Treatments for Chest pain
Treatments for Chest pain
The list of treatments mentioned in various sources
for Chest pain
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
Chest pain: Is the Diagnosis Correct?
The first step in getting correct treatment is
to get a correct diagnosis.
Differential diagnosis list for Chest pain may include:
Hidden causes of Chest pain may be incorrectly diagnosed:
Chest pain: Marketplace Products, Discounts & Offers
Products, offers and promotion categories available for Chest pain:
Chest pain: Research Doctors & Specialists
- Nerve Specialists:
- Cholesterol Specialists:
- Cardiac (Heart) Specialists:
- Pain Specialists:
- Arthritis & Joint Health Specialists (Rheumatology):
- more specialists...»
Research all specialists including ratings, affiliations, and sanctions.
Unlabeled Drugs and Medications to treat Chest pain:
Unlabelled alternative drug treatments for Chest pain include:
- Amiodarone
- Cordarone
- Alti-Amiodarone
- Braxan
- Gen-Amiodarone
- Med-Amiodarone
- Novo-Amiodarone
- Pacerone
Hospital statistics for Chest pain:
These medical statistics relate to hospitals, hospitalization and Chest pain:
- 1.74% (221,519) of hospital consultant episodes were for pain in throat and chest in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 83% of hospital consultant episodes for pain in throat and chest required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 52% of hospital consultant episodes for pain in throat and chest were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 48% of hospital consultant episodes for pain in throat and chest were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 88% of hospital consultant episodes for pain in throat and chest required emergency hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- more hospital information...»
Hospitals & Medical Clinics: Chest pain
Research quality ratings and patient incidents/safety measures
for hospitals and medical facilities in specialties related to Chest pain:
Hospital & Clinic quality ratings » »
Choosing the Best Treatment Hospital:
More general information, not necessarily in relation to Chest pain,
on hospital and medical facility performance and surgical care quality:
Medical news summaries about treatments for Chest pain:
The following medical news items
are relevant to treatment of Chest pain:
Buy Products Related to Treatments for Chest pain
Book Excerpts: Treatment of Chest pain
Treatments of Chest pain: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the treatments of Chest pain.
Chest Pain:
Treatment
(In a Page: Signs and Symptoms)
-
Attention to airway, breathing, and circulation
-
All patients with suspected coronary artery disease should initially be treated with supplemental O2, aspirin, and nitroglycerin; morphine may be added if pain does not subside
-
- If an acute myocardial infarction is suspected, β-blockers, ACE inhibitors, heparin (usually low molecular weight heparin, enoxaparin), thrombolytic therapy or primary angioplasty (PTCA), and/or glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide, abciximab, or tirofiban) may be indicated
Treat other etiologies as appropriate (e.g., antiarrhythmics and/or cardioversion for arrhythmias, pericardiocentesis for cardiac tamponade, H2 blockers or PPIs for GERD and peptic ulcer disease, antibiotics for pneumonia, bronchodilators and steroids for asthma)
Emergent surgery for aortic dissections that involve the aortic arch proximal to left subclavian artery (type A); strict blood pressure control for type B dissections that only involve the aorta distal to left subclavian artery
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Flank Pain/CVA Tenderness:
Treatment
(In a Page: Signs and Symptoms)
-
Disk disease: NSAIDs and physical therapy; surgery is rarely indicated
-
Muscle spasm: Rest, physical therapy, analgesics
-
Renal calculi: Increased fluid intake, analgesics, consider surgery
-
Pyelonephritis, cystitis, and perirenal abscess: Antibiotics and increased fluid intake
-
Pancreatitis: Analgesics, antibiotics, consider surgery
-
Glomerulonephritis: Antibiotics (if poststreptococcal), loop diuretics, antihypertensive agents
-
Polycystic kidney disease: Manage blood pressure
-
Renal infarction: Surgery, antihypertensive, streptokinase
-
Papillary necrosis: Dialysis, treat underlying cause
-
Cholelithiasis: Cholecystectomy, analgesics
-
Appendicitis and ectopic pregnancy: Surgery
-
Renal and bladder cancer: Surgical resection, chemotherapy, and radiation
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Chest Pain:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Most patients/families with chest pain simply want reassurance that symptoms are not cardiac in origin
-
A careful history and physical exam are most important; however, a normal CXR and ECG provide therapeutic reassurance to the patient/family
-
Further cardiology consultation is rarely required but should be considered with patients experiencing chest pain with exercise, a history of Kawasaki disease, Marfan syndrome (this is an emergency), and for those patients with persistent chest pain
-
Costochondritis: Treated with NSAIDs until resolved
-
Pericarditis: Treated with aspirin or NSAIDs; requires cardiology follow-up until resolved, rarely requires pericardiocentesis
-
Appropriate therapy of identified pulmonary, gastrointestinal, or musculoskeletal problems
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Chest expansion, asymmetrical:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If you detect asymmetrical chest expansion, first consider traumatic injury to the patient's ribs or sternum, which can cause flail chest, a life-threatening emergency characterized by paradoxical chest movement. Quickly take the patient's vital signs and look for signs of acute respiratory distress — rapid and shallow respirations, tachycardia, and cyanosis. Use tape or sandbags to temporarily splint the unstable flail segment.
Depending on the severity of respiratory distress, administer oxygen by nasal cannula, mask, or mechanical ventilator. Insert an I.V. line to allow fluid replacement and administration of pain medication. Draw a blood sample from the patient for arterial blood gas analysis, and connect the patient to a cardiac monitor.
Although asymmetrical chest expansion may result from hemothorax, tension pneumothorax, bronchial obstruction, and other life-threatening causes, it isn't a cardinal sign of these disorders. Because any form of asymmetrical chest expansion can compromise the patient's respiratory status, don't leave the patient unattended, and be alert for signs of respiratory distress.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Flank pain:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If the patient has suffered trauma, quickly look for a visible or palpable flank mass, associated injuries, CVA pain, hematuria, Turner’s sign, and signs of shock, such as tachycardia and cool, clammy skin. If one or more is present, insert an I.V. line to allow fluid or drug infusion. Insert an indwelling urinary catheter to monitor urine output and evaluate hematuria. Obtain blood samples for typing and crossmatching, a complete blood count, and electrolyte levels.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Chest pain:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient when his chest pain began. Did it develop suddenly or gradually? Is it more severe or frequent now than when it first started? Does anything relieve the pain? Does anything aggravate the pain? Ask the patient about associated symptoms. Sudden, severe chest pain requires prompt evaluation and treatment because it may herald a life-threatening disorder. (See Managing severe chest pain, pages 134 and 135.)
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Myocardial infarction:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Thrombolytic therapy, oxygen, nitroglycerin or angioplasty (or both)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Chest expansion, asymmetrical:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If you detect asymmetrical chest expansion, first consider traumatic injury to the patient’s ribs or sternum, which can cause flail chest, a life-threatening emergency characterized by paradoxical chest movement. Quickly take the patient’s vital signs and look for signs of acute respiratory distress—rapid and shallow respirations, tachycardia, and cyanosis. Use tape or sandbags to temporarily splint the unstable flail segment.
Depending on the severity of respiratory distress, administer oxygen by nasal cannula, mask, or mechanical ventilator. Insert an I.V. line to allow fluid replacement and administration of pain medication. Draw a blood sample from the patient for arterial blood gas analysis, and connect the patient to a cardiac monitor.
