Sandbox john

Multiple Tables

• 0.

Disease	Findings
DISEASE NAME	PRESENTS WITH_____
DISEASE NAME	PRESENTS WITH____

• 1.

Unfavorable Prognostic Factors

▸  Presenting with encephalopathy or coma

▸  Younger than 10 years or elderly

▸  Late start of antibiotics

▸  Sterile cultures

Favorable prognostic factors

▸  Craniotomy instead of burr holes as surgical procedure

▸  Early treatment

▸  Young age (optimal between 10-20 years)

▸  Patient presents awake, alert and oriented

▸  Source of infection: paranasal sinuses

▸  Aerobic streptococci isolated in culture

▸  Aerobic streptococci as single pathogen

• 2.

Unfavorable Prognostic Factors
▸  Presenting with encephalopathy or coma
▸  Younger than 10 years or elderly
▸  Late start of antibiotics
▸  Sterile cultures
Favorable Prognostic Factors
▸  Craniotomy instead of burr holes as surgical procedure
▸  Early treatment
▸  Young age (optimal between 10-20 years)
▸  Patient presents awake, alert and oriented
▸  Source of infection: paranasal sinuses
▸  Aerobic streptococci isolated in culture
▸  Aerobic streptococci as single pathogen

• 3.

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

• 4.

Group A (May be sent home)   ▸  Group criteria ❑ Patients who do not have warning signs PLUS ❑ Able to tolerate adequate volumes of oral fluids OR ❑ Able to pass urine at least once every 6 hours   ▸  Laboratory tests ❑ Complete blood count ❑ Hematocrit (Hct)   ▸  Management ❑ Adequate bed rest ❑ Adequate fluid intake ❑ Acetaminophen (Paracetamol)   ▸  Monitoring ❑ Patients with stable Hct may be sent home. ❑ Daily review for disease progression:    ❑ Decreasing white blood cell count    ❑ Defervescence    ❑ Warning signs (until out of critical period) ❑ Immediate return to hospital if development of any warning signs ❑ Written advice for management

Group B (Referred for in-hospital care)   ▸  Group criteria ❑ Patients with any of the warning signs:    ❑ Abdominal pain or tenderness    ❑ Persistent vomiting    ❑ Clinical fluid accumulation    ❑ Mucosal bleed    ❑ Lethargy, restlessness    ❑ Liver enlargment >2 cm    ❑ Increase in hematocrit with rapid decrease in platelet count   ▸  Laboratory tests ❑ Complete blood count ❑ Hematocrit (Hct)   ▸  Management ❑ Obtain reference Hct before fluid therapy ❑ Give isotonic solutions such as 0.9 % saline or Ringer’s Lactate    ❑ Start with 5–7 ml/kg/h for 1–2 h    ❑ Then reduce to 3–5 ml/kg/h for 2–4 h    ❑ Then reduce to 2–3 ml/kg/h or less according to clinical response Reassess clinical status and repeat Hct ❑ If Hct remains the same or rises only minimally:    ❑ Continue with 2–3 ml/kg/h for another 2–4 h ❑ If worsening of vital signs and rapidly rising Hct:    ❑ Increase rate to 5–10 ml/kg/h for 1–2 h Adjust fluid infusion rates ❑ Reduce intravenous fluids gradually when:    ❑ Adequate urine output and/or fluid intake    ❑ Hct deceases below the baseline value in a stable patient   ▸  Monitoring ❑ Vital signs and peripheral perfusion (q1–4 until out of critical phase):    ❑ Urine output (4–6 hourly)    ❑ Hct (before and after fluid replacement, then 6–12 hourly)    ❑ Blood glucose    ❑ Renal function    ❑ Liver function    ❑ Coagulation profile

Group C (Require emergency treatment)   ▸  Group criteria ❑ Patients with any of the warning signs:    ❑ Abdominal pain or tenderness    ❑ Persistent vomiting    ❑ Clinical fluid accumulation    ❑ Mucosal bleed    ❑ Lethargy, restlessness    ❑ Liver enlargment >2 cm    ❑ Increase in hematocrit with rapid decrease in platelet count   ▸  Laboratory tests ❑ Complete blood count ❑ Hematocrit (Hct) ❑ Other organ function tests as indicated   ▸  Management Management of compensated shock ❑ Resuscitation with isotonic crystalloid at 5–10 ml/kg/h over 1 hour ❑ If patient improves:    ❑ Reduce IV fluids gradually to 5–7 ml/kg/h for 1–2 h    ❑ Then to 3–5 ml/kg/h for 2–4 h    ❑ Then to 2–3 ml/kg/h for 2–4 h    ❑ Then reduced further depending on hemodynamic status    ❑ IV fluids can be maintained for up to 24–48 h ❑ If patient is still unstable:    ❑ Check Hct after first bolus    ❑ If Hct increases: repeat a second bolus at 10–20 ml/kg/h for 1 h    ❑ If Hct decreases: transfuse as soon as possible Management of hypotensive shock ❑ Resuscitation with crystalloid/colloid at 20 ml/kg for 15 min ❑ If patient improves:    ❑ Control rate at 10 ml/kg/h for 1 h, then reduce gradually ❑ If patient is still unstable:    ❑ Review the HCT taken before the first bolus    ❑ If HCT was low: transfuse as soon as possible    ❑ If HCT was high: IV colloids at 10–20 ml/kg for 0.5–1 h    ❑ If patient is improving: reduce the rate to 7–10 ml/kg/h for 1–2 h ❑ If patient is still unstable after second bolus:    ❑ If HCT decreases: transfuse as soon as possible    ❑ If HCT increases: continue colloid at 10–20 ml/kg for 1 h Management of hemorrhagic complications ❑ Give 5–10 ml/kg of packed red cells or 10–20 ml/kg of whole blood