أحمد عبدالرحمن سعد الحارثي معيد بكلية الصيدلة / قسم الصيدلة الإكلينيكية الأوراق الثبوتية لبدل الحاسب الآلي # استخدام الحاسب لتقديم محاضرة في موضوع مختص عن طريق برامج التقديم والشرح مثل بوربوينت. ( power point )

Case presentation Course : Infectious disease Presented by : Khaled Alsalloumi

Case presentation Date of Admission : 20 /5 /1434 Gender : Female Age : 69 years

Case presentation Chief complaint : disturbed of consciousness since early morning. History of present illness: 69 years old Saudi female with history of COPD, on mechanical ventilator at home, she came to ER with realative complaining cough and disturbed of consciousness since early morning.

Case presentation History of present illness: History of HTN, COPD. No chest pain Bedridden patient Ventilator dependent patient Bedridden patient on tracheostomy, underweight Chest : bilateral crepitation, no edema Diagnosis: Ventilator related pnumonia COPD exacerbation with RF

Case presentation Pneumonia is an inflammatory condition of the lung affecting primarily the microscopic air sacs known as alveoli. It is usually caused by infection with viruses or bacteria and less commonly other microorganisms.

Case presentation Typical symptoms : Cough Chest Pain Fever Sweats Difficulty breathing

Case presentation Nosocomial pneumonia : Hospital acquired pneumonia Ventilator associated pneumonia Nosocomial pneumonia is the most common nosocomial infection.

Case presentation Risk factor for Nosocomial pneumonia: Elderly Hyperglycemia Patient with chronic lung disease Supine patient position Blood transfusion Intubation and mechanical ventilation

Case presentation Clinical classification: Community acquired pneumonia Nosocomial pneumonia Pneumonia in immunocompromised host Community acquired pneumonia Pneumonia occurring in the community or in the first 3 days of hospitalization and without instruments.

Case presentation Management : The doctor ask CBC Chemistry(Na,K,Ca,ALT,AST,urea,creatinine), septic screen(blood, urine, sputum) Daily coagulation profile (INR,PT,PTT)

Case presentation 4:30 AM 22 /51:30 PM 21 /5 PH: 7,418PH: 7,327 PCO2: 72,2PCO2: 83,9 PO2: 173PO2: 33 PCO2 ( 32_48 ) PO2 ( 83_108) PH ( 7,350_7,450 )

Case presentation 1:27 PM 22/511:6 PM 20/5 Glucose 56 ( 74 _ 106 ) Glucose 124 ( 74 _ 106 ) Urea 56 ( 15 _ 39 ) Urea 74 ( 15 _ 39 ) Creatinine 0,6 ( 0,6 _ 1,3 ) Creatinine 0,7 ( 0,6 _ 1,3 ) Sodium 144 ( 136 _ 145 ) Sodium 146 ( 136 _ 145 ) ALT 59 ( 30 _ 65 ) ALT 58 ( 30 _ 65 ) AST 60 ( 15 _ 37 ) AST 60 ( 15 _ 37 )

Case presentation Medications : Tazocin 4,5mg TID IV Clindamycin 600mg TID IV Omeprazole 40mg OD PO Heparin 5000 BID SC

Case presentation Ventolin Nep Q4h Atrovent Nep Q4h,5mg Make frequent suction. D/C Clindamycin

Case presentation Start Clarithromycin 500mg PO BID ABG now then every 12 h. Feeding the patient by PEG tube 50ml/3h Change the position every 2h. Mibo ointment BID

Case presentation D/C Tazocin Human Albumin 20 BID IV Duration treatment: 5 _ 8 days. Longer duration of therapy may be needed if : Extrapulmonary infection such as meningitis or endocarditis.

Case presentation The reference : Pharmacotherapy Handbook ( CECILY V. DIPIRO ) Micromedex Medscape

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