Although asymmetrical chest expansion may result from hemothorax, tension pneumothorax, bronchial obstruction, and other life-threatening causes, it isn’t a cardinal sign of these disorders. Because any form of asymmetrical chest expansion can compromise the patient’s respiratory status, don’t leave the patient unattended, and be alert for signs of respiratory distress.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Flank pain:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient has suffered trauma, quickly look for a visible or palpable flank mass, associated injuries, CVA pain, hematuria, Turner’s sign, and signs of shock (such as tachycardia and cool, clammy skin). If one or more of these signs is present, insert an I.V. line to allow fluid or drug infusion. Insert an indwelling urinary catheter to monitor urine output and evaluate hematuria. Obtain blood samples for typing and crossmatching, complete blood count, and electrolyte levels.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Chest pain:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient when his chest pain began. Did it develop suddenly or gradually? Is it more severe or frequent now than when it first started? Does anything relieve the pain? Does anything aggravate it? Ask the patient about associated symptoms. Sudden, severe chest pain requires prompt evaluation and treatment because it may herald a life-threatening disorder. (See Managing severe chest pain, pages 162 and 163.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Myocardial infarction:
Treatment
(Handbook of Diseases)
The goals of treatment are to relieve chest pain, to stabilize heart rhythm, to reduce cardiac workload, to revascularize the coronary artery, and to preserve myocardial tissue. Arrhythmias, the predominant problem during the first 48 hours after the infarction, may require an antiarrhythmic, possibly a pacemaker and, rarely, cardioversion.
To preserve myocardial tissue, I.V. thrombolytic therapy should be started within 6 hours after the onset of symptoms (unless contraindications exist). Thrombolytic therapy includes either streptokinase or recombinant tissue plasminogen activator and is usually followed by I.V. infusion of heparin.
Percutaneous transluminal coronary angioplasty (PTCA) may be another option. If PTCA is performed soon after the onset of symptoms, the thrombolytic agent may be administered directly into the coronary artery. Emergency coronary artery bypass surgery may be necessary in some cases.
Other treatments include:
❑ antiplatelet drugs, such as aspirin, to inhibit platelet aggregation (should be initiated within 24 hours after onset of symptoms)
❑ sublingual or I.V. nitrates, such as nitroglycerin, to relieve pain by redistributing blood to ischemic areas of the myocardium, thus increasing cardiac output and reducing myocardial workload
❑ morphine I.V. for pain and sedation
❑ bed rest with bedside commode to decrease cardiac workload
❑ oxygen administration at a modest flow rate for 3 to 6 hours (a lower concentration is necessary if the patient has chronic obstructive pulmonary disease)
❑ drugs to increase myocardial contractility or blood pressure
❑ pulmonary artery catheterization to detect left- or right-sided heart failure and to monitor the patient’s response to treatment
❑ angiotensin-converting enzyme inhibitors to improve survival rate in a low ejection fraction (a large anterior-wall MI).
Other medications, such as antiarrhythmics, diuretics, glycoprotein IIb/IIIa inhibitors, beta-adrenergic blockers, and calcium channel blockers, are used as needed.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Chest expansion, asymmetrical:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Because asymmetrical chest expansion increases the work of breathing, supplemental oxygen is usually given during acute events. Assess the patient’s respiratory status frequently.
If the patient is intubated, regularly auscultate breath sounds in the lung peripheries to ensure equal ventilation. Maintain the ventilator settings and alarms, as ordered.
Patient teaching
Explain all procedures and tests, especially if the patient is intubated. Teach the patient and his family early signs of infection.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Flank pain:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Administer pain medication. Continue to monitor the patient’s vital signs, and maintain a precise record of the patient’s intake and output.
Diagnostic evaluation may involve serial urine and serum analysis, excretory urography, flank ultrasonography, computed tomography scan, voiding cystourethrography, cystoscopy, and retrograde ureteropyelography, urethrography, and cystography.
Patient teaching
Provide information on the importance of increased fluid intake, unless contraindicated. Explain signs and symptoms that are imperative to report. Emphasize the importance of taking drugs as prescribed. Stress the importance of keeping follow-up appointments.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Chest pain:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
As needed, prepare the patient for cardiopulmonary studies, such as an ECG and a lung scan. Perform a venipuncture to collect a serum sample for cardiac enzyme and other studies. Assess the cardiovascular system frequently. Interpret changes in cardiac rhythm. Be prepared for emergency procedures.
Keep in mind that a patient with chest pain may deny his discomfort, so stress the importance of reporting symptoms to allow adjustment of his treatment.
