Sandbox G: Difference between revisions

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<div style="width: 1px; height: 1px; background-color: #999999; position: fixed; top: 10px; left: 10px"></div><div style="-webkit-user-select: none;"><div style="width: 75%;">
{| class="infobox" style="border: 0; float: right; width: 24%; position: fixed; top: 173px; right: 14px; background: #104E8B; border-radius: 10px 10px 10px 10px; margin: 0 0 0 0; padding: 5px 5px; font-weight: bold;"
| style="text-align: center; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); font-size: 120%;" |  [[{{PAGENAME}}#Overview|{{fontcolor|#F8F8FF|TITLE}}]]
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[[{{PAGENAME}}#Diagnostic Criteria|{{fontcolor|#F8F8FF|Diagnostic Criteria}}]]
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[[{{PAGENAME}}#Classification|{{fontcolor|#F8F8FF|Classification}}]]
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[[{{PAGENAME}}#Causes|{{fontcolor|#F8F8FF|Causes}}]]
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[[{{PAGENAME}}#Focused Initial Rapid Evaluation|{{fontcolor|#F8F8FF|Focused Initial Rapid Evaluation}}]]
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[[{{PAGENAME}}#Complete Diagnostic Approach|{{fontcolor|#F8F8FF|Complete Diagnostic Approach}}]]
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[[{{PAGENAME}}#Management|{{fontcolor|#F8F8FF|Management}}]]
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[[{{PAGENAME}}#Dos and Don'ts|{{fontcolor|#F8F8FF|Dos and Don'ts}}]]
|}
__NOTOC__
__NOTOC__
{{CMG}}; {{AE}} {{GRN}}
{{CMG}}
 
==Overview==


==Medical Therapy==
==Diagnostic Criteria==


<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font><ref name="pmid20307191">{{cite journal| author=Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC et al.| title=Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). | journal=Infect Control Hosp Epidemiol | year= 2010 | volume= 31 | issue= 5 | pages= 431-55 | pmid=20307191 | doi=10.1086/651706 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20307191  }} </ref> <ref name="pmid23439232">{{cite journal| author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 4 | pages= 478-98; quiz 499 | pmid=23439232 | doi=10.1038/ajg.2013.4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232  }} </ref> <SMALL>
==Classification==


{|
==Causes==
| valign=top |
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Initial episode'''
</font>
</div>


<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
===Life Threatening Causes===
<font color="#FFF">
<span style="font-size: 85%;">Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.</span>
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Mild to moderate'''
</font>
</div>


<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
===Common Causes===
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Severe'''
</font>
</div>


<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
==Focused Initial Rapid Evaluation==
<font color="#FFF">
<span style="font-size: 85%;">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Severe complicated'''
'''Abbreviations''':
</font>
CBC, complete blood count;
</div>
DC, differential count;
ICU, intensive care unit;
INR, international normalized ratio;
LFT, liver function test;
PT, prothrombin time;
PTT, partial prothrombin time;
SaO2, arterial oxygen saturation;
ScvO2, central venous oxygen saturation;
SvO2, mixed venous oxygen saturation;
SMA-7, sequential multiple analysis-7.
</span>


<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
{{Familytree/start}}
<font color="#FFF">
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
'''Recurrence'''
==Disease Suspected==
</font>
</div>}}
</div>
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| |!| | | |}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
==Immediate Treatment==
</div>}}
{{Familytree/end}}


<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
==Complete Diagnostic Approach==
<font color="#FFF">
<span style="font-size: 85%;">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''First recurrence'''
'''Abbreviations''':
</font>
CBC, complete blood count;
</div>
DC, differential count.
</span>


<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
{{Familytree/start}}
<font color="#FFF">
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Second recurrence'''
==Focused History==
</font>
</div>}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| |!| | | |}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
==Physical Examination==
</div>}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| |!| | | |}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
==Laboratory Workup==
</div>}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| |!| | | |}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
==Imaging Study==
</div>}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| |!| | | |}}
{{Familytree|boxstyle=width: 600px; text-align: left; font-size: 100%; padding: 0px; vertical-align: text-top;| A01 | | |A01=<div style="padding: 0px 10px;">
==Other Investigation==
</div>}}
{{Familytree/end}}
</div>
</div>


| valign=top |
==Management==
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Mild to moderate}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Recommended treatment'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 50 mg orally q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''If no improvement in 5-7 days'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 125 mg orally q6h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Severe}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Reommended treatment'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 125 mg orally q6h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Severe complicated}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Recommended treatment'''''<sup>†</sup>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 500 mg orally q6h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> If '''''[[ileus]]''''' present, add '''''[[Vancomycin]] 500 mg in 100 mL NS per rectum q6h as retention enema'''''.</SMALL>
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|First recurrence}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | Recommended treatment'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''Same as first episode but stratified by severity'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Second recurrence}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Recommended treatment'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] in tapered and pulsed doses'''''
      125 mg 4 times daily for 14 days
      125 mg 2 times daily for 7 days
      125 mg once daily for 7 days
      125 mg once every 2 days for 8 days (4 doses)
      125 mg once every 3 days for 15 days (5 doses)
|-
|}
|}
|}


==Dos and Don'ts==


===Dos===


===Emperic therapy===
===Don'ts===


==Guidelines==


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Disease]]
[[Category:Medicine]]
[[Category:Resident survival guide]]

Latest revision as of 13:26, 30 April 2015

TITLE

Diagnostic Criteria

Classification

Causes

Focused Initial Rapid Evaluation

Complete Diagnostic Approach

Management

Dos and Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Diagnostic Criteria

Classification

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Focused Initial Rapid Evaluation

Abbreviations: CBC, complete blood count; DC, differential count; ICU, intensive care unit; INR, international normalized ratio; LFT, liver function test; PT, prothrombin time; PTT, partial prothrombin time; SaO2, arterial oxygen saturation; ScvO2, central venous oxygen saturation; SvO2, mixed venous oxygen saturation; SMA-7, sequential multiple analysis-7.

Disease Suspected

 
 
 
 
 
 
 
 

Immediate Treatment

 
 

Complete Diagnostic Approach

Abbreviations: CBC, complete blood count; DC, differential count.

Focused History

 
 
 
 
 
 
 
 

Physical Examination

 
 
 
 
 
 
 
 

Laboratory Workup

 
 
 
 
 
 
 
 

Imaging Study

 
 
 
 
 
 
 
 

Other Investigation

 
 

Management

Dos and Don'ts

Dos

Don'ts

Guidelines

References

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