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A patient with severe pneumonia is being treated with intravenous cefuroxime and is doing well until day 3 of hospitalization, when he develops a temperature of 102.6°F (39.2°C) and complains of unilateral pleuritic chest pain and associated shortness of breath. You are uncertain as to the etiology of the recurrent fever. After assessing the patient's clinical status, what should be the next step in management?
a-Add anaerobic coverage to the current cefuroxime
b-Obtain a CT scan of the chest
c-Perform an echocardiogram
d-Schedule bronchoscopy
e-Ask for a surgical consultation
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it seems to be a complication of pneumonia , could be empyma !!
no sufficient data
so i'll go with CT scan , maybe we have to know what's goinig on before covering anaerobic
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B? agree with rami's logic..
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the diagnoses could be PE, empyema, mucus plug .. ct should be prefered here. so i ll go with others. B
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i have confusion between b and c........
b for as above people said
c for septic pulmonary emboli...from heart
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A common reason for clinical failure of therapy in this setting is persistent effusion resulting in inflammation and the formation of an empyema. Imaging, such as plain chest radiography with lateral decubitus films or, preferably, a chest CT scan, can help assess the progression of the effusion and determine whether it is loculated, which would be suggestive of an empyema. Empiric changes to antibiotic coverage are unlikely to be helpful in a patient who was previously doing well on a sensible regimen. Surgical consultation should be considered if imaging studies confirm the suspected empyema or worsening effusion, but not as an initial step. An echocardiogram will not be helpful in evaluating this patient's suspected empyema; however, it may be useful in evaluating alternative diagnoses, such as endocarditis.