Patient teaching
Explain the purpose and procedure of each diagnostic test to the patient to help alleviate his anxiety. Prepare him if cardiac catheterization or fibrinolytic therapy is indicated. Explain the purpose of any prescribed drugs and make sure that he understands the dosage, schedule, and possible adverse effects. Teach the patient with coronary artery disease to recognize the typical features of cardiac ischemia as well as symptoms that require prompt medical attention. Teach him how to administer sublingual nitroglycerin and advise him to seek medical attention if the pain lasts more than 20 minutes, fails to respond to nitroglycerin, or has a different pattern than the usual angina.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Chest expansion, asymmetrical:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If you detect asymmetrical chest expansion, first consider traumatic injury to the patient’s ribs or sternum, which can cause flail chest, a life-threatening emergency characterized by paradoxical chest movement. Quickly take the patient’s vital signs and look for signs of acute respiratory distress — rapid and shallow respirations, tachycardia, and cyanosis. Use tape or sandbags to temporarily splint the unstable flail segment.
Depending on the severity of respiratory distress, administer oxygen by nasal cannula, mask, or mechanical ventilator. Insert an I.V. line to allow fluid replacement and administration of pain medication. Draw a blood sample from the patient for arterial blood gas analysis, and connect the patient to a cardiac monitor. Don’t leave the patient unattended, and be alert for signs of respiratory distress.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Flank pain:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient has suffered trauma, quickly look for a visible or palpable flank mass, associated injuries, CVA pain, hematuria, Turner’s sign, and signs of shock (such as tachycardia and cool, clammy skin). If one or more is present, insert an I.V. line to allow fluid or drug infusion. Insert an indwelling urinary catheter to monitor urine output and evaluate hematuria. Obtain blood samples for typing and crossmatching, complete blood count, and electrolyte levels.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Chest pain:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach patients with coronary artery disease about the typical features of cardiac ischemia as well as the symptoms that should prompt them to seek medical attention. If the pain fails to disappear after sublingual nitroglycerin, lasts more than 20 minutes, or has a different pattern from the usual angina, the patient must be evaluated immediately.
Explain the purpose and procedure of each diagnostic test to the patient to help alleviate his anxiety. Also explain the purpose of any prescribed drugs, and make sure that the patient understands the dosage, schedule, and possible adverse effects.
Keep in mind that a patient with chest pain may deny his discomfort, so stress the importance of reporting symptoms to allow adjustment of his treatment.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Chest expansion, asymmetrical:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ If you're caring for an intubated patient, regularly auscultate breath sounds in the lung peripheries to help detect a misplaced ET tube.
▪ If you detect a misplaced ET tube, prepare the patient for a chest X-ray to allow rapid repositioning of the tube.
▪ Because asymmetrical chest expansion increases the work of breathing, supplemental oxygen is usually given during acute events.
▪ If the patient is acutely hypoxic, prepare him for ET intubation.
Patient teaching
▪ Teach the patient to recognize early signs and symptoms of respiratory distress.
▪ Encourage coughing and deep-breathing exercises to promote oxygenation.
▪ With flail chest, show the patient how to splint his chest so he can perform breathing exercises more effectively.
▪ Teach the patient techniques that can help reduce anxiety.
▪ Once the patient is stable, explain the cause of his respiratory distress and the treatment plan.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Flank pain:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Administer pain medication and evaluate effect.
▪ Monitor the patient's vital signs.
▪ Maintain a precise record of his intake and output.
▪ Prepare the patient for tests, such as serial urine and serum analysis, excretory urography, flank ultrasonography, a computed tomography scan, voiding cystourethrography, cystoscopy, and retrograde ureteropyelography, urethrography, and cystography.
Patient teaching
▪ Teach the patient about the underlying cause of flank pain.
▪ Describe the treatment plan and the need for follow-up care.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Chest pain:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for cardiopulmonary studies, such as an electrocardiogram, chest X-ray, magnetic resonance imaging, and a lung perfusion scan.
▪ Collect a serum sample for cardiac enzyme and electrolyte levels.
▪ Provide emotional support because chest pain produces increased anxiety.
