random shit

Question 1

abx for sepsis

Answer 1

Initiate empiric, broad-spectrum IV antibiotic therapy, ideally within 1 hour of presentation, targeted at suspected source(s) of infection. Maximal dosing should be used. Examples include:
Vancomycin plus one of these:
- Third- or fourth-generation cephalosporin (eg, ceftriaxone, cefepime [antipseudomonal]) or
- Carbapenem (eg, meropenem, imipenem) or
- Piperacillin-tazobactam.

Question 2

best initial imaging for nec fasc

Answer 2

CT- gas in tissue is highly specific and prompts immediate surgical eval

Question 3

empiric abx for nec fasc

Answer 3

1. carbapenem or zosyn
2. PLUS vanc for MRSA
3. PLUS clinda for antitoxin effects of strep and staph

Question 4

steps of vag hyst

Answer 4

1. inject vasoconstrictor (vasopressin or local/epi) for hydrodissection and hemostasis
2. cut circumferential cervical incision at cervical jxn and push vaginal epithelium away from cervix
3. get in the posterior (better if CD bc adhesions). replace speculum. tag peritoneum to vag
4. sharply dissect cervix from anterior vag. use Metz to enter anterior at peritoneal reflection (will slide like silk)
5. do hyst backwards (uterosacral, cardinal/uterines, broad, utero-ovarian, round, tubes)
6. delivery uterus
7. if taking adnexa, clamp twice and tie transfix stitch. cut. tie another stitch. then flash
8. cuff closure- 0 vicryl. running or interrupted. doesn’t matter

Question 5

does packing after vag hyst reduce bleeding?

Answer 5

no and it is uncomfortable
makes more sense if you did a/p repair, but packing has to come out before the 1st void. if you want to keep it in, the pt needs a foley

Question 6

what bugs are we usually treating in CAP?

Answer 6

*Streptococcus pneumoniae (most common bacterial CAP pathogen)

*Atypical pathogens (eg, Legionella spp, Mycoplasma pneumoniae, Chlamydia pneumoniae)

Question 7

outpt Rx of CAP in pregnancy

Answer 7

1. amox or augmentin
2. PLUS azithro

ALLERGY TO PCN?
1. if mild, use 3rd gen ceph like cefpodoxime
2. if severe, use clinda

Duration = 5 days

Question 8

inpt Rx for CAP in preg

Answer 8

1. rocephin or cefotaxime or bactrim
2. azithro
3. maybe add vanc if critically ill or any other recent abx

can swap third gen ceph for pseudomonas coverage if risk factors present

Question 9

what abx to avoid in preg (3)

Answer 9

1. tetracyclines
2. clarithomycin
3. flouroquinolones

Question 10

abx for PP endometritis

Answer 10