Mediastinitis - Revision history

Rossdonaldson1: Text replacement - "CXR" to "CXR"

2016-09-09T16:16:08Z

Text replacement - "*CXR" to "*CXR"

← Revisión anterior		Revisión del 16:16 9 sep 2016
Línea 24:		Línea 24:

	==Evaluation==		==Evaluation==
	*CXR - often first modality		*[[CXR]] - often first modality
	**Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions		**Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions
	*CT with IV contrast if diagnosis in doubt		*CT with IV contrast if diagnosis in doubt

Neil.m.young: Text replacement - "==Diagnostic Evaluation==" to "==Evaluation=="

2016-07-28T06:00:26Z

Text replacement - "==Diagnostic Evaluation==" to "==Evaluation=="

← Revisión anterior		Revisión del 06:00 28 jul 2016
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	==Differential Diagnosis==		==Differential Diagnosis==

	==~~Diagnostic~~ Evaluation==		==Evaluation==
	*CXR - often first modality		*CXR - often first modality
	**Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions		**Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions

Neil.m.young: Text replacement - "* " to "*"

2016-07-05T23:08:17Z

Text replacement - "* " to "*"

← Revisión anterior		Revisión del 23:08 5 jul 2016
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	==Background==		==Background==
	* Inflammation of the mediastinum		*Inflammation of the mediastinum
	**Commonly caused by esophageal rupture or perforation		**Commonly caused by esophageal rupture or perforation
	**Infection may be caused by esophageal rupture/perforation or spread of infection from remote site		**Infection may be caused by esophageal rupture/perforation or spread of infection from remote site
Línea 6:		Línea 6:

	===Etiology===		===Etiology===
	* Prior cardiovascular surgery (most common cause)<ref>Infections of the mediastinum. SB - Thorac Surg Clin 2009 Feb; PMID 19288819 </ref>		*Prior cardiovascular surgery (most common cause)<ref>Infections of the mediastinum. SB - Thorac Surg Clin 2009 Feb; PMID 19288819 </ref>
	* [[Esophageal Perforation\|Esophageal rupture (Boerhaave Syndrome)]]		*[[Esophageal Perforation\|Esophageal rupture (Boerhaave Syndrome)]]
	* [[Ludwig Angina]]		*[[Ludwig Angina]]
	* [[Thoracic Trauma]]		*[[Thoracic Trauma]]
	* Lung infection extension		*Lung infection extension

	==Clinical Features==		==Clinical Features==
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	*[[Neck pain]] and swelling		*[[Neck pain]] and swelling
	**Crepitus		**Crepitus
	* Signs of [[Sepsis]]		*Signs of [[Sepsis]]
	* Hamman sign on auscultation of precordium (crunch heard during systole)		*Hamman sign on auscultation of precordium (crunch heard during systole)

	==Differential Diagnosis==		==Differential Diagnosis==

Ostermayer: Text replacement - "Category:Pulm" to "Category:Pulmonary"

2016-03-22T16:12:08Z

Text replacement - "Category:Pulm" to "Category:Pulmonary"

← Revisión anterior		Revisión del 16:12 22 mar 2016
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	[[Category:ID]]		[[Category:ID]]
	[[Category:~~Pulm~~]]		[[Category:Pulmonary]]

Mholtz at 04:21, 8 September 2015

2015-09-08T04:21:05Z

← Revisión anterior		Revisión del 04:21 8 sep 2015
Línea 2:		Línea 2:
	* Inflammation of the mediastinum		* Inflammation of the mediastinum
	**Commonly caused by esophageal rupture or perforation		**Commonly caused by esophageal rupture or perforation
	**~~Typically~~ caused by infection		**Infection may be caused by esophageal rupture/perforation or spread of infection from remote site
	***Streptococcus and Bacteroides		***Streptococcus and Bacteroides
	**Can be traumatic (swallowed razor blades, etc)

	===Etiology===		===Etiology===
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	==Differential Diagnosis==		==Differential Diagnosis==