Patient teaching
▪ Explain the purpose and procedure of each diagnostic test to the patient to help alleviate his anxiety.
▪ Teach the patient about the cause of his chest pain once a diagnosis is established.
▪ Explain the purpose of any prescribed drugs, and make sure that the patient understands the dosage, schedule, and possible adverse effects.
▪ Stress the importance of reporting symptoms to allow for the adjustment of treatment.
▪ Teach the patient with coronary artery disease about the typical features of cardiac ischemia as well as the symptoms that should prompt him to seek immediate medical attention.
▪ Discuss lifestyle changes that can reduce the risk of coronary artery disease.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Chest Pain - Case 14-1: 17-Year-Old Boy:
VI. Treatment
(Pediatric Complaints and Diagnostic Dilemmas)
There is no standard protocol to treat patients with SLE, because each child has
a unique presentation. The primary goal is to prevent exacerbations, rather
than to treat each flare episodically. Certain recommendations are universal,
including the need to avoid exposure to excessive sunlight.
A variety of pharmacologic agents are available to treat symptoms of SLE. NSAIDs
are typically used for the treatment of musculoskeletal complaints. Patients
with anti-cardiolipin antibodies often receive low-dose aspirin to decrease the
risk of thromboembolism. Hydroxychloroquine can be very effective in
conjunction with glucocorticoids to minimize disease exacerbations. However,
these agents may not always be effective in controlling the disease, and other
immunosuppressive agents, such as azathioprine, cyclophosphamide, and
methotrexate, may be needed.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Chest Pain - Case 14-2: 15-Year-Old Boy:
VI. Treatment
(Pediatric Complaints and Diagnostic Dilemmas)
If the patient has hemodynamic compromise, pericardiocentesis is indicated.
Certainly, in cases of tamponade this is necessary. A second option for
drainage is an open surgical procedure, which allows for removal of the
pericardial fluid as well as obtaining pericardial tissue for culture and
histopathologic studies. Controversy does exist as to whether
pericardiocentesis or open drainage should be the procedure of choice in
uncomplicated cases of suspected tuberculous pericarditis. Either way, one must
strive to prevent the formation of a constrictive pericarditis.
Antibiotic therapy consists of the same regimens as are prescribed for pulmonary
tuberculosis. Adjuvant corticosteroid therapy appears to decrease the amount of
effusion and reaccumulation of pericardial fluid, reducing the need for
repeated interventions.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Chest Pain - Case 14-3: 20-Year-Old Boy:
VI. Treatment
(Pediatric Complaints and Diagnostic Dilemmas)
Patients who present with myocarditis may have only mild symptoms of congestive
heart failure. They can be monitored with no specific immediate intervention.
It is not uncommon for bed rest to be prescribed, because this is thought to
possibly decrease intramyocardial viral replication.
However, some patients have poor cardiac output and poor tissue perfusion. In
these cases, digitalis and diuretics may be prescribed. One should also
consider anticoagulation medications including aspirin, warfarin, and heparin
to prevent thromboembolic disease.
With EBV myocarditis, some would advocate the use of steroids and even
acyclovir. However, this combination has not been extensively studied, because
the disease entity is relatively rare.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Chest Pain - Case 14-4: 17-Year-Old Boy:
VI. Treatment
(Pediatric Complaints and Diagnostic Dilemmas)
A variety of treatment options exist for management of a pneumothorax, ranging
from observation to simple aspiration with a catheter, chest tube insertion,
pleurodesis, thoracoscopy with a single port, video-assisted thoracoscopic
surgery, and thoracotomy.
Patients with small primary spontaneous pneumothoraces may be observed without
intervention if there is no respiratory distress. They may be treated with
supplemental oxygen to hasten the reabsorption of air. With supplemental
oxygen, the air is reabsorbed at a rate of 2% per day. With larger primary
spontaneous pneumothoraces, needle aspiration or chest tube insertion is
required. Secondary spontaneous pneumothoraces are likely to require
intervention, because patients are usually ill due to their underlying lung
disease.
