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DU PA Inf Dz Emerg

Duke PA Infectious Disease Emergencies

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