Ward Round Notes

The mechanisms and uses for several groups or antibiotics are described below but resistance and preferred antibiotic choices may vary between local regions and hospital. Please refer to these when considering antibiotic choice for different infections. Antibiotic group Mechanism Indications Examples Side effects and contra-indications Penicillins (Benzylpenicillin, phenoxy-methylpenicillin)   Binds to penicillin binding protiens and inhibits the last stage of cell wall synthesis causing cell lysis. Narrow spectrum – effective against streptococcus (e.g. group A strep, strep pneumonia, s.viridans) Occaisionally effective against non penicillinase producing staphylococcus. Aminoglycosides can be added synergistically against Group B strep, s viridans and enterococcus faecalis. Respiratory infections. Syphilis. Anaphylaxis/ hypersensitivity B lactamase resistant penicillins: fluc...

Persistent hyperkalaemia (above 7mmol/L) Acidosis - pH less than 7.2 or base excess over 10 refractory pulmonary oedema Uraemic encephalopathy Uraemic pericarditis High catabolic state with progressive renal failure Reference Longmore M, Wilkinson IB, Davidson EH, Foulkes A, Mafi AR, Oxford handbook of clinical medicine, 8th ed. Oxford, Oxford university press, 2010. 

Immediate ECG changes (stage1)  Widespread, saddle shaped ST elevation (except AvR and lead 1)  PR interval depression (except AvR and lead 1)  Reciprocal changes in lead 1 and AvR.  Sinus tachycardia due to pain or effusion.  (taken from: http://cdn.lifeinthefastlane.com/wp-content/uploads/2011/03/V5-pericarditis.jpg)  1-3 weeks (stage 2)  Flattened T waves, no ST elevation or PR interval depression.  3- several weeks (stage 3)  Inverted T waves several weeks + (stage 4) ECG returns to normal *not all patients go through the later stages of ECG changes. http://lifeinthefastlane.com/ecg-library/basics/pericarditis/ (this is a brilliant site!) http://emedicine.medscape.com/article/156951-overview

Demographics: Acute urinary retention is a medical emergency . It is relatively common occurring in 7/1000 men. It is more common in men than women, and incidence is higher in men over 70. Causes: The most common cause of acute urinary retention is benign prostatic hypertrophy. Other causes include: structural changes near the bladder and urethra in men ·       Meatal stenosis ·       Penile constricting bands ·       Phimosis ·       Urethral strictures In women ·       Prolapse ·       Urethral strictures