The main debate with spontaneous pneumothoraces is the ability to prevent
recurrences. With a primary spontaneous pneumothorax, the recurrence rate is
about 30%, and most recur 6 months to 2 years after the initial event. Smoking
and younger age are risk factors for recurrent disease. The recurrence rate
with secondary spontaneous pneumothoraces is similar at 39% to 47%.
The general consensus is to recommend preventative therapy after the second
ipsilateral pneumothorax. However, patients who participate in risky activities
such as scuba diving or flying should be considered for intervention after
their first spontaneous pneumothorax. Options for recurrence prevention include
the instillation of sclerosing agents through a chest tube and mechanical
pleurodesis. With video-assisted thoracoscopic procedures, blebs can also be
identified and oversewn.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Chest Pain - Case 14-5: 3-Year-Old Girl:
VI. Treatment
(Pediatric Complaints and Diagnostic Dilemmas)
In the majority of cases, the causative organism is hypothesized but not
verified. Therefore, therapy must be empiric. In the newborn period, the most
common organisms are group B streptococci, gram-negative bacteria (particularly
Escherichia coli and Klebsiella spp.), and Listeria monocytogenes. Therefore, a combination of ampicillin and either gentamicin or cefotaxime is
often used. There is no consensus as to when the newborn period is over, but
after 2 to 3 months of age, the causative organisms tend to switch to
C. trachomatis, viruses, S. pneumoniae, B. pertussis, and S. aureus. Currently, the prevailing opinion is to treat these children (who are generally
in the 3- to 4-month age group) with amoxicillin, ampicillin, or cefotaxime.
From 4 months to approximately 4 years of age, the causative organisms tend to
include viruses,
S. pneumoniae, H. influenzae, M. pneumoniae, and M. tuberculosis. In a study of 3,475 S. pneumoniae isolates by Whitney and colleagues, ampicillin was effective against 98% of
isolates with intermediate sensitivity against penicillin, whereas erythromycin
and second-generation cephalosporin antibiotics were effective against only 65%
of those same isolates. For these reasons, many clinicians commence treatment
with either amoxicillin or ampicillin for lobar pneumonia and consider a switch
to a macrolide only if the child does not improve clinically, raising their
suspicion for a
Mycoplasma infection. Children with antecedent influenza infection are at higher risk for
pneumonia due to
S. aureus. An agent with activity against both S. pneumoniae and S. aureus, such as amoxicillin-clavulanate, clindamycin, or azithromycin, is preferred to
treat pneumonia in the child with influenza.
Finally, in the 5- to 15-year-age group, Mycoplasma spp. and C. pneumoniae are more common than other etiologic agents, including S. pneumoniae and M. tuberculosis. Therefore, the prevailing opinion for this age group is to commence treatment
with either macrolide or fluoroquinolone antibiotics. Certainly, in any age
range, one should pursue the diagnosis of
M. tuberculosis if it is at all clinically suspected.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Chest Pain - Case 14-6: 15-Year-Old Boy:
VI. Treatment
(Pediatric Complaints and Diagnostic Dilemmas)
Inotropic agents such as the sympathomimetic drugs dopamine, dobutamine, and
epinephrine are often required to support the poor cardiac output. Milrinone
and amrinone are inotropes that can be used to treat patients with signs of
congestive heart failure. Digoxin is used for long-term therapy and increased
cardiac contractility.
Because fluid overload is quite common in this clinical scenario, diuretics such
as furosemide are often necessary. Peripheral vasodilators, including
nitroprusside and hydralazine, may be used to decrease afterload and thereby
increase cardiac output. Angiotensin-converting enzyme (ACE) inhibitors can
have similar effects to reduce afterload.
With dilation of the cardiac chambers, the patient is at risk for thrombus
formation. Use of anticoagulants or antiplatelet drugs should be considered. If
the underlying cause of the cardiomyopathy is determined, a more specific
therapy may be warranted.
Finally, in severe cases, cardiac transplantation is required. It is difficult
to determine which children or adolescents should be considered for
transplantation. Certainly, this option should be explored for those children
who are still quite ill despite maximal intervention.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
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