Pelvic Inflammatory Disease (PID)
OVERVIEW
- includes: endometritis, chorioamnionitis, intra-amniotic infection syndrome, salpingitis, tubo-ovarian abscess, pelvic cellulitis, pelvic peritonitis
- may be sexually acquired or from ascending infection from endogenous vaginal flora (post-abortion, postpartum, post op infection, post IUCD infection)
HISTORY
- abdominal/pelvic pain
- fever
- discharge
- history of above predispositions
EXAMINATION
- sometimes minimal signs
- SIRS
- vaginal discharge
- cervical excitation
- adnexal tenderness
INVESTIGATIONS
- bloods for infection
- first pass urine -> Chlamydia PCR
- MSU -> rule out UTI
- high vaginal swab (gonorrhoea)
Bacteria
- Chlamyophilia trachomatis
- Neisseria gonorrhoea
- Mycoplasma hominis
- Ureaplasma urealyticum
- Actinomyces (if IUD in situ)
MANAGEMENT
- source control (abscess, IUCD, products of conception)
Non-sexually acquired PID
- Amoxycillin 2g IV Q6hrly + Gentamicin 5mg/kg IV OD + Metronidazole 500mg Q12hrly
Sexually acquired PID
- treat partners too
- Doxycycline 100mg PO/IV Q12hrly + Metronidazole 500mg Q12hrly + Ceftriaxone 1g OD
OR Gentamicin 5mg/kg IV OD + Clindamycin 600mg IV Q8hrly - if patient pregnant or breastfeeding -> substitute doxycycline for roxithromycin 300mg OD
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