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DU PA Inf Dz Emerg
Duke PA Infectious Disease Emergencies
| Question | Answer |
|---|---|
| what is the mortality rate of sepsis/septic shock | 40-50% |
| presence of infection + systemic response | sepsis |
| sepsis (presence of infection + systemic response), + one or more sepsis related organ dysfunctions | severe sepsis |
| sepsis (presence of infection + systemic response) + hypotension + tissue hypoperfusion | septic shock |
| remote tissue inflammation, vasodilation, increased microvascular permeability, leukocyte accumulation, temp >38 or <36, HR >90, RR >20 or PaCO2 <32, WBC >12,00 or <4,00 or >10 percent bands | SIRS (Systemic Inflammatory Response Syndrome) |
| bacteria commonly involved in sepsis | E.coli, S. pneumoniae, S. aureus, Multidrug resistant gram negatives (Pseudomonas, Acinetobacter, Proteus, Klebsiella, Enterobacter), Group A strep, anaerobics |
| labs to get in the w/u of sepsis | CBC, chems (LFTs, bicarb, creatinine), PT/PTT, Lactate |
| an important marker of global tissue hypoxia | lactate |
| additional labs to evaluate source of sepsis | blood cultures, UA,urine C & S, CXR, discharge from lesions, sterile fluids if suspected |
| treatment priorities for sepsis | oxygen, aggressive fluid replacement, vasopressors (dopamine, dobutamine, norepi, vasopressin) |
| empiric broad spectrum antibiotics used in sepsis | 3rd gen cephalosporins + aminoglycoside (ceftazidime and gentamycin), +/- vancomycin (MRSA)/clindamycin (anerobes) |
| recombinant human activated protein C, only FDA approved drug used solely for the treatment of sepsis in the adult patient with high risk of death. only for use in the ICU | Xigris |
| viral meningitis mortality is low except for __ | HSV |
| what is the classic triad of meningitis | fever, stiff neck and altered mental status (present in 2/3 of meningitis pts) |
| special tests for meningitis | Brudzinski's and Kernig's |
| CSF tube #1 is used for what purpose | appearance; cell count & diff |
| CSF tube #2 is used for what purpose | glucose and protein |
| CSF tube #3 is used for what purpose | gram stain and culture |
| CSF tube #4 is used for what purpose | repeat cell count with differential |
| empiric treatment for bacterial meningitis | begin antibiotics immediately (ceftriaxone or cefotoaxime 2 g IV and vanc. add ampicillin for pts <3months/>55 and or immunocomp |
| what do you add to empiric therapy for meningitis if HSV is suspected | acyclovir |
| what do you give concurrently with empiric antibiotics when treating bacterial meningitis | dexamethasone, continue for 4 days |
| supportive care for bacterial meningitis | hydration, pain meds, anticonv, antiemtics |
| signs of meningococcemia is typical meningitis plus | petechial rash, hypotension, shock/sepsis |
| etoh abuse and pneumonia what organism | klebsiella, gram neg bac, H. flu |
| health care associated pneumonia | pseudomonas, MRSA |
| what is the PORT score | Pneumonia Patient Outcomes Research Team study (pneumonia severity index), based on age, nursing home status, coexisting illnesses, physical exam, lab, radiographic findings |
| outpatient antibiotics for pneumonia | azithro, doxy, levo, cefpodoxime+azithro |
| inpatient regmines for pneumonia | ceftriaxone+azithro, resp fluoroq, +/- vanc |
| who are the high risk TB patients | elderly/nursing home, immingrants, HIV, ETOH/drugs, residents/staff of prisons or shelters |
| most commonly seen in acute endocarditis | S. aureus |
| endocarditis bacteremic symptoms | chills, fever, nausea, fatigue |
| endocarditis cardiac symptoms | tachy, new murmurs, CHF |
| endocarditis embolic symptoms | stroke, pneumo, renal sequelae |
| cutaneous findings of endocarditis | petechiae, splinter hem, osler nodes, janeway lesions, roth spots |
| most common etiology of UTI | E. coli |
| what patients with cystitis should get a urine culture | anyone who is not a healthy young female |
| what is the duration of treatment for uncomplicated cystitis in non-pregnant women/men | 3-5 days |
| what is the duration of treatment for uncomplicated cystitis in children, preg women, and complicated infections in everyone else | 7-10 days |
| antibiotics for cysitis | tmp/smz, nitrofurantoin, quinolones, cephalexin |
| treatment for pyelonephritis | cipro 7-10 days, levo for 7 days, augmentin 10 days, cephalexin 10 days |
| etiology of impetigo | group A strep, or S. aureus |
| treatment of impetigo | cephalexin, diclox, mupirocin, retapamulin |
| superficial cellulitis with lymphatic involvement | erysipelas |
| etiology of erysipelas | GABHS |
| spreading, edematous inflammation of dermis and subQ tissue | cellulitis |
| etiologies of cellulitis | GABHS, S. aureus, gram neg bac, anaerobes in DM/PVD, bites, mycobacteria |
| outpatient treatment for cellulitis | cephalexin, diclox, augmentin, doxy, minocycline, (MRSA-tmp/smx-bactrim or clinda |
| inpatient treatment for cellulitis | IV clinda, IV vanc +/- cefazolin |
| treatment of a fresh bite <24 hours old | exploration/irrigation/immobilization, primary closure if face/head/neck, tetanus/rabies prophylaxis |
| prophylactic antibiotics for fresh bite | augmentin, moxifloxacin, clindamycin + ciprofloxacin |
| most common travel related infection | malaria |
| incubation of malaria in returning travelers | varies from <2 weeks to >6 weeks |
| Necrotizing soft tissue infxns: etiologies | GAS, C. perfringens, MRSA |
| Necrotizing soft tissue infxns: tx | IV vancomycin + IV clindamycin + IV piperacillin/tazobactam |
| Pneumonia: worrisome S/S | RR >30; HR >125; SBP <90 |
| most common organism in bite infxn | Human: Strep spp; cat (80% become infected): pasteurella |
Created by:
bwyche
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