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COURSE IN THE WARD. 1 ST Hospital Day. IVF: D5 IMB 500mL to run at 12-13 gtts /min Request for: CBC with platelet Gram stain of wound discharge Culture and sensitivity of wound discharge Medications: - PowerPoint PPT Presentation
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COURSE IN THE WARD
IVF: D5 IMB 500mL to run at 12-13 gtts/min Request for:
◦ CBC with platelet◦ Gram stain of wound discharge◦ Culture and sensitivity of wound discharge
Medications:◦ Clindamycin 150mg/slow IV infusion (32.1mg/kg/day) over
30 mins. now then every 8 hrs. ANST◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30
mins. every 8 hrs.◦ Paracetamol 250mg/5mL, 4 mL every 4 hours for Temp. >
38.5°C or for pain (14 mg/kg/dose )◦ Refer to Pediatric Surgery for further evaluation and
management
1ST Hospital Day
Incision and Drainage of Abscess◦ 20cc purulent discharge◦ Specimen sent for GS/CS
For daily COD
1st Hospital Day
Complete Blood CountHgb 110RBC 4.11Hct 0.33MCV 79.90MCH 26.80MCHC 33.50RDW 14.00MPV 6.20Platelet 281WBC 12.10 Neutrophils 0.54 Lymphocytes 0.41 Monocytes 0.03 Eosinophils 0.02
Microbiology ExaminationGram (+) Cocci in Pairs FewPus Cells ++++
D1-2 ◦ Clindamycin 150mg/slow IV infusion
(32.1mg/kg/day) over 30 mins. now then every 8 hrs. ANST
◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30 mins. every 8 hrs.
Decreased to D5 IMB 500mL to run at 9-10 gtts/min
Patient was transferred to malward IVF to consume Increase oral fluid intake
2nd Hospital Day
Culture and Sensitivity: Wound Discharge
Staphylococcus aureus Heavy Growth
*MRSA Positive
Sensitive to:
Azithromycin Chloramphenicol ClindamycinErythromycin Gentamycin Co-trimoxazole
Vancomycin
Resistant to:
Penicillin
D5-6◦ Clindamycin 150mg/slow IV infusion
(32.1mg/kg/day) over 30 mins. now then every 8 hrs. ANST
◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30 mins. every 8 hrs.
0.65% NaCl Nasal drops 2-3 gtts/nostril then suction Q6
5th Hospital Day
Day 14◦ Clindamycin 150mg/slow IV infusion (32.1mg/kg/day) over 30
mins. now then every 8 hrs. ANST◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30 mins.
every 8 hrs. Disharged
◦ Final Diagnosis: Abscess secondary to MRSA ◦ Take Home Medications:
Co-trimoxazole 400mg 180mg/5mL, 4mL Q12 to complete for 2 weeks
Mupirocin ointment, apply on affected area TID◦ Anticipatory Guidance◦ Immunization update◦ For follow up at OPD on Oct 10, 2010
14th Hospital Day