	==~~Workup~~==		==Diagnostic Evaluation==
	* Septic workup to include:
	** CBC
	** Blood cultures
	** Gram Stain
	** Cultures of mediastinal pacing wires
	*CXR - often first modality		*CXR - often first modality
	**Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions		**Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions
	* CT if diagnosis in doubt		*CT with IV contrast if diagnosis in doubt
			*Septic workup to include:
			**CBC
			**Lactic acid
			**Blood cultures (incl gram Stain)
			**Cultures of mediastinal fluid

	==Management==		==Management==
	*~~Airway intact?~~		*Aggressive airway management
	* ''Patients with mediastinitis emergently require surgery''		*''Patients with mediastinitis emergently require surgery''
	**Consult		**Consult
	***CT Surgery for repair		***CT Surgery for repair
	***ENT if upper neck area		***ENT if upper neck area
	***GI for possible endoscopy		***GI for possible endoscopy
	* Start broad-spectrum antibiotics to include Pseudomonal coverage<ref>El Oakley, RM et al. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996. PMID 8619682</ref>		*Start broad-spectrum antibiotics to include Pseudomonal coverage<ref>El Oakley, RM et al. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996. PMID 8619682</ref>

	==Disposition==		==Disposition==
	* Admit		*Admit to ICU

	==See Also==		==See Also==
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	*[[Thoracic Trauma]]		*[[Thoracic Trauma]]

	==~~Sources~~==		==References==
	<references/>		<references/>
	~~Medscape: Mediastinitis Treatment & Managemen. Mueller DK, et al.~~

	[[Category:ID]]		[[Category:ID]]
	[[Category:Pulm]]		[[Category:Pulm]]

Rossdonaldson1 at 12:58, 3 February 2015

2015-02-03T12:58:24Z

← Revisión anterior		Revisión del 12:58 3 feb 2015
Línea 5:		Línea 5:
	***Streptococcus and Bacteroides		***Streptococcus and Bacteroides
	**Can be traumatic (swallowed razor blades, etc)		**Can be traumatic (swallowed razor blades, etc)

			===Etiology===
			* Prior cardiovascular surgery (most common cause)<ref>Infections of the mediastinum. SB - Thorac Surg Clin 2009 Feb; PMID 19288819 </ref>
			* [[Esophageal Perforation\|Esophageal rupture (Boerhaave Syndrome)]]
			* [[Ludwig Angina]]
			* [[Thoracic Trauma]]
			* Lung infection extension

	==Clinical Features==		==Clinical Features==
	*Fever		*[[Fever]]
	*Dyspnea		*[[Dyspnea]]
	*Chest pain		*[[Chest pain]]
	*Neck pain and swelling		*[[Neck pain]] and swelling
	**Crepitus		**Crepitus
	* Signs of [[Sepsis]]		* Signs of [[Sepsis]]
	* Hamman sign on auscultation of precordium (crunch heard during systole)		* Hamman sign on auscultation of precordium (crunch heard during systole)

	==~~Etiology~~==		==Differential Diagnosis==
	* Prior cardiovascular surgery (most common cause)<ref>Infections of the mediastinum. SB - Thorac Surg Clin 2009 Feb; PMID 19288819 </ref>
	* [[Esophageal Perforation\|Esophageal rupture (Boerhaave Syndrome)]]
	* [[Ludwig Angina]]
	* [[Thoracic Trauma]]
	* Lung infection extension

	==Workup==		==Workup==

Arsmd: restructured, new info, mngt

2015-02-02T15:54:35Z

restructured, new info, mngt

← Revisión anterior		Revisión del 15:54 2 feb 2015
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	==Background==		==Background==
	* ~~A serious infection~~ of the mediastinum ~~with significant morbidity~~ and ~~mortality<ref>Infections of the mediastinum.~~		* Inflammation of the mediastinum
	~~SB - Thorac Surg Clin 2009 Feb; PMID 19288819 </ref> and generally requires surgery~~		**Commonly caused by esophageal rupture or perforation
			**Typically caused by infection
			***Streptococcus and Bacteroides
			**Can be traumatic (swallowed razor blades, etc)

