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The Gist of Emergency Medicine - part 6

soi phế quản. (6) viêm phổi do Pneumocystis carinii (hầu như chỉ xảy ra với AIDS) → xảy ra trong tình dục khác giới! → chụp x-ray có thể được tiêu cực ban đầu. → tham khảo ý kiến các tài liệu tham khảo / chuyên gia bệnh truyền nhiễm, các khuyến nghị có thể đã thay đổi | The Gist of Emergency Medicine 96 L penicillin bronchoscopy. 6 Pneumocystis carinii pneumonitis occurs almost exclusively with AIDS occurs in heterosexuals too the chest x-ray may be negative initially. consult references infectious disease specialist recommendations may have changed. L bactrim 20mg trimethoprim kg and 100mg sulfamethoxazole kg day I.V. divided q6h concomitant prednisone po total of 3 weeks of therapy prophylactic therapy e.g. q 4 week pentamidine aerosols. See also 4 F p.140. 7 Pneumonia in immunosuppressed patients e.g. chemotherapy asplenic systemic steroids HIV if at all possible establish an etiological diagnosis. L e.g. claforan tobramycin clindamycin until culture results are known. See also Pneumocystis carinii pneumonitis above. 8 An uncomplicated community acquired pneumonia may be treated with erythromycin but this does not cover hemophilus influenza. Azithromycin may be used for mild to moderate infections covers H. influenza L 500mg po stat then 250mg day for days 2-5. 9 Nursing home acquired pneumonia if not requiring I.V. antibiotics may be given cipro ciprofloxacin 250-750mg bid po plus penicillin po. Substitute a macrolide for penicillin prn e.g. Biaxin . 2 Lateral decubitus films may reveal small pleural effusions and underlying disease in larger effusions. Thoracocentesis remove up to 1500cc biopsy studies rbc s wbc s cytology cultures stains specific gravity protein glucose. ciprofloxacin may also be given I.V. and has a wide range of indications consult references . Note ciprofloxacin clarithromycin and azithromycin are expensive antibiotics. Chest The Gist of Emergency Medicine 97 3 Uncomplicated TB L isoniazid 300mg pyridoxine and rifampin 600mg od plus pyrazinamide 15mg kg day or in pregnancy substitute ethambutol 15mg kg day for pyrazinamide. Is the patient HIV positive 4 ARDS Adult respiratory distress syndrome L ABC s invasive hemodynamic monitoring prn peep prn diuretics prn vasodilators prn I.V. fluids prn and L .