Flashcards in Infectious Diseases Deck (97)
factitious fever - findings
young woman pt
fever diary - unusual fever patterns (very high or brief spikes), absent diurnal variation
rapid defervescence w/o chills
which drugs can cause malignant hyperthermia?
1. inhalational anesthetics - halothane, isoflurane, enflurane etc
2. depolarizing mm relaxants - succinylcholine, decamethonium
pt develops sustained muscle contractions, skeletal mm rigidity, elevated CK and acute renal failure, tachycardia, hypercarbia, hypertension, hyperthermia, tachypneas and cardiac arrhythmias a few hours after general anesthesia...diagnosis?
what can you suspect in a pt w/ a family history of problems during anesthesia?
risk of malignant hyperthermia
MC offending agents in neuroleptic malignant syndrome
- can occur after all D2-receptor antagonists, usually soon after starting or with dose escalation
in whom has neuroleptic malignant syndrome been reported in?
Parkinson pts who abruptly discontinue levodopa or anticholinergic therapy
compared to neuroleptic malignant syndrome, what findings are unique to serotonin syndrome?
what is always next best step in septic pts with identified source of infection?
remove source of infection - indwelling catheters, drain abscess, surgical debridement
when can you use drotrecogin alfa (activated protein C)?
in severe sepsis or septic shock - APACHE score > 25 or two or more sepsis-induced organ dysfunctions (recently, shown to have no survival benefit, taken off market in 2011)
when should you consider using vasopressors in shock?
if fluid challenge fails to achieve a mean arterial pressure > 65 mmHg despite adequate fluid resuscitation (4-6L w/in 6 hours)
in pts with severe sepsis, what intervention will most likely improve survival?
aggressive fluid resuscitation w/ reduction of lactic acidosis w/in 6 hours
reasonable goals for fluid resuscitation (4)
1. SCVO2 atleast 70%
2. CVP of 8-12 mmHg
3. MAP > 65 mmHg
4. urine output atleast 0.5 ml/kg/hr
blood transfusion in shock pts?
transfusion threshold of 7g/dl is acceptable, conservative approach
for IV fluid resuscitation in shock, which is better...colloid or crystalloid solutions?
none - there is no benefit of one over the other
MC vasopressor used in septic shock
norepinephrine - potent vasocontrictor that reverses the endotoxin-induced vasodilation
role of Dopamine in shock
DA is a useful vasopressor - do not use low dose DA (no benefit on renal or other clinical outcomes)
s/e: tachycardia, arrhythmias
drotrecogin alfa (protein C) therapy should be considered in patients with the following criteria (3)
1. septic shock requiring vasopressors/fluids
2. sepsis-induced ARDS requiring mechanical ventilation
3. any two sepsis-damaged organs
diagnostic criteria for sepsis (2)
1. culture proven infection/visual ID of infection
2. evidence of systemic response to infection (fever, HR, RR, elevated WBC w/ immature band forms)
severe sepsis - definition
sepsis associated w/ organ dysfunction, hypoperfusion or hypotension
septic shock - definition
subset of severe sepsis; sepsis-induced hypotension despite adequate fluid resuscitation plus presence of perfusion abnormalities (i.e. lactic acidosis)
definition of SIRS (systemic inflammatory response syndrome)
atleast TWO of the following:
1. fever > 38 or < 36
2. HR > 90/min
3. RR > 20/min or PCO2 < 32 mmHg
4. WBC > 12000 or < 4000 or > 12% band forms
complications of untreated group A strep infection
pt presents with sore throat not improving on antibiotics, fever, dysphagia, pooling of saliva and drooling, muffled voice and deviation of uvula - probable diagnosis?
next best step if you suspect peritonsillar abscess?
emergency ENT consultation
treatment of peritonsillar abscess
needle drainage or surgical incision
antibiotics - ampicillin/sulbactam or parenteral penicillin G + metronidazole
can you recommend echinacea for prevention of URIs?
no - studies have failed to show consistent benefit
MCC of otitis media
strep.pneumo (followed by H.influenza and Staph aureus, Moraxella)
first line antibiotic for tx. of otitis media
- oral macrolides in penicillin allergic pts
if sx of otitis media do not improve w/in 48-72 hrs of amoxicillin use, what should you do?
initiate amoxicillin-clavulanate, cefuroxime or ceftriaxone