When to Refer a Patient to a Physician

Pediatric patients should be referred to physicians if any of the following symptoms are present: skin rash chronic cough “bark like” cough stridor hoarseness constant ear pain or pulling/tugging at ears seizure or convulsion recently rapid or difficulty breathing severe abdominal pain or cramping diarrhea > 2 days vomiting > 12 hours infant not feeding … Continue reading

Vancomycin

Typical starting dose:  15 mg/kg based on actual body weight   (as long as the patient has normal renal function, and the dose doesn’t exceed 2000 mg) Should always check computer system for patient records indicating whether the patient has received vanco and if so the dosing used at that time as well as the … Continue reading

Intra-abdominal Infections

Three basic types of Intra-Abdominal Infections: Individual organ infections Generalized peritonitis Abscesses Organ specific infections (these infections are the result of primary or secondary bacterial infections caused by enteric organisms in the hepatobiliary tree or intestinal tract): Appendicitis (appendix) Appendix removal remains the primary treatment. Preoperative prophylaxis:  Cefoxitin or Cefotetan If the appendix is perforated … Continue reading

Hepatitis

Hep A:  transmitted via fecal-oral, person-person, contaminated food or water Usually self-limiting at which time life-long immunity is conferred Cytolytic T-cell mediated response Kids can be asymptomatic Hep B:  transmitted via blood, saliva, urine, vag fluids, semen, perinatal transmission Leading cause of chronic hepatitis (10% of adults w/ acute hepatitis will develop chronic disease), cirrhosis … Continue reading

Upper Respiratory Tract Infections (URTI)

Pathogens commonly responsible for: pharyngitis, otitis media, sinusitis, and acute epiglotitis Otitis media (2nd most common type of pediatric infection) Causes:  Strept pneumoniae (most common), H influenzae ( 1/2 of H influenzae is beta-lactamase producing), M. Catarrhalis (usually self limiting, 90% of m. catt. Produces beta lactamase), viruses Penicillin resistant strept pneumoniae is on the … Continue reading

Lower Respiratory Tract Infections (LRTI)

Pathogens, signs, symptoms, treatment, clinical parameters for monitoring of Acute Bronchitis, AECB, CAP, HCAP, and Bronchiolitis Acute bronchitis = inflammation of the tracheobronchial tree Cough < 2-3 weeks in duration Usually caused by virus Trxt:  apap/ibu + cough suppressant at night to help w/ sleep + antibiotic if signs of fever, HR> 100, RR > … Continue reading

Sepsis and Septic Shock

Definitions pertaining to sepsis and septic shock Infection:  inflammatory response to microorganisms or an invasion of normally sterile tissues Urine & CSF are both fluids that are supposed to be sterile Inflammation=increase in white count and/or fever SIRS (Systemic inflammatory response syndrome): response to infection, but doesn’t have to be an infection  (trauma, burns, pancreatitis, … Continue reading

Osteomyelitis

Osteomyelitis is an infectious process that occurs in the bone(s) (rarely occurs in multiple bones, ex. Vetebral osteomyelitis) Review common causes of osteomyelitis The classification of osteomyelitis is based on the route of entry of the organism to the bone Contiguous spread of organisms from adjoining soft tissue to the bone secondary to trauma, injury … Continue reading

Endocarditis

Epidemiology of infectious endocarditis (IE) 20% of cases have definitive infective endocarditis (very difficult to diagnose) Most common in people in their 70s Pathophysiology of IE Most patients develop endocarditis through one of three routes:  rheumatic heart disease, degenerative valve lesions (may occur secondary to arteriosclerosis or a thrombus), congenital valvular lesions (mainly in kids … Continue reading

Tuberculosis (TB)

Tuberculosis = Mycobacterium tuberculosis Risk factors, pathophysiology, epidemiology, and diagnostic criteria for tuberculosis Risk factors for infection:  location/place of birth, traveling, immigrants, ethnicity (minorities), HIV, chemical dependency (exposure to high risk groups) Risk factors for the active disease:  time since infection (increased risk if within 2 years since acquiring the infection), age (increased risk for … Continue reading