SAQ 405 – Paediatrics – pneumonia with parapneumonic effusion
Model Answer
Paediatrics – pneumonia with parapneumonic effusion.
a. Chest x-ray description and interpretation
- Large left-sided opacification with a meniscus, consistent with a large pleural effusion.
- Left lung consolidation, most marked in the lower zone.
- Mediastinal and tracheal shift to the right.
- Right perihilar opacity and right lower-zone air bronchograms.
- Obliteration of the left hemidiaphragm.
- Overall interpretation: severe left-sided pneumonia with parapneumonic effusion or empyema.
b. Investigations
| Investigation | Justification |
|---|---|
| Venous blood gas | Assess ventilation, acidosis, lactate, and possible need for positive-pressure support. |
| Blood cultures, ideally two sets | Guide antibiotic therapy in severe pneumonia or sepsis. |
| Pleural aspiration or pleurocentesis if available | Diagnostic culture and may be therapeutic if empyema is suspected. |
| EUC/renal function | Assess organ dysfunction and support safe antibiotic/fluid prescribing. |
| Blood glucose | Reduced oral intake and sepsis increase hypoglycaemia risk. |
| COVID or respiratory viral testing as locally indicated | Informs infection control and aerosol-generating procedure planning. |
c. Management
- Give oxygen using an age-appropriate delivery route, aiming for oxygen saturation above 94%.
- Give IV broad-spectrum antibiotics, for example cefotaxime 50 mg/kg or ceftriaxone 50 mg/kg plus clindamycin/lincomycin; use vancomycin instead if MRSA is a concern.
- Arrange urgent retrieval or transfer to a tertiary paediatric centre for PICU and paediatric surgical/cardiothoracic input.
- Prepare for escalation including RSI/intubation if respiratory failure evolves.
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