Case 04 - Crystal, 19 Years Old Answers | PIAC Series

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ANSWERS
Case 04 - Crystal, 19 Years Old 

Crystal is a 19y/o morbidly obese WF who undergoes laparoscopic cholecystectomy; she is admitted postop with poorly controlled pain. She has asthma and smokes 2 ppd.

On postop day 2 the patient develops a fever to 38.9 and cough; CXR shows new LLL infiltrate

Questions

1). What were Crystal's predisposing risk factors for HCAP (health care associated pneumonia)?
  • What are the likely causative organisms?
  • What preventative measures are utilized to prevent HCAP?

Answers

  • Predisposing risk factors:

For Crystal - pre-existing lung disease, smoking, recent intubation
- Other risk factors - over-sedation, PPI use, aspiration

  • Likely causative organisms:

- Early onset: Strep pneumo, hemophilus, moraxella,
- Late onset (hospital day 5 or later): aerobic gram neg bacilli (Pseudomonas, Enterobacter, etc.), Staph aureus (esp MRSA)

  • Preventative measures:

- Early ambulation
- Incentive spirometry
- Judicious use of PPI
- Measures to decrease risk of aspiration


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