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囊性纤维病抗生素的应用(英文PPT)Inhaled Antibiotics in Cystic Fibrosis课件.ppt

囊性纤维病抗生素的应用(英文PPT)Inhaled Antibiotics in Cystic Fibrosis课件.ppt

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囊性纤维病抗生素的应用(英文PPT)Inhaled Antibiotics in Cystic Fibrosis课件

Inhaled Antibiotics in Cystic Fibrosis By Tony S. Poteat, M.D. Resident Grand Rounds November 24, 1998 Case Presentation HPI: 41 yo WM with cystic fibrosis presents with a seven day history of increased shortness of breath and diaphoresis. Increased sputum production. Sputum is thicker and is now green. He reports noncompliance with his pulmozyme and flovent. Case Presentation He had finished his 28 day course of inhaled tobramycin 7 days prior to admission. PMH: Cystic fibrosis diagnosed at age 28. Nasal polyps All: Tetracycline Case Presentation Medications: Inhaled tobramycin 300 mg b.i.d. for 28 days then off for 28 days. Ventolin 3 puffs t.i.d. Flovent 2 puffs b.i.d. Serevent 2 puffs b.i.d. Pulmozyme 2.5 mg nebulized q.d. Home oxygen 3L by nasal cannula. Pancreatic enzymes with each meal. Case Presentation SH: 10 pack year history of tobacco, quit at age 28. Occasional red wine. Disability since 3/95, was an auto technician. ROS: Patient feels that he has lost 5-10 pounds over the last month. Case Presentation PE: Vitals 95.9 / 107 / 25 / 133/90 Gen: Anxious WM in mild respiratory distress. HEENT: NC/AT, EOMI, PERRL, OP clear Neck: Supple, no lymphadenopathy Case Presentation CV: tachycardic no murmur, rubs, or gallops Lungs: Crackles in the left base, decreased breath sounds and wheezes bilaterally Abd: Benign Ext: Clubbing in all extremities, no edema Case Presentation Labs: 15.3 17.9 416 71% segs 18% lymphs 10% monos SMAC: WNL ABG: 7.406/49/49/30/83% on 3L Case Presentation CXR: Cystic changes, peribronchial thickening, no focal infiltrates. Sputum culture from 4 months earlier grew 4+ Pseudomonas aeruginosa sensitive to Zosyn. Spirometry from 4 months earlier showed an FEV1 of 18% predicted and a FVC of 45% predicted. Case Presentation Hospital Course: The patient’s sats improved on 60% face shie

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