COURSE IN THE WARD

IVF: D5 IMB 500mL to run at 12-13 gtts/min Request for:

◦ CBC with platelet◦ Gram stain of wound discharge◦ Culture and sensitivity of wound discharge

Medications:◦ Clindamycin 150mg/slow IV infusion (32.1mg/kg/day) over

30 mins. now then every 8 hrs. ANST◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30

mins. every 8 hrs.◦ Paracetamol 250mg/5mL, 4 mL every 4 hours for Temp. >

38.5°C or for pain (14 mg/kg/dose )◦ Refer to Pediatric Surgery for further evaluation and

management

1ST Hospital Day

Incision and Drainage of Abscess◦ 20cc purulent discharge◦ Specimen sent for GS/CS

For daily COD

1st Hospital Day

Complete Blood CountHgb 110RBC 4.11Hct 0.33MCV 79.90MCH 26.80MCHC 33.50RDW 14.00MPV 6.20Platelet 281WBC 12.10 Neutrophils 0.54 Lymphocytes 0.41 Monocytes 0.03 Eosinophils 0.02

Microbiology ExaminationGram (+) Cocci in Pairs FewPus Cells ++++

D1-2 ◦ Clindamycin 150mg/slow IV infusion

(32.1mg/kg/day) over 30 mins. now then every 8 hrs. ANST

◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30 mins. every 8 hrs.

Decreased to D5 IMB 500mL to run at 9-10 gtts/min

Patient was transferred to malward IVF to consume Increase oral fluid intake

2nd Hospital Day

Culture and Sensitivity: Wound Discharge

Staphylococcus aureus Heavy Growth

*MRSA Positive

Sensitive to:

Azithromycin Chloramphenicol ClindamycinErythromycin Gentamycin Co-trimoxazole

Vancomycin

Resistant to:

Penicillin

D5-6◦ Clindamycin 150mg/slow IV infusion

(32.1mg/kg/day) over 30 mins. now then every 8 hrs. ANST

◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30 mins. every 8 hrs.

0.65% NaCl Nasal drops 2-3 gtts/nostril then suction Q6

5th Hospital Day

Day 14◦ Clindamycin 150mg/slow IV infusion (32.1mg/kg/day) over 30

mins. now then every 8 hrs. ANST◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30 mins.

every 8 hrs. Disharged

◦ Final Diagnosis: Abscess secondary to MRSA ◦ Take Home Medications:

Co-trimoxazole 400mg 180mg/5mL, 4mL Q12 to complete for 2 weeks

Mupirocin ointment, apply on affected area TID◦ Anticipatory Guidance◦ Immunization update◦ For follow up at OPD on Oct 10, 2010

14th Hospital Day