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% Document Info
\author{gnvr (Guenevere)}
\pdfinfo{
  /Title (lung-abscess-des-jardins.pdf)
  /Creator (Cheatography)
  /Author (gnvr (Guenevere))
  /Subject (Lung Abscess (Des Jardins) Cheat Sheet)
}

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\noindent
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Lung Abscess (Des Jardins) Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{gnvr (Guenevere)} via \textcolor{DarkBackground}{\uline{cheatography.com/147429/cs/34540/}}}
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\noindent
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}gnvr (Guenevere) \\
  \uline{cheatography.com/guenevere} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 8th October, 2022.\\
   Updated 8th October, 2022.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{x{2.8 cm} x{5.2 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Anatomic Alterations of the Lungs}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Lung abscess}} & necrosis of lung tissue that in severe cases leads to a localized air- and fluid-filled cavity \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
 & also known as "{\bf{necrotizing pneumonia}}" or "{\bf{lung gangrene}}" \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
 & The fluid in the cavity is a collection of purulent exudate that is composed of liquefied white blood cell remains, proteins, and tissue debris. \tn 
% Row Count 13 (+ 6)
% Row 3
\SetRowColor{white}
{\emph{Pyogenic membrane}} & encapsulates the air- and fluid-filled cavity \tn 
% Row Count 15 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & consists of a layer of fibrin, inflammatory cells, and granulation tissue \tn 
% Row Count 18 (+ 3)
% Row 5
\SetRowColor{white}
Early stages & pathology is indistinguishable from that of any acute pneumonia \tn 
% Row Count 21 (+ 3)
% Row 6
\SetRowColor{LightBackground}
 & Polymorphonuclear leukocytes and macrophages move into the infected area to engulf any invading organisms. This action causes the pulmonary capillaries to dilate, the interstitium to fill with fluid, and the alveolar epithelium to swell from the edema fluid. In response to this inflammatory reaction, the alveoli in the infected area become consolidated \tn 
% Row Count 35 (+ 14)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
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\begin{tabularx}{8.4cm}{x{2.8 cm} x{5.2 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Anatomic Alterations of the Lungs (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
 & As the inflammatory process progresses, {\bf{tissue necrosis}} involving all the lung structures occurs. \tn 
% Row Count 4 (+ 4)
% Row 8
\SetRowColor{white}
 & In severe cases, tissue necrosis ruptures into a bronchus and allows a partial or total drainage of the liquefied contents from the cavity \tn 
% Row Count 10 (+ 6)
% Row 9
\SetRowColor{LightBackground}
 & An air- and fluid-filled cavity also may rupture into the intrapleural space via a {\bf{bronchopleural fistula}} and cause {\bf{{\emph{pleural effusion}}}} and {\bf{{\emph{empyema}}}} \tn 
% Row Count 17 (+ 7)
% Row 10
\SetRowColor{white}
After a period of time & {\bf{fibrosis}} and {\bf{calcification}} of the tissues around the cavity encapsulate the abscess \tn 
% Row Count 21 (+ 4)
% Row 11
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Major pathologic or structural changes}}} \tn 
% Row Count 22 (+ 1)
% Row 12
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{•	 Alveolar consolidation} \tn 
% Row Count 23 (+ 1)
% Row 13
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{•	 Alveolar-capillary and bronchial wall destruction} \tn 
% Row Count 25 (+ 2)
% Row 14
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{•	 Tissue necrosis} \tn 
% Row Count 26 (+ 1)
% Row 15
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{•	 Cavity formation} \tn 
% Row Count 27 (+ 1)
% Row 16
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{•	 Fibrosis and calcification of the lung parenchyma} \tn 
% Row Count 29 (+ 2)
% Row 17
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{•	 Bronchopleural fistulas and empyema} \tn 
% Row Count 30 (+ 1)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Anatomic Alterations of the Lungs (cont)}}  \tn
% Row 18
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\mymulticolumn{2}{x{8.4cm}}{•	 Atelectasis} \tn 
% Row Count 1 (+ 1)
% Row 19
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{•	 Excessive airway secretions} \tn 
% Row Count 2 (+ 1)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Etiology and Epidemiology}}  \tn
% Row 0
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{\bf{Lung abscesses}} & most commonly occur as a complication of {\bf{aspiration pneumonia}} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
 & —i.e., the pathologic events that follow shortly after aspirating either acidic gastric fluids or a variety of anaerobic organisms that are normally found in oropharyngeal secretions \tn 
% Row Count 11 (+ 8)
% Row 2
\SetRowColor{LightBackground}
 & {\bf{Anaerobic organisms}} often colonize in the small grooves and spaces between the teeth and gums in patients with poor oral hygiene; they are frequently associated with gingivitis and dead or abscessed teeth. \tn 
