Lung Abscess
CLINICAL FEATURES
- fever
- cough
- SOB
- sputum
- nonresolving pneumonia
RISK FACTORS
- dental caries
- foreign body aspiration (tooth, peanut)
- severe necrotising pneumonia
- altered LOC
- dysphagia
- IV drug use (septic emboli)
- septic thrombophlebits (pelvic or internal jugular)
- tumour
- Tb
- vasculitis
MANAGEMENT
- identify organism (bronchoscopy, FNA, CT guided)
- drain if not draining into airway (U/S or CT)
- physiotherapy
- antibiotics
-> benzylpenicillin + metronidazole
-> or clindamycin - if aerobic gram –ve bacilli suspected (alcoholic patients)
-> metronidazole + ceftriaxone/cefotaxime/piperacillin-tazobactam/ticarcillin+clavulanate - once defervesce
-> amoxicillin-clavulanate or clindamycin - 14 days of total therapy usually adequate (may be longer)
- look for resolution of free fluid in cavity
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC