This report updates, expands, and replaces the previously published CDC "Guideline for Prevention of Nosocomial Pneumonia". The new guidelines are designed to reduce the incidence of pneumonia and other severe, acute lower respiratory tract infections in acute-care hospitals and in other health-care settings (e.g., ambulatory and long-term care institutions) and other facilities where health care is provided. Among the changes in the recommendations to prevent bacterial pneumonia, especially ventilator-associated pneumonia, are the preferential use of oro-tracheal rather than naso-tracheal tubes in patients who receive mechanically assisted ventilation, the use of noninvasive ventilation to reduce the need for and duration of endotracheal intubation, changing the breathing circuits of ventilators when they malfunction or are visibly contaminated, and (when feasible) the use of an endotracheal tube with a dorsal lumen to allow drainage of respiratory secretions; no recommendations were made about the use of sucralfate, histamine-2 receptor antagonists, or antacids for stress-bleeding prophylaxis. For prevention of health-care--associated Legionnaires disease, the changes include maintaining potable hot water at temperatures not suitable for amplification of Legionella spp., considering routine culturing of water samples from the potable water system of a facility's organ-transplant unit when it is done as part of the facility's comprehensive program to prevent and control health-care--associated Legionnaires disease, and initiating an investigation for the source of Legionella spp. when one definite or one possible case of laboratory-confirmed health-care--associated Legionnaires disease is identified in an inpatient hemopoietic stem-cell transplant (HSCT) recipient or in two or more HSCT recipients who had visited an outpatient HSCT unit during all or part of the 2-10 day period before illness onset. In the section on aspergillosis, the revised recommendations include the use of a room with high-efficiency particulate air filters rather than laminar airflow as the protective environment for allogeneic HSCT recipients and the use of high-efficiency respiratory-protection devices (e.g., N95 respirators) by severely immunocompromised patients when they leave their rooms when dust-generating activities are ongoing in the facility. In the respiratory syncytial virus (RSV) section, the new recommendation is to determine, on a case-by-case basis, whether to administer monoclonal antibody (palivizumab) to certain infants and children aged <24 months who were born prematurely and are at high risk for RSV infection. In the section on influenza, the new recommendations include the addition of oseltamivir (to amantadine and rimantadine) for prophylaxis of all patients without influenza illness and oseltamivir and zanamivir (to amantadine and rimantadine) as treatment for patients who are acutely ill with influenza in a unit where an influenza outbreak is recognized. In addition to the revised recommendations, the guideline contains new sections on pertussis and lower respiratory tract infections caused by adenovirus and human parainfluenza viruses and refers readers to the source of updated information about prevention and control of severe acute respiratory syndrome.

/pdf/guidelines-for-preventing-health-care-associated-pneumonia-3ebalxrxyl.pdf

Guidelines for Preventing Health-Care-- Associated Pneumonia, 2003 Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee

Background: There has been increasing interest in the concept that exposures to environmental chemicals may be contributing factors to the epidemics of diabetes and obesity. On 11–13 January 2011, ...

Role of Environmental Chemicals in Diabetes and Obesity: A National Toxicology Program Workshop Review

Summary This report updates, expands, and replaces the previously published CDC "Guideline for Prevention of Nosocomial Pneumonia". The new guidelines are designed to reduce the incidence of pneumonia and other severe, acute lower respiratory tract infections in acute-care hospitals and in other health-care settings (e.g., ambulatory and long-term care institutions) and other facilities where health care is provided. Among the changes in the recommendations to prevent bacterial pneumonia, especially ventilator-associated pneumonia, are the preferential use of orotracheal rather than naso-tracheal tubes in patients who receive mechanically assisted ventilation, the use of noninvasive ventilation to reduce the need for and duration of endotracheal intubation, changing the breathing circuits of ventilators when they malfunction or are visibly contaminated, and (when feasible) the use of an endotracheal tube with a dorsal lumen to allow drainage of respiratory secretions; no recommendations were made about the use of sucralfate, histamine-2 receptor antagonists, or antacids for stress-bleeding prophylaxis. For prevention of health-care--associated Legionnaires disease, the changes include maintaining potable hot water at temperatures not suitable for amplification of Legionella spp., considering routine culturing of water samples from the potable water system of a facility's organ-transplant unit when it is done as part of the facility's comprehensive program to prevent and control health-care--associated Legionnaires disease, and initiating an investigation for the source of Legionella spp. when one definite or one possible case of laboratory-confirmed health-care--associated Legionnaires disease is identified in an inpatient hemopoietic stem-cell transplant (HSCT) recipient or in two or more HSCT recipients who had visited an outpatient HSCT unit during all or part of the 2--10 day period before illness onset. In the section on aspergillosis, the revised recommendations include the use of a room with high-efficiency particulate air filters rather than laminar airflow as the protective environment for allogeneic HSCT recipients and the use of high-efficiency respiratory-protection devices (e.g., N95 respirators) by severely immunocompromised patients when they leave their rooms when dust-generating activities are ongoing in the facility. In the respiratory syncytial virus (RSV) section, the new recommendation is to determine, on a case-by-case basis, whether to administer monoclonal antibody (palivizumab) to certain infants and children aged <24 months who were born prematurely and are at high risk for RSV infection. In the section on influenza, the new recommendations include the addition of oseltamivir (to amantadine and rimantadine) for prophylaxis of all patients without influenza illness and oseltamivir and zanamivir (to amantadine and rimantadine) as treatment for patients who are acutely ill with influenza in a unit where an influenza outbreak is recognized.

http://rn.org/courses/coursematerial-71.pdf

Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their ventilator-associated pneumonia (VAP) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.1. Occurrence of VAP in acute care facilities.a. VAP is one of the most common infections acquired by adults and children in intensive care units (ICUs).i. In early studies, it was reported that 10%-20% of patients undergoing ventilation developed VAP. More-recent publications report rates of VAP that range from 1 to 4 cases per 1,000 ventilator-days, but rates may exceed 10 cases per 1,000 ventilator-days in some neonatal and surgical patient populations. The results of recent quality improvement initiatives, however, suggest that many cases of VAP might be prevented by careful attention to the process of care.2. Outcomes associated with VAPa. VAP is a cause of significant patient morbidity and mortality, increased utilization of healthcare resources, and excess cost.i. The mortality attributable to VAP may exceed 10%.ii. Patients with VAP require prolonged periods of mechanical ventilation, extended hospitalizations, excess use of antimicrobial medications, and increased direct medical costs.

/pdf/strategies-to-prevent-ventilator-associated-pneumonia-in-3t2uasv83v.pdf

Strategies to prevent ventilator-associated pneumonia in acute care hospitals.

These guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea. They are not intended to replace physician judgement regarding specific patients or clinical or public health situations. This document does not provide detailed recommendations on infection prevention and control aspects related to infectious diarrhea.

/pdf/2017-infectious-diseases-society-of-america-clinical-28jdypf5cm.pdf

2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea.

Organophosphates and carbamates are often seen in rural areas and vitally important. Here is presented a case referred to our hospital with the diagnosis of foreign body aspiration, however revealed the signs of cholinergic poisoning in physical examination. The aim in this case is the questioning approach related with clinical suspicion contributes substantially to diagnosis is emphasized.

Yabancı Cisim Aspirasyonu Öyküsüyle Gölgelenmiş Bir Kolinerjik Zehirlenme Olgusu

Ecstasy, the street name for 3,4-methylenedioxyamphetamine, is a derivative of amphetamine with sympathomimetic effects and may cause life-threatening sudden cardiac arrhythmias, severe hyponatraemia, seizures and multiple organ failures. A three-year-old male child had been intubated after a seizure due to accidental intake of ecstasy when he presented to our paediatric emergency unit. On physical examination, the patient had poor health status and was unconscious and his pupils were mydriatic, his body temperature was 37.6 degree Celsius, his heart rate was 148/min, his blood pressure was 120/80 mmHg, his PaO2/FiO2 was 72 mmHg and his oxygen index was 18. Toxicological analyses showed 3,4-methylenedioxyamphetamine. The patient was diagnosed as acute respiratory distress syndrome. Appropriate ventilation strategies were used. On the ninth day after his admission, the patient had stabile vital signs and he was discharged. In this report, this three-year-old paediatric case of acute respiratory distress syndrome due to ecstasy intake will be presented.

https://journals.sagepub.com/doi/pdf/10.1177/102490791602300406

A Paediatric Case of Acute Respiratory Distress Syndrome following Toxicity due to Ecstasy

