Good Morning It’s Friday!!!
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Transcript of Good Morning It’s Friday!!!
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GOOD MORNINGIT’S FRIDAY!!!
August 20, 2010
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Osteomyelitis 1% of pediatric admissions Neonates*
Hematogenous spread* Tibia or femur
50% associated with septic joint* GBS & E.Coli
Older children* Staph aureus*, Group A Strep, HIB, Salmonella
(SCD) Rare joint involvement
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Osteomyelitis Direct invasion Spread from focus
Trauma Staph aureus
Puncture Pseudomonas
Sole of sneaker E. coli
Animal Bite Anaerobes Staph
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Osteomyelitis Hematogenous*
Acute pain and decreased movement* Possible swelling or redness* Systemic Symptoms
Fever Malaise Irritability
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Osteomyelitis Following trauma
Insidious, subacute onset Localized pain, edema and redness Absence of systemic symptoms
Chronic Local findings may be absent or intermittent Possible sinus tracts Absence of systemic symptoms
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Osteomyelitis Lab findings
Elevated or normal leukocyte
ESR/CRP elevated
Positive blood culture 50%
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Osteomyelitis Imaging
Plain films 1-2 weeks*
Edema of surrounding tissues Periosteal reaction New bone formation
2 weeks Lytic lesions
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Osteomyelitis Imaging*
Bone Scan 2-3 days Unclear location Nonspecific
MRI Specific Abscess
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Pelvic Osteomyelitis* Stats
Older children Mean 8.1y
Boys > Girls Ilium > ischium or pubis Right > left
Increased risk for abscess formation Late diagnosis Staph aureus
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Osteomyelitis Treatment*
High dose Bactericidal levels in bone 4-6 weeks
Staph or Strep Oxacillin or naficillin 1st or 2nd generation cephalosporins Clindamycin
HIB 2nd or 3rd generation cephalosporin
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Osteomyelitis Treatment
Sickle Cell 3rd generation cephalosporin
Other bugs to consider Pseudomonas, anaerobes, GBS and E. coli
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Osteomyelitis Complications
Recurrence 5-10% are chronic
Abscess