% Row Count 20 (+ 9)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Aspiration}} often occurs in the patient with a decreased level of consciousness.} \tn 
% Row Count 22 (+ 2)
% Row 4
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Predisposing factors & (1) alcohol abuse, \tn 
% Row Count 24 (+ 2)
% Row 5
\SetRowColor{white}
 & (2) seizure disorders, \tn 
% Row Count 25 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & (3) general anesthesia, \tn 
% Row Count 26 (+ 1)
% Row 7
\SetRowColor{white}
 & (4) head trauma, \tn 
% Row Count 27 (+ 1)
% Row 8
\SetRowColor{LightBackground}
 & (5) cerebrovascular accidents, and \tn 
% Row Count 29 (+ 2)
% Row 9
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 & (6) swallowing disorders. \tn 
% Row Count 30 (+ 1)
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\begin{tabularx}{8.4cm}{x{2.64 cm} x{5.36 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Etiology and Epidemiology (cont)}}  \tn
% Row 10
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\mymulticolumn{2}{x{8.4cm}}{Anatomically, lung abscesses most commonly develop in lung regions that are dependent in the recumbent position} \tn 
% Row Count 3 (+ 3)
% Row 11
\SetRowColor{white}
e.g. & posterior segments of the upper lobes \tn 
% Row Count 5 (+ 2)
% Row 12
\SetRowColor{LightBackground}
 & superior segments of the lower lobes \tn 
% Row Count 7 (+ 2)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{The {\bf{right lung}} is more commonly involved than the left.} \tn 
% Row Count 9 (+ 2)
% Row 14
\SetRowColor{LightBackground}
{\bf{Flash burn}} & aspiration of acidic gastric fluids is associated with immediate injury to the tracheobronchial tree and lung parenchyma \tn 
% Row Count 14 (+ 5)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{A lung abscess may also develop as a result of:}}} \tn 
% Row Count 16 (+ 2)
% Row 16
\SetRowColor{LightBackground}
 & (1) {\bf{bronchial obstruction with secondary cavitating infection}} (e.g., distal to bronchogenic carcinoma or an aspirated foreign body) \tn 
% Row Count 22 (+ 6)
% Row 17
\SetRowColor{white}
 & (2) {\bf{vascular obstruction with tissue infarction}} (e.g., septic embolism, vasculitis) \tn 
% Row Count 26 (+ 4)
% Row 18
\SetRowColor{LightBackground}
 & (3) {\bf{interstitial lung disease with cavity formation}} (e.g., pneumoconiosis {[}silicosis{]}, Wegener's granulomatosis, and rheumatoid nodules) \tn 
% Row Count 32 (+ 6)
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\begin{tabularx}{8.4cm}{x{2.64 cm} x{5.36 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Etiology and Epidemiology (cont)}}  \tn
% Row 19
\SetRowColor{LightBackground}
 & (4) {\bf{bullae or cysts that become infected}} (e.g., congenital or bronchogenic cysts) \tn 
% Row Count 4 (+ 4)
% Row 20
\SetRowColor{white}
 & (5) {\bf{penetrating chest wounds that lead to an infection}} (e.g., bullet wound) \tn 
% Row Count 8 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{8.4cm}{x{4.24 cm} x{3.76 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Organisms Known to Cause Lung Abscess}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{\{\{ac\}\}{\bf{Common Organisms Associated with Aspiration}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Anaerobic gram-positive cocci & Peptostreptococci \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & Peptococci \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
Anaerobic gram-negative bacilli & {\emph{Bacteroides fragilis}} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & {\emph{Prevotella melaninogenica}} \tn 
% Row Count 9 (+ 2)
% Row 5
\SetRowColor{white}
 & {\emph{Fusobacterium}} species \tn 
% Row Count 11 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{\{\{ac\}\}{\bf{Less Common Organisms}}} \tn 
% Row Count 12 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Klebsiella}}} \tn 
% Row Count 13 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Staphylococci}}} \tn 
% Row Count 14 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Mycobacterium tuberculosis}} (plus atypical organisms {\emph{Mycobacterium kansasii}} and {\emph{Mycobacterium avium}})} \tn 
% Row Count 17 (+ 3)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Histoplasma capsulatum}}} \tn 
% Row Count 18 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Coccidioides immitis}}} \tn 
% Row Count 19 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Blastomyces}}} \tn 
% Row Count 20 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Aspergillus fumigatus}}} \tn 
% Row Count 21 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{\{\{ac\}\}{\bf{Parasites}}} \tn 
% Row Count 22 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Paragonimus westermani}}} \tn 
% Row Count 23 (+ 1)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Echinococcus}}} \tn 
% Row Count 24 (+ 1)
% Row 17
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Entamoeba histolytica}}} \tn 
% Row Count 25 (+ 1)
% Row 18
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{\{\{ac\}\}{\bf{Rare Causes}}} \tn 
% Row Count 26 (+ 1)
% Row 19
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Streptococcus pneumoniae}}} \tn 
% Row Count 27 (+ 1)
% Row 20
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Pseudomonas aeruginosa}}} \tn 
% Row Count 28 (+ 1)
% Row 21
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Legionella pneumophila}}} \tn 