	==Clinical Features==		==Clinical Features==
	* [[Chest ~~Pain (DDx)\|Chest Pain]]~~		*Fever
			*Dyspnea
			*Chest pain
			*Neck pain and swelling
			**Crepitus
	* Signs of [[Sepsis]]		* Signs of [[Sepsis]]
	* Hamman sign on auscultation of precordium (crunch heard during systole)		* Hamman sign on auscultation of precordium (crunch heard during systole)

	==Etiology==		==Etiology==
	* Prior cardiovascular surgery (most common cause)		* Prior cardiovascular surgery (most common cause)<ref>Infections of the mediastinum. SB - Thorac Surg Clin 2009 Feb; PMID 19288819 </ref>
	* [[Esophageal Perforation\|Esophageal rupture (Boerhaave Syndrome)]]		* [[Esophageal Perforation\|Esophageal rupture (Boerhaave Syndrome)]]
	* [[Ludwig Angina]]		* [[Ludwig Angina]]
Línea 21:		Línea 28:
	** Gram Stain		** Gram Stain
	** Cultures of mediastinal pacing wires		** Cultures of mediastinal pacing wires
			*CXR - often first modality
			**Typically reveals subcutaneous emphysema, widening of the mediastinum and pleural effusions
	* CT if diagnosis in doubt		* CT if diagnosis in doubt

	==Management==		==Management==
			*Airway intact?
	* ''Patients with mediastinitis emergently require surgery''		* ''Patients with mediastinitis emergently require surgery''
			**Consult
			***CT Surgery for repair
			***ENT if upper neck area
			***GI for possible endoscopy
	* Start broad-spectrum antibiotics to include Pseudomonal coverage<ref>El Oakley, RM et al. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996. PMID 8619682</ref>		* Start broad-spectrum antibiotics to include Pseudomonal coverage<ref>El Oakley, RM et al. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996. PMID 8619682</ref>

	==Disposition==		==Disposition==
	* Admit		* Admit

	==See Also==		==See Also==
	*[[Pneumomediastinum]]		*[[Pneumomediastinum]]

Rossdonaldson1 at 11:50, 30 September 2014

2014-09-30T11:50:12Z

← Revisión anterior		Revisión del 11:50 30 sep 2014
Línea 36:		Línea 36:
	<references/>		<references/>
	Medscape: Mediastinitis Treatment & Managemen. Mueller DK, et al.		Medscape: Mediastinitis Treatment & Managemen. Mueller DK, et al.

			[[Category:ID]]
			[[Category:Pulm]]

Josgood: /* Management */

2014-04-18T06:18:34Z

Management

← Revisión anterior		Revisión del 06:18 18 abr 2014
Línea 25:		Línea 25:
	==Management==		==Management==
	* ''Patients with mediastinitis emergently require surgery''		* ''Patients with mediastinitis emergently require surgery''
	* Start broad-spectrum antibiotics to include Pseudomonal coverage		* Start broad-spectrum antibiotics to include Pseudomonal coverage<ref>El Oakley, RM et al. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996. PMID 8619682</ref>

	==Disposition==		==Disposition==

Josgood: /* Management */

2014-04-18T05:58:13Z

Management

← Revisión anterior		Revisión del 05:58 18 abr 2014
Línea 24:		Línea 24:

	==Management==		==Management==
	* ''Patients with mediastinitis require surgery''		* ''Patients with mediastinitis emergently require surgery''
	* Start broad-spectrum antibiotics to include Pseudomonal coverage		* Start broad-spectrum antibiotics to include Pseudomonal coverage

	==Disposition==		==Disposition==
	* Admit		* Admit

Mediastinitis - Revision history

Rossdonaldson1: Text replacement - "*CXR" to "*CXR"

Neil.m.young: Text replacement - "==Diagnostic Evaluation==" to "==Evaluation=="

Neil.m.young: Text replacement - "* " to "*"

Ostermayer: Text replacement - "Category:Pulm" to "Category:Pulmonary"

Mholtz at 04:21, 8 September 2015

Rossdonaldson1 at 12:58, 3 February 2015

Arsmd: restructured, new info, mngt

Rossdonaldson1 at 11:50, 30 September 2014

Josgood: /* Management */

Josgood: /* Management */

Rossdonaldson1: Text replacement - "CXR" to "CXR"