pom- ie prophy Flashcards
definition of ie
microbial infection of heart valves or endocardium
lesion of ie
vegetation on a heart valvue, or eslsewhere on endocardium
ie is higher among…?
ie drug users- usually leion on mitral but in drug users , tricuspid
2-6% risk for ie for pt with ?
hemodialysis
2-31% risk for pt with?
previous ie
amphotocerin b can cause
renal toxicity
renal toxicity can lead to
anemia
put pt on ? for fungal ie
amphotocerin b
if put pt on amphotocerin b for ie what might happen?
renal toxicity and anemia
ie is more common in men or women?
men
median age of onset of ie?
50
ie is more common in??
elderly- 25% cases
endocarditis etiology
bac infect damed endocardium or endothelial tissue located near high flow shunts between arterial/ venous channels
80% of ie cases caused by
staph
% caused by what is decreasing?
strep
what is a major risk of ie in hiv infected pt?
continued iv drug use
3 groups of ie lesions
cardiac, embolic, general
cardiac lesion describe
usually on valvue it self- mitral valve- but no longer required to prophy
can occur at contact area of jet flow, non bacterial thrombotic endocarditis (NBTE)
NBTE
nonbac thrombotic endocarditis
jet flow
area where blood keeps pulstaing and bringing bacteria back in
embolic lesion
vegetasions become friable and dtach
petichial hemorrhages on skin and mucous membranes in embolic lesions?
osler’s nodes, splinter hemorrhages
splinter hemmorage
look like got spliner onder fingernail
oslers nodes
on lower extremeity
general lesion
enlarged spleen, club fingers, arthritis, systemic dz, organ failure, morbidity mortality is 10-80%
classic findings of ie? 4
fever, anemia, + blood cultures, heart murmur
diagnostic triad of ie?
fever, cardiac murmur, + blood cultures- not always present!
2 types of ie we need to know
sbe, abe
abe
acute bacterial endocarditis- usually by staph
clinical appearance of abe
dev over days or 1-2 week complications dev death in 6 wk w/o tx staph aureas preceded by suppurative infection NOT oral bc staph doesnt live in oral cavity
sbe clincial appearance
MORE IMPORTNAT TO DENTIST, MAY OCCUR AFTER ORAL PROCEDURE BC SCAUSE BY ALPHA HEMOLYTIC STREPH
symptoms in 2 weeks
progress over weeks to months
more immature neutraphils means
acute infection
lab findings in ie
cbc - elevated wbc, neutraphil
esr- elevated in 90%
c- reactive protein is positive
serum ig is increased
s aureus causes
abe
s viridans causes
sbe
electrocardiogram
if infection goes into myocardium-disturbance of conduction
tte
test for diag of ie- transthoracic echocardiogram- put over sternum
tee
more accurate echocardiogram for diag ie- but more invasive (transesophogeal echocardiogram)
other imaging studies for ie
chest x ray, ct, mri, angiography
how to tx ie?
early, antibiotics via iv for awhile
tx of s viridans endo? (remember sbe)
penni G- 4 million units iv for 4 week
tx pcn resistant strep?
penni g IV and Gentimicin IV for 6 wk
s aureus endo- tx if infection doesnt involve prosthetic material and is methicillin susceptible
naficillin iv
s aureus assoc with prosthetic materials and methicillin susceptible
naficillin iv and gentamicin iv, 6 wk
methi resistant s aureus ie?
vancomycin iv + gentimicin iv + rifampin 300 mg po for 6 wk or longer
when to operate?
debride if fungus, valve replacement, , heart failure
aha designations made in 1997?
high, mod, neg
NEED TO PREMED MOD AND HIGH
who to premed? 4 categories
prosthetic cardiac valve or prosthetic material used for cardiac valve repair, previous infective endocarditis, congentital heard disease, cardiac transplantation recipients who develop cardiac valvulopathy
which types of CHD do we premed?
unrepaired cyanoic CHD (pallitave shunts and conduits), completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention during the first six months after the procedure, and repaired chd with residual defects at the site or adj to site of prosthetic pattch or prosthetic deice
cyanotic congenital heart dz- cyanosis?
results from mixing of unoxygenated blood in the systemic circ caued by intracardiac shunting of blood from rigt to left side of heart
is prophy rec for cabg or coronary artery stent?
NO
bleeding during dental work can result in
transient bacteremia
when else can transient bacteremia occur?
brushing, flossing
how likely for TB to occur during perio, ext?
perio-88, ext- 85
do dental procedure cause ie?
it’s not really that likely- 3-20% likely
how effective is prophy?
49-91%
what are we prophying against in dental prophy
alpha hemo strep
what do we use to prophy?
amox
is prophy helpful?
- sometimes, but condition would occur 47 times in 10 million if not prophy- v small, but v bad dz so worth it? but no prophy leads to 5 cases ie and no death, prophy leads to 2 cases of death, 175 allergy
why do we prophy?
CYA
what procedure should you prophy for?
if you’re gonna manip the gum, prophy
what are we giving
amox 2 g 1 hour before procedure
children prophy? what do we give?
50 mg 1 hour before
what if allergic to amox?
clinda 600mg for adult, 20 mg/kg for kid
or
cephalexin 2 g adult, 50 m/kg kid
or
azithromycin or clarithromycin 500mg adult, 15 mg/kg kid
what if allergic to penni or ampi and can’t take oral?
cefazolin or ceftraxone , 1 gm IM or IV adult, 50 mg/kg IM or IV for kid
OR
clinda 600 mg IM or IV , kid- 20 mg/kg IM < IV
if pt bleeds during procedure and you didnt have them prophy?
do prophy within 2 hrs
if pt is taking oral penni already, what should you do?
give clinda
what else can we do to dec chance of bacteremia?
chlorohexidine, OH, peiro maint, max dental tx at each appt
how long should you wait between prophy visits?
10 day
how long before appt to prophy-?
30-60 min
1st of 3 new prosthetic prophy recs?
you can maybe discontinue prophy prostethic pt, just be mindful and involve pt in decisin (silly)
2nd of 3 recs for prosthetic prophy
chlorohexidine rinse, inconclusive, use your judgement
3rd of 3 recs for prosthetic prophy
about oral hygiene- what is appropriate is different for everyone- you decide