% Row Count 29 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{8.4cm}{x{2.16 cm} x{5.84 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{CLINICAL DATA OBTAINED AT THE PATIENT'S BEDSIDE}}  \tn
% Row 0
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\mymulticolumn{2}{x{8.4cm}}{\{\{ac\}\}{\bf{The Physical Examination}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{Vital Signs}} & {\bf{Increased Respiratory Rate (Tachypnea)}} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & •	Stimulation of peripheral chemoreceptors (hypoxemia) \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
 & •	Decreased lung compliance–increased ventilatory rate relationship \tn 
% Row Count 8 (+ 3)
% Row 4
\SetRowColor{LightBackground}
 & •	Stimulation of J receptors \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
 & •	Pain, anxiety, fever \tn 
% Row Count 11 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & {\bf{Increased Heart Rate (Pulse) and Blood Pressure}} \tn 
% Row Count 13 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Pleuritic Chest Pain, Decreased Chest Expansion}}} \tn 
% Row Count 15 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Cyanosis}}} \tn 
% Row Count 16 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Cough, Sputum Production, and Hemoptysis}}} \tn 
% Row Count 17 (+ 1)
% Row 10
\SetRowColor{LightBackground}
 & Early Stages: inflammatory pneumonia-like phase; nonproductive barking or hacking cough \tn 
% Row Count 20 (+ 3)
% Row 11
\SetRowColor{white}
 & If the abscess progresses into an air- and fluid-filled cavity and ruptures through a bronchus, the patient may suddenly cough up large amounts of sputum. \tn 
% Row Count 26 (+ 6)
% Row 12
\SetRowColor{LightBackground}
 & {\bf{Foul-smelling brown}} or {\bf{gray sputum}} indicates a putrid infection that is caused by {\emph{numerous organisms}}, including {\emph{anaerobes}}. \tn 
% Row Count 31 (+ 5)
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\vfill
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\begin{tabularx}{8.4cm}{x{2.16 cm} x{5.84 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{CLINICAL DATA OBTAINED AT THE PATIENT'S BEDSIDE (cont)}}  \tn
% Row 13
\SetRowColor{LightBackground}
 & An {\bf{odorless green or yellow sputum}} indicates a nonputrid infection caused by a {\emph{single aerobic organism}}. \tn 
% Row Count 4 (+ 4)
% Row 14
\SetRowColor{white}
 & {\bf{Blood-streaked sputum}} is common in patients with a lung abscess. \tn 
% Row Count 7 (+ 3)
% Row 15
\SetRowColor{LightBackground}
 & Occasionally, {\bf{frank hemoptysis}} is seen \tn 
% Row Count 9 (+ 2)
% Row 16
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Chest Assessment Findings}}} \tn 
% Row Count 10 (+ 1)
% Row 17
\SetRowColor{LightBackground}
 & Increased tactile and vocal fremitus \tn 
% Row Count 12 (+ 2)
% Row 18
\SetRowColor{white}
 & Crackles \tn 
% Row Count 13 (+ 1)
% Row 19
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{The following may be heard directly over the abscess:} \tn 
% Row Count 15 (+ 2)
% Row 20
\SetRowColor{white}
 & Dull percussion note \tn 
% Row Count 16 (+ 1)
% Row 21
\SetRowColor{LightBackground}
 & Bronchial breath sounds \tn 
% Row Count 17 (+ 1)
% Row 22
\SetRowColor{white}
 & Diminished breath sounds \tn 
% Row Count 18 (+ 1)
% Row 23
\SetRowColor{LightBackground}
 & Whispered pectoriloquy \tn 
% Row Count 19 (+ 1)
% Row 24
\SetRowColor{white}
 & Pleural friction rub (if abscess is near pleural surface) \tn 
% Row Count 21 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Clinical Data from Lab Tests}}  \tn
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\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/guenevere_1665205830_sa.PNG}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{8.4cm}{x{2.8 cm} x{5.2 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{ABNORMAL LAB TEST AND PROCEDURE RESULTS}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Sputum Examination}} & Many of these organisms are "slow growers" and may take some time to be identified completely on culture media. \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Anaerobic Organisms} \tn 
% Row Count 6 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Anaerobic Gram-Positive Cocci} \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
 & Peptostreptococci \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Peptococci \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Anaerobic Gram-Negative Bacilli} \tn 
% Row Count 10 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & {\emph{Bacteroides fragilis}} \tn 
% Row Count 11 (+ 1)
% Row 7
\SetRowColor{white}
 & {\emph{Prevotella melaninogenica}} \tn 
% Row Count 13 (+ 2)
% Row 8
\SetRowColor{LightBackground}
 & {\emph{	Fusobacterium species}} \tn 
% Row Count 14 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.84 cm} x{6.16 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{RADIOLOGIC FINDINGS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Chest Radiograph}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & Increased opacity \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & Cavity formation \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
 & Cavities with air-fluid levels \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Fibrosis and calcification \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
