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AGH PEDIA > PCAP Guideline > Flashcards

PCAP Guideline Flashcards

1
Q

The most common cause of PCAP

bacterial vs viral

A

bacterial

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2
Q

bacterial etiologies of PCAP

A

Step. Pneumonia > H. Influenzae > Mycoplasma > Chlamydia

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3
Q

PCAP A Management

A

OPD

follow up at the end of treatment

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4
Q

PCAP B

A

OPD

Follow up after 3 days

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5
Q

PCAP C Management

A

Admit to wards

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6
Q

PCAP D

A

Admit to ICU

Refer to specialist

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7
Q

PCAP A

A

minimal

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8
Q

PCAP B

A

Low

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9
Q

PCAP C

A

Moderate

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10
Q

PCAP D

A

High

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11
Q

Compliant caregiver

A

PCAP A +
PCAP B +
PCAP C -
PCAP D -

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12
Q

Ability to follow up

A

PCAP A +
PCAP B +
PCAP C None
PCAP D None

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13
Q

Dehydration

A

PCAP A None
PCAP B Mild
PCAP C Moderate
PCAP D Severe

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14
Q

Feeding

A

PCAP A Yes
PCAP B Yes
PCAP C No
PCAP D No

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15
Q

Age

A

PCAP A >11 months
PCAP B > 11 months
PCAP C <11 months
PCAP D < 11 months

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16
Q

PCAP A

RR

A

2-12 mos >/= 50
1-5 yrs >/=40
> 5 yrs >/=30

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17
Q

PCAP B

RR

A

2-12 mos >50
1-5 yrs >40
>5 yrs >30

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18
Q

PCAP C

RR

A

2-12 mos >60
1-5 yrs >50
>5 yrs >35

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19
Q

PCAP D

RR

A

2-12 mos >70
1-5 yrs >50
>5 yrs >35

20
Q

PCAP

Retractions

A

PCAP C - intercostal/ subcostal

PCAP D - supraclavicular

21
Q

Head bobbing

A

PCAP A -
PCAP B -
PCAP C +
PCAP D +

22
Q

Cyanosis

A

PCAP A
PCAP B
PCAP C +
PCAP D +

23
Q

Grunting

A

PCAP A
PCAP B
PCAP C
PCAP D +

24
Q

Apnea

A

PCAP A
PCAP B
PCAP C
PCAP D +

25
Q

Sensorium

A

PCAP A - Awake
PCAP B - Awake
PCAP C -Irritable
PCAP D - Lethargic/ stuporous/ Comatose

26
Q

Complications

A

PCAP A
PCAP B
PCAP C +
PCAP D +

27
Q

Diagnostic aids

A

PCAP A/ B - none, managed on outpatient basis

Routine exam for PCAP C/ D

  • CXR PAL
  • WBC count
  • Culture and sensitivity: blood (PCAP D), pleural fluid, ETA upon intubation
  • Blood gas/ O2 sat

Sputum CS - older children
ESR CRP - not routinely requested

28
Q

BPS score in hospitalized patients 1 month - 5 years

A

BPS >/= 4

29
Q

Increase agge =

A

higher chance of bacterial pathogen, inc frequency of atypical organism

30
Q

predictors of bacterial pathogen

A

hospitalized patients 1 month – 5 years

increase age

decreased breath sounds

31
Q

Antibiotics recommended in

A
  1. PCAP A/B - beyong 2 yrs of age, high grade fever without wheeze
  2. PCAP C- beyond 2 yrs of age, high grade fever without wheeze, having alveolar consolidation in chest xray, WBC count > 15000
  3. PCAP D
32
Q

Empiric treatment

PCAP A or B w/o previous antibiotic

A

Amoxicillin 45 mg/kg/day in 3 divided doses x 3 days (minimum)

if hypersensitive to amoxicillin - macrolide

Other regimens: cotrimoxazole, azithromycin, erythromycin, co-amoxiclav, clarithromycin

33
Q

PCAP C w/o previous antibiotic

complete immunization against Hib

A

Pen G 100, 000 u/kg/day

oral amox- can tolerate feeding ( comparable to parenteral penicillin)

34
Q

PCAP w/o Hib immunization

A

IV Ampicillin 100 mg/kg/day in 4 divided doses

-monotherapy/ combination + chloramphenicol in patients who cannot tolerate feeding

other regiments: amoxicillin / sulbactam, cefuroxime, chloramphenicol

35
Q

PCAP D

A

consult a specialist

36
Q

CA- MRSA suspected

A

refer to specialist

37
Q

Clinical management of MRSA

A

follow antibiotic susceptibility based on culture studies
Vancomycn - 1st line
CA MRSA- synergisticaly inhibited y vancomycin + gentamicin

38
Q

initial treatment viral

A

ancillary tx

oseltamivir 2 mg/kg/dose BID x 5 days

39
Q

response to antibiotics

A

improved RR < age specific range

- without chest indrawing, or any danger signs (central cynosis, inability to drink, abnormally sleepy, convulsions_

40
Q

treatment failure

A

same RR > age specific range without chest indrawing or any danger signs
worse- developed chest indrawing or any danger signs

41
Q

PCAP A/ B not responding to antibiotics within 72 hours consider

A

change initial antibiotic
start oral macrolide
re-evaluate diagnosis

42
Q

causes of tx failure

A

coinfection with RSV

nonadherence to tx

43
Q

PCAP C not responding

A

penicillin resistant strep
presence of pulmonary or extrapulmonary complications
or
other diagnosis

44
Q

causes tx failuure PCAP C

A

antibiotic resistance
clincal sepsis
progressive pneumonia
mixed infection

45
Q

if PCAP D not responding to antibiotiics

A

immediate reconsultation with a specialist

AGH PEDIA (5 decks)

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