Karbonmonoksit (CO) renksiz, kokusuz, tatsiz ve irritan olmayan bir gaz olmasi nedeniyle zehirlenildiginin fark edilmesi oldukca zordur. Istatistikler, ulkemizde CO zehirlenmesi ve buna bagli olumlerin en cok isinma amacli kullanilan sobalardan kaynaklandigini gostermektedir. Bulanti, bas agrisi ve sersemlik hissinden, komaya kadar degisen klinik gorunumu olabilir. Bu calismada, iki kez ayni tabloda acil servisimize basvuran, CO zehirlenmesi dusunulen, temas oykusu olmayan, tum aile fertlerinin de farkinda olmadan etkilendigi bir olgu sunulmustur. Anahtar Kelimeler: Karbonmonoksit zehirlenmesi, soba, anamnez It is very difficult to recognize carbon monoxide (CO) poisoning since CO is a colorless, odorless, tasteless, and non-irritating gas. Statistical data indicates that CO poisoning and related deaths in Turkey are mostly caused by coal burning stoves used for heating. There are a wide variety of clinical features, ranging from nausea, headache and dizziness to coma. In this study, we present a case of poisoning in a patient who attended the emergency department twice with the same clinical signs. The patient was considered to have CO poisoning, had no anamnesis of exposure, and all family members were affected without being aware of it.

Olgu Sunumu / Case Report

Objective: The clinical signs and symptoms of brain edema resulting from diabetic ketoacidosis (DKA) may not always be ob vious. When the intracranial pressure increases, the optic nerve sheath diameter (ONSD) simultaneously increases and can be imaged with ultrasonography. We aimed to discuss the determinative features of ONSD measurements in brain edema (BE) in DKA. Materials and Methods: Patients who were classified as having mild, moderate and severe DKA were included in the study. Transorbital ultrasonography was performed during the first two hours of treatment while the patients remained in the supine neutral position with their eyes closed. The optic nerve sheath diameters, which appeared as a hypoechoic double-edged line 3 mm deep to the globe, were measured. The same measurements were repeated in outpatient clinic controls. The ONSD values and metabolic, neurological conditions of the patients were compared. Results: Eight patients with a mean age of 8.8±3 (Standard Deviation (SD)) years were included in the study. Seven of them presented with moderate to severe DKA. Two patients suffering from headaches were found to have mild BE according to the brain computerized tomography (CT). The ONSD was 5.7±0.93 mm (mean±SD) in the patients with moderate-severe DKA and 4 mm in the single patient with mild DKA. The ONSDs of the two patients with BE on the CT were 6.8 mm and 5.9 mm. The mean ONSD of the five patients with severe DKA was 4.4±0.32 mm in the outpatient clinic checks. Conclusion: The measurement of ONSD by USG may be a supportive method for predicting BE in children with DKA. 

Can brain edema be predicted with optic nerve sheath diameter measurement in cases with diabetic ketoacidosis?: a preliminary study

Introduction: The pseudo-tumor cerebri (PTC) is defined as the idiopathic or benign intracranial hypertension (IH), complaints of which cannot be explained in a different way. PTC is an exclusion diagnosis, in which the neuroophtalmopathology of IH cannot be determined. The patients with PTC may have complaints such as headache, nausea, vomiting, temporary blurred vision, and mild-level vision loss or unilateral or bilateral abducens nerve paralysis may develop. The radiological examination of patients yields normal results. In case that IH develops due to any reason, the enlargement is seen in optic nerve sheath diameter (ONSD) in the acute period. Case reports: 14 year-old patient, who has been diagnosed for PTC in our unit, optic nerve sheath diameter (ONSD) measurement and follow-up of pressure change of whom have been performed by using ultrasonography (USG) method, is presented in order to discuss the contribution of this non-invasive method to diagnosis, treatment, and observation processes. Conclusion: USG and ONSD measurement in PTC cases may be effective and reliable monitoring method as much as invasive methods.

/pdf/measuring-the-optic-nerve-sheath-diameter-by-using-4nk6sb5fkv.pdf

Measuring the optic nerve sheath diameter by using ultrasonography in diagnosis and follow-up of pseudo-tumor cerebri: A case report

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