 & Pleural effusion \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
Early Stages & reveals localized consolidation \tn 
% Row Count 8 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Later, characteristic radiographic appearance of a lung abscess appears after:} \tn 
% Row Count 10 (+ 2)
% Row 8
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 & (1) the infection ruptures into a bronchus, and/or \tn 
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% Row 9
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 & (2) tissue destruction and necrosis have occurred, and/or \tn 
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% Row 10
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 & (3) partial evacuation of the purulent contents has occurred \tn 
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% Row 11
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\mymulticolumn{2}{x{8.4cm}}{The abscess usually appears on the radiograph as a {\bf{circular radiolucency}} that contains an air-fluid level, surrounded by a dense wall of lung parenchyma.} \tn 
% Row Count 20 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.04 cm} x{4.96 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{General Management of Lung Abscess}}  \tn
% Row 0
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\mymulticolumn{2}{x{8.4cm}}{\{\{ac\}\}{\bf{Medications and Procedures Commonly Prescribed by the Physician}}} \tn 
% Row Count 2 (+ 2)
% Row 1
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\mymulticolumn{2}{x{8.4cm}}{Treatment varies based on the severity of the pneumonia and the lung abscess.} \tn 
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% Row 2
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\mymulticolumn{2}{x{8.4cm}}{Treatment includes appropriate (usually intravenous) {\bf{antimicrobial therapy}} coupled with {\bf{prompt drainage}} and {\bf{surgical debridement}}.} \tn 
% Row Count 7 (+ 3)
% Row 3
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{\bf{{\emph{Clindamycin}}}} & standard treatment for a lung abscess caused by an anaerobic pathogen \tn 
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% Row 4
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\mymulticolumn{2}{x{8.4cm}}{Other drugs that may be used are any combination of:} \tn 
% Row Count 12 (+ 2)
% Row 5
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 & {\bf{{\emph{beta-lactam–beta-lactamase inhibitors}}}} (e.g., ampicillin-sulbactam) \tn 
% Row Count 16 (+ 4)
% Row 6
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 & {\bf{{\emph{penicillin}}}} plus {\bf{{\emph{metronidazole}}}} \tn 
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% Row 7
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 & {\bf{{\emph{carbapenem}}}} \tn 
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% Row 8
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{\bf{{\emph{Linezolid}}}} & When the lung abscess is caused by methicillin-resistant Staphylococcus aureus (MRSA) \tn 
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% Row 9
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Alternative to linezolid & {\emph{vancomycin}} \tn 
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% Row 10
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 & {\emph{ceftaroline}}, {\emph{trimethoprim-sulfamethoxazole}}, and {\emph{telavancin}}. \tn 
% Row Count 28 (+ 3)
% Row 11
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\mymulticolumn{2}{x{8.4cm}}{\{\{ac\}\}{\bf{Respiratory Care Treatment Protocols}}} \tn 
% Row Count 29 (+ 1)
% Row 12
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Oxygen Therapy Protocol}}} \tn 
% Row Count 30 (+ 1)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.04 cm} x{4.96 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{General Management of Lung Abscess (cont)}}  \tn
% Row 13
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 & treat hypoxemia, decrease the work of breathing, and decrease myocardial work \tn 
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% Row 14
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 & Hypoxemia caused by capillary shunting is often refractory to oxygen therapy. \tn 
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% Row 15
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Bronchopulmonary Hygiene Therapy Protocol}}} \tn 
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% Row 16
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 & e excessive production and accumulation of mucus associated with a ruptured lung abscess \tn 
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% Row 17
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Lung Expansion Therapy Protocol}}} \tn 
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% Row 18
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 & alveolar consolidation and atelectasis \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{When treated properly, most patients with a lung abscess show improvement. In acute cases, the size of the abscess quickly decreases and eventually closes altogether. In severe or chronic cases, the patient's improvement may be slow or insignificant, even with appropriate therapy.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}