H20
    • Bacterial: elevated
    • Viral: elevated
  18. How do WBCs present for normal, bacterial and viral meningitis?
    • Normal: < 5 (cells/mm3)
    • Bacterial: 1000-5000 (cells/mm3)
    • Viral: 100-1000 (cells/mm3)
  19. How does the differential lab present for normal, bacterial and viral meningitis?
    • Normal: > 90% monos
    • Bacterial: > 80% PMNs
    • Viral: 50% lymphs
  20. How does protein present for normal, bacterial and viral meningitis?
    • Normal: < 50 mg/dL 
    • Bacterial: 100-500 mg/dL
    • Viral: 30-100 mg/dL
  21. How does glucose present for normal, bacterial and viral meningitis?
    • Normal: 50-66% simultaneous serum value/ 0.6 CSF:serum glucose
    • Bacterial: < 40 (<60% simultaneous serum value); < 0.4 CSF:serum glucose (> 2 months); < 0.6 CSF:serum glucose (neonates)
  22. What are the common pathogens for meningitis in < 1 month of age?
    • Streptococcus agalactiae
    • E. cole
    • L. monocytogenes
    • Klebsiella spp
  23. What is the antibiotic therapy for meningitis in < 1 month of age?
    Ampicillin + Cefotaxime or Gentamicin
  24. What are the common pathogens of meningitis in 1-23 months?
    • S. pneumoniae
    • N. meningitidis
    • S. agalactiae
    • H. influenzae
    • E. coli
  25. What is the antibiotic therapy for meningitis in 1-23 months of age?
    Vancomycin + Ceftiaxone OR Cefotaxime
  26. What are the common pathogens of meningitis in children > 2 years?
    • N. meningitidis
    • S. pneumoniae
  27. What is the antibiotic therapy for meningitis in children > 2 years?
    Vancomycin + Ceftriaxone OR Cefotaxime
  28. What are the doses of antibiotics for the treatment of meningitis in infants and children?
    • Ampicillin: 100 mg/kg/dose IV q 6 h
    • Cefotaxime: 225-300 mg/kg/day IV divided q 6-8 h
    • Ceftriaxone: 100 mg/kg/day IV divided q 12 h
    • Vancomycin: 15 mg/kg/dose IV q 6 h
  29. What is the duration of treatment for meningitis?
    • Based on pathogen:
    • N. meningitides, H. influenza : 7 days
    • S. pneumonia: 10-14 days
    • S. agalactiae: 14-21 days
    • Aerobic gram-negative bacilli: 21 days
    • L. monocytogenes: > 21 days
  30. Discuss adjunctive dexamethasone therapy for meningitis.
    • routine use controversial
    • evidence of decreased hearing loss in infants & children w/ H. influenzae type b meningitis
    • no significant difference in time to bacterial eradication
    • administer before (up to 1 hr) or at the same time as 1st dose of abx
    • dexamethasone 0.15 mg/kg/dose q 6 h for 2-4 days
    • disadvantage: dec. amount of drug that penetrates CNS
  31. What prevention techniques are available for N. meningitidis?
    • 1. chemoprophylaxis (close contacts or rifampin)
    • 2. vaccination:
  32. Discuss chemoprophylaxis of N. meningitidis.
    • 1. close contacts: persons w/ prolonged contact to infected person or their secretions w/in 1 wk before sx begin until 24h after abx are initiated
    • 2. rifampin
  33. What are the rifampin dosages for prevention of N. meningitidis?
    • < 1 month: 10 mg/kg/day divided q 12 h x 4 doses
    • infants & children: 20 mg/kg/day divided q 12 h x 4 doses
    • adults: 600mg q 12 h x 4 doses
  34. What are the 2 types of vaccinations for meningitis and who are vaccines recommended for?
    • 1. conjugated vaccine: Menactra > 9 months; Menveo > 2 years
    • 2. polysaccharide: Menomune > 56 years

    recommendation: all persons aged 11-18 yrs; persons 9-23 mos at inc risk, 2-10 yrs & 19-55 yrs at inc risk
  35. What vaccines are available for meningitis due to S. pneumoniae?
    • 1. pneumococcal polysaccharide vaccine (23-valent)
    • - > 65 yo and 2-64 yo w/ increased risk factors
    • 2. pneumococcal conjugate vaccine (13-valent)
    • - all children < 23 mos and children 24-59 mos w/ chronic illnesses
  36. What are the s/sx of community acquired pneumonia?
    • Infants: poor feeding, lethrgy, irritability, poor color, +/- fever, cough, grunting, nasal flaring, use of accessory muscles
    • Older children: fever, cough, malaise, wheezing, chest pain
  37. What are the clinical s/sx of CAP?
    • fever
    • cyanosis
    • respiratory distress: tachypnea, cough, nasal flaring, decreased breath sounds, rales
  38. What are the diagnostic tests used for CAP?
    • CXR
    • CBC w/ differential
    • blood culture
    • sputum culture
    • rapid influenza
    • ESR
    • CRP
  39. What is the etiology of CAP?
    • 1. Viral: RSV, influenza A or B, adenovirus, rhinovirus, parainfluenza viruses
    • 2. Bacterial: S. pneumonia, H. influenza type b & Non-typeable H. influenza
    • 3. Atypical: Mycoplasma pneumoniae & Chlamydia pneumoniae
  40. Which patients are eligible for hospitalization associated with CAP?
    • 1. Age: younger than 3-6 months
    • 2. Social: family cannot provide adequate care
    • 3. Hypoxia: oxygen saturation less than 90%
    • 4. Moderate to severe respiratory distress: RR >70 breaths/min for infants < 12 mos of age and > 50 breaths/min for older children
    • 5. Toxic appearance
    • 6. Dehydration
    • 7. Suspicious of MRSA or other particularly virulent pathogen
    • Failed outpatient tx: 48-72 hrs w/o improvement
  41. Age 0 - 20 days: which pathogens, outpatient and inpatient treatment
    • P: Group B streptococci, Listeria monocytogenes, gram neg enteric bacteria
    • Out: none - admit pt
    • In: ampicillin + gentamicin or cefotaxime
  42. Age 3 weeks to 3 months: which pathogens, outpatient and inpatient treatment?
    • P: Chlamydia trachomatis, respiratorysyncytial virus (RSV), parainfluenza virus, Streptococcus pneumoniae
    • Out: azithromycin 10mg/kg x 1, 5mg/kg x 4 doses; clarithromycin or erythromycin
    • In: afebrile: azithromycin or erythromycin IV; febrile: IV macrolide + cefotaxime or ceftriaxone
  43. 4 months to 4 years: which pathogens, outpatient and inpatient treatment
    • P: RSV, S. pneumoniae, H. influenzae, Mycoplasma pneumoniae
    • Out: amoxicillin PO 90 mg/kg/day divided BID
    • In: ceftriaxone or cefuroxime IV
  44. 5 years to 15 years:  pathogens, outpatient and inpatient therapy
    • P: mycoplasma pneumoniae, chlamydia pneumoniae, streptococcus pneumoniae
    • Out: azithromycin 10 mg/kg x 1, 5 mg/kg x 4 doses; clarithromycin or erythromycin
    • In: macrolide IV + ceftriaxone or cefuroxime IV
  45. What is the treatment for viral CAP?
    • No abx initially: deterioration in clinical status should signal possibility of superimposed bacterial infx & abx therapy should be initiated
    • Supportive measures: oxygen supplementation, fluids, antipyretics

What would you like to do?

Home > Flashcards > Print Preview