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
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Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC