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YEAR 3 NICE > Sepsis > Flashcards

Sepsis Flashcards

1
Q

want to give sepsis bundle within what time

A

one hour

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2
Q

when do you want to do multiple blood culture sets

A

endocarditis suspected

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3
Q

what fluids for sepsis

A

500ml of hartmanns/saline over 15-20 mins

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4
Q

if lactate is high consider giving

A

fluids

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5
Q

non blanching rash can also be

A

sepsis

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6
Q

mottled skin appearance can suggest

A

sepsis

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7
Q

what is colonisation

A

presence of microbe in th ebody WITHOUT an inflammatory response

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8
Q

what is defined as sepsis shock

A

sepsis and both of persistent HYPOtension (requiring vasopressors to maintain MAP to at least 65) and lactate greater than 2
(despite adequate volume resusitation)

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9
Q

refractory hypotension suggests

A

septic shock

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10
Q

when do you upgrade to next NEWs level give one example

A

neutropenic

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11
Q

when should NEWs not be used for pregnancy

A

if under 16 or in pregnant woman and it may be unreliable in those with spinal cord injury

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12
Q

when should you used scale 2 of oxygen sats on News score

A

if hypercapnic

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13
Q

vasopressors that can be used in sepsis

A

Norepinephrine, epinephrine, vasopressin

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14
Q

what are the empiric antibiotics

A

amoxicilin, gentamicin and metronidazole

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15
Q

skin, soft tissue, lines, devices suggest what bacteria

A

gram positive cocci

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16
Q

biliary, urinary, gut can suggest what bacteria

A

gram negative bacilli

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17
Q

what orgainsm can autolyse so on the gram stain the organism is not seen

A

strep pneumonia

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18
Q

if on gram stain it shows a gram postive cocci in clusters aka staph aureus then what to we do

A

rapid PCR test

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19
Q

why do we do PCR for staph aureus

A

tells us if its a staph aureus and whether it has the methicillin resistant gene to make it an MRSA

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20
Q

PCR can be used to

A

detect specific genes

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21
Q

if gram stain shows a gram positive cocci in pairs or chains aka streptococcal species we can do what

A

agglutination assay

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22
Q

bad thing about agglutination test

A

not sensitive as read by humans so subject to error

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23
Q

difference in apha, beta and gamma haemolysis

A

a- incomplete
b- complete
g- none

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24
Q

after gram stain and rapid test we then set up

A

culture plates

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25
Q

if big circle in disc diffusion means what

A

antibitoic is sensitive and working

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26
Q

method that tells us whether the organism is resistant or sensitive

A

disc diffusion

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27
Q

what can you do to avoid false negatives

A

take cultures before starting antibiotics

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28
Q

cultures cannot detect dead bacteria. so if culture fails but there is a strong suspicion of infection you can do

A

PCR or sequencing

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29
Q

very high levels of CRP are associated with what infection

A

bacterial

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30
Q

gram negative is what colour

A

pink

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31
Q

why is gram positive purple

A

thick petidoglycan wall

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32
Q

5 main gram negativce

A

E.coli, Neisseria meningitis, proteus, klebsiella and Enterobacter (not to be confused with gram pos enterococcus)

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33
Q

the pathogenicity is often associated with the what layer of the gram negative cell

A

LPS - lipopolysaccharide

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34
Q

e.coli is a

A

gram neg bacilli/rods

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35
Q

what are coliforms

A

gram neg rods

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36
Q

extended spectrum beta lactamases cannot give what antibitotics

A

penicillins, cephalosporins, aztreonam

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37
Q

the bigger the clear circle in culture

A

the better the antibiotic as there is no bacteria growth

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38
Q

what do you need to minitor daily if start patietn on gentamicin

A

renal function daily

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39
Q

gram neg coccobacillus

A

H. influenza

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40
Q

when classed as hospital acquired pneumonia

A

been in for longer than 48hrs

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41
Q

what bacteria needs chocolate agar as will generally not grow on blood agar

A

h. influenza

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42
Q

what antibiotic is often given for h. influenza

A

amoxicillin

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43
Q

what anibiotic is given for atypical pneumonia eg mycoplasma, Coxiella, Chlamydophilia, Legionella

A

doxycycline
Clarithromycin also works
Levofloxacin if penicilin allergic or Legionella (however c.diff risk as is a fluoquionolone)

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44
Q

fluoroquinolones end in

A

floxacin

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45
Q

when to not use urinalysis

A

those over 65 or those with urinary catheters

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46
Q

first line for complicated UTI

A

amoxicillin and gentamicin

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47
Q

if complicated UTI wg with fever what will not be effective

A

nitrofurantoin

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48
Q

finding staph epidermidis is only significant if got

A

prosthetic material

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49
Q

Most e.coli are sensitive to what

A

co- trimoxazole

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50
Q

what can treat staph epidermidis if got proshetic material

A

Vancomycin

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51
Q

what bacteria will you make the patient more unwell if you give them IV antiviotics

A

c. difficile and e.coli

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52
Q

examples of gram NEG COCCI

A

neisseria meningitidis

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53
Q

clostridium is a gram positive

A

bacilli

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54
Q

what is the causative organism of Lyme disease

A

Borrelia burgdorferi

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55
Q

examples of spiral shaped organisms (spiroachaetes)

A

Borrelia burgdorferi and treponema pallidum

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56
Q

coagulase differentiated from staph aureus and epidermidis. But what differentiates between strep and staph

A

Catalase

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57
Q

what is catalase positve

A

staphylococcus

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58
Q

what is catalase negative

A

strep

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59
Q

examples of alpha haemolytic strep

A

viridans and pneumonia

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60
Q

what is given for staph aureus if allergic to fluclox or MRSA species

A

Iv vancomycin

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61
Q

example of beta haemolytic strep

A

pyogenes

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62
Q

where is strep pyogenes found

A

skin and soft tissue infection

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63
Q

what organisms cause subacute endocarditis

A

viridans and enterococci

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64
Q

what are significant pathogens in urinary tract infection

A

enterococci

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65
Q

streptoccus are commensal in the GI tract eg viridans lives in the — and enterocci lives in the

A

mouth, bowel

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66
Q

what drug are widely used for streptococcus

A

penicllins

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67
Q

green discolouration is what haemolysis

A

alpha

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68
Q

alpha haemolysis can suggest

A

strep viridans or pneumoniae

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69
Q

beta haemolysis - cplete clearing and what colour

A

bright yellow

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70
Q

beta organisms -

A

strep pyogenes

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71
Q

gamma haemolysis organisms

A

enteroccoi

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72
Q

alpha haemoltic strep in suspected endocarditis are suggestive of viridans or pneumoniae but which one is it

A

viridans - as much more common cause of endocardiits

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73
Q

dukes criteria

A

likelihood of endocardiits

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74
Q

classification of streptoccocus using

A

lancefield antigen

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75
Q

pyogenes infections associated with

A

pharyngitis or skin infections

76
Q

bacteria associated with pregnancy and neonates

A

strep agalactiae

77
Q

gram positive bacilli includes

A

listeria, colstridium

78
Q

common gram pos

A

strep, staph listeria, clostridium

79
Q

drug of choice for enterococcus

A

amoxicillin
vancomycin if allergic

80
Q

alpha haemolytic

A

viridans and pneumoniae

81
Q

clostridium perfringens

A

soft tissue infection

82
Q

more difficult for antibiotics to get into what areas as they have tight junctions

A

CNS, eyes and prostate

83
Q

sepsis usually requires antibitoics given how

A

IV

84
Q

what can measure the minimum inhibitory conc of antibiotics

A

broth dilution

85
Q

when is wound swaps only really recommednded

A

if open wound with significant exudate

86
Q

strep pyogenes is sensitive to

A

penicllin

87
Q

pseudomomas aeruginosa is well known to colonise chronic wounds. How do you manage it

A

nothing just stick with original treatment

88
Q

what antibiotic is usually given for a skin infection

A

flucloxacillin

89
Q

c. difficle is a

A

bacilli

90
Q

rf for c. difficile

A

gastric acid suppression

91
Q

what antibiotic are not effective against C. difficile

A

IV

92
Q

additional test for c. diff

A

PCR stool

93
Q

why cannot use hand gel and got to use soap and water for c.diff

A

spores are resistant to alcohol gel

94
Q

bloody diarrhoea top of the differential is

A

shiga toxin producing e.coli

95
Q

what is a key concern from shiga toxin producing e.coli

A

haemolytic uraemic sydnrome

96
Q

haemolytic uraemic syndrome triad

A

haemolytic anaemia, thrombocytopenia, aki

97
Q

diagnosis of shiga toxin producing e.coli

A

selective culture and shiga toxin testing of stool

98
Q

management of shiga toxin producing e.coli

A

supprtive -fluids.
Avoid antibiotics as increased risk of haemolytic uraemic syndrome

99
Q

ideally how do you want to take blood cultures in endocarditis

A

3 sets 6 hrs apart
however if sepsis- minimum 2 sets over first hour

100
Q

if got implantable cardiac electric device usualy organism is

A

staph especially staph aureus

101
Q

what staph aureus is most common in ICED infection(cardiac device)

A

Methycillin sensitive staph aureus ( not resistant)!

102
Q

in ICED can be staph auerus or epidermidis. epidermidis has Mec gene which is MRSA so what do you give

A

IV vancomycin first lien

103
Q

if septic arthritis is confimed what is mandatory

A

washout

104
Q

most common pathogens for CAP -comm acquired pneum

A

step pneum and h. infleunza

105
Q

curb 65 is what (CAP)

A

new confusion
urea over 7
resp rate over 30
bp <90/60
age over 65

106
Q

curb score -0-2

A

amoxicillin and doxycycline in allergy

107
Q

what antibiotic for mild curb if penicillin allergic and need IV

A

clarithromycin

108
Q

curb65 of 3 or more

A

Co - amoxiclav plus doxycycline
allergy - levofloxacin

109
Q

what antibiotic is used in severe disease for gram neg cover

A

co-amoxiclav

110
Q

additional investigation if legionella

A

urinary antigen

111
Q

what should be offered to all pts with pneumonia

A

HIV testing

112
Q

what is done 6 weeks after penumonia

A

CXR - to ensure resolution and no underlying malignancy is at risk

113
Q

most common organism for peripheral venous cannula that may have been from surgery

A

staph aureus

114
Q

staph aureus bacteraemia mx

A

48 hourly cultures until negative
Thansthoracic echo in all
Minimum 2 weeks IV fluxclo therapy traditionally recommended. if allergic then Iv vancomycin

115
Q

when can you assume someone is neutropenic in cases of potential neutropenic sepsis

A

if had chemo within the past 3 weeks

116
Q

mx of neutropenic + sepsis and news score is less than 6

A

Piperacillin/ tazobactam

117
Q

mx of neutropenic septic SHOCK or news over 7

A

Piperacillin/tazobactam and gentamicin

118
Q

why do cf patients need longer duration of treatment

A

biofilm forms

119
Q

CMV you get

A

visual changes

120
Q

what is raised in pneumocystis jiroveci

A

LDH

121
Q

most common aspergillus

A

A. fumigatus

122
Q

what lab testing for malaria

A

blood smears

123
Q

malaria can occur up to how long post travel

A

up to 1 year

124
Q

plasmodium falciparum

A

malaria

125
Q

enteric fever can present as

A

fever and abdo pain - typhoid

126
Q

dengue has what 3 symptoms

A

fever, athralgia and leukopenia

127
Q

mx for dengue is

A

supportive care

128
Q

ebola is a

A

viral haemorrhagic fever

129
Q

risk of c. diff remains up to how long after an antibiotic course

A

12 weeks

130
Q

4 C antibitoics

A

co - amoxiclav
clindamycin
ciprofloxacin (and other quinolones)
cephalosporins eg ceftriaxone

131
Q

what should only be used as a last resort

A

fluoroquinolones

132
Q

what can identify bacteria in 6hrs

A

MALDI TOF

133
Q

gram neg associated with

A

GI tract

134
Q

gram pos associated with

A

skin and mucous membranes

135
Q

vancomycin side effect

A

red person syndrome

136
Q

nitrofurantoin can cause

A

peripheral neuropathy

137
Q

what drug is an enzyme inducer

A

rifampicin

138
Q

what antibiotic interacts with alcohol

A

metronidazole

139
Q

macrolides and quinolones can prolong the

A

QT interval

140
Q

side effects common to antibiotics in general

A

Gi disturbance and skin rash

141
Q

capillary leakage in sepsis can result in

A

oedema, diarrhoea and vomiting

142
Q

sepsis defined by

A

News score greater than 5 and infection

143
Q

mottled skin and non blanchign rash can suggest

A

sepsis

144
Q

septic shock is when

A

persisten hypotension despite adequate fluid

145
Q

sepsis 6 bundle should be given within how long from recognition

A

1 hr

146
Q

what oxygen mask for critically unwell eg in sepsis

A

non re breathe

147
Q

most common source of sepsis

A

chest

148
Q

antibiotics for cellulitus

A

fluclox and if allergic then doxycycline

149
Q

what fluids are first line for resuscitation

A

crystalloids

150
Q

examples of crystalloids

A

hartmanns, plasmalyte and sodium chloride

151
Q

caution regarding what with lots of hartmanns

A

potassium overload

152
Q

what can help guide fluid therapy and help guide ICU referral if needed

A

lactate and Urine output

153
Q

target output for UO in sepsis

A

0.5ml/kg/hr

154
Q

do get the urine output of a patient you need to do what

A

catheterise the patient

155
Q

bioavailabilty of the antibiotic refers to

A

absorption

156
Q

what is - the fraction of the administered drug that reaches the systemic circulation in the unchanged form

A

bioavailability

157
Q

gentamicin is in what class of antibiotics

A

aminoglycosides

158
Q

rougly how long does it take for lab results to come back eg how long might they be on empirical antibitiotics

A

48-72hrs

159
Q

treating what can give antibiotics in the abscence of a positive culture

A

cellulitis as the most common causative organisms are strep and staph

160
Q

what antibiotics are useless in ESBLs

A

penicillins , cephalosporins, aztreonam

161
Q

older people often have asymptomatic bacteriuria but it does not indicate

A

infection

162
Q

what urine does not mean infection

A

dark or foul smelling - may just be a sign of dehydration

163
Q

how long after giving antibiotics for sepsus should you review to see if can stop or switch therapy

A

48-72hrs

164
Q

what is the drug of choice for sepsis with coliforms

A

gentamicin

165
Q

complicatef UTI in priamry care

A

co amoxiclav or co-trimoxazole
whereas secondary care - amox and gent then step down to co trimoxzole

166
Q

examples of anaerobes

A

clostridium and bacteriodes

167
Q

antibiotic of choice for sepsis with anaerobes

A

metronidzole

168
Q

drug of choice for sepsis and enterococci in GI tract

A

amoxicillin

169
Q

neutropenic sepsis mx

A

piperacillin/ tazobactam

170
Q

mx for neutropenic sepsis with septic shock

A

piperacillin/tazobactam and gentamicin

171
Q

mx of bacterial meningitis

A

ceftriaxone and dexamethasone

172
Q

if listeria cover required in bacterial meningitis then

A

stop dexamethasone and add amoxicillin

173
Q

what that is not a bacteria will stain methyl purple

A

candida

174
Q

vibrio shape looks like what

A

curved c shape

175
Q

diplococci grow in

A

pairs

176
Q

example of a gram pos diplococci

A

strep pneumoniae

177
Q

another example of a gram pos cocci in chians

A

strep pyogenes

178
Q

strep pyogenes infection can present as

A

tonsilitis, scarlet fever

179
Q

strep pneumoniae and viridans show what haemolysis

A

alpha

180
Q

staph epidermidis shows what haemolysis

A

gamma

181
Q

strep pyogenes shows what haemolysis

A

beta

182
Q

neisseria and h. infleunxa are both gram negative what is slight difference

A

n- diplococci
h- coccabacilli

183
Q

example of spirochetes

A

treponema pallidum and borrelia burgdorferi

184
Q

bacteria that dont gram stain

A

myobacteria tuberculosis hence why you need to do ziehl neelson stain

185
Q

difference between strep penumoniae and strep pyogenes

A

pyogenes is in chains and pneumoniae is diplococci

186
Q

gram positive clusters can also be

A

staph epidermidis

YEAR 3 NICE (14 decks)

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