Sepsis Flashcards

Question

EtCO2 and Lactate (??)

Answer 1

Low EtCO2 associated with high lactic acid Low EtCO2 predicts mortality

Answer 2

Distinguishing necrotizing fasciitis from necrotizing myositis may be difficult as skeletal muscle and fascia are involved in both syndromes Necrotizing fasciitis: -Most often monomicrobial -Usual causative agent is Streptococcus pyogenes (Group A beta-hemolytic streptococci) -Can also be caused by other streptococcal species, and occasionally by Staphylococcus aureus -Infections can be polymicrobial (mixed aerobic and anaerobic bacteria) -A history of exposure to brackish water or MARINE LIFE should raise suspicion for Vibrio vulnificans or Aeromonas species -Patients with burn injuries are susceptible to Pseudomonas species Necrotizing myositis -Often caused by Clostridia species (clostridial myonecrosis or "gas gangrene")

Answer 3

Presentation is similar to cellulitis but way worse rapid progression systemic toxicity severe pain (pain often subsides as nerve are destroyed) multi-organ failure is common as infection progresses

Answer 4

Elevated white blood cell count, erythrocyte sedimentation rate and C-reactive protein Elevated creatine kinase may indicate muscle involvement Blood, wound, and tissue cultures should be obtained Histologic specimens may demonstrate Extensive tissue destruction Thrombosis of blood vessels Bacteria spreading along fascial planes

Answer 5

creatine kinase?

Answer 6

CT or MRI of the affected area may show gas in tissues or fascial plane infection Imaging may also appear normal, so rely on clinical suspicion and surgical evaluation

Answer 7

Antibiotic therapy should then be tailored to culture results Broad-spectrum antibiotic therapy Should be initiated whenever the diagnosis is suspected Should cover aerobic and anaerobic organisms

Answer 8

Carbap(enem) + agent against MRSA + clindamycin for its antitoxin effects against strains of streptococci + staphylococci

Answer 9

Patients with exposure histories that suggest less common etiologies should have additional therapy targeted to those organisms (sea world worker) Intravenous immunoglobulin for streptococcal necrotizing soft tissue infections -Has been shown to reduce mortality when added to surgical and antibiotic therapy

Answer 10

Early and extensive debridement is essential for survival Surgical evaluation should not be delayed while awaiting imaging or other diagnostic tests, especially in the setting of rapid progression of clinical manifestations

Answer 11

Antibiotic therapy should be continued until all infected tissue has been removed and the patient has stabilized

Answer 12

Multiple organisms that can cause toxic shock syndrome (TSS) include: Staphylococcus aureus Streptococcus Certain Clostridium species (C perfringens, C sordellii) (TSS defined as a systemic shock response to ^)

Answer 13

Strains of staphylococci may produce toxins that can cause three important entities -Scalded skin syndrome, typically in children, or bullous impetigo in adults -TSS -Enterotoxin food poisoning

Answer 14

Any streptococcal infection—and necrotizing fasciitis in particular, can cause TSS TSS is due to pyrogenic erythrotoxin superantigen that stimulates massive release of inflammatory cytokines believed to mediate the shock Invasive disease -Risk factors are age (very young or older persons) and underlying medical conditions -Bacteremia occurs in most cases

Answer 15

C sordellii is a rare cause of endometritis and toxic shock syndrome following childbirth Fatal cases of uterine infection following medically induced abortion with mifepristone have been reported

Answer 16

Toxic shock is characterized by abrupt onset of high fever, vomiting, and watery diarrhea Sore throat, myalgias, and headache are common A diffuse macular erythematous rash and nonpurulent conjunctivitis (like allergic eyes) are common, and desquamation (skin pealing off), especially of the palms and soles, is typical during recovery

Answer 17

Toxic shock is characterized by abrupt onset of high fever, vomiting, and watery diarrhea Sore throat, myalgias, and headache are common A diffuse macular erythematous rash and nonpurulent conjunctivitis (like allergic eyes) are common, and desquamation (skin pealing off), especially of the palms and soles, is typical during recovery

Answer 18

Invasion of skin or soft tissues Acute respiratory distress syndrome Kidney failure Skin rash and desquamation may not be present

Answer 19

Abdominal pain Absence of fever Onset of illness was within 4–5 days of ingestion of mifepristone Clinical course is fulminant Infection appeared to be limited to the uterus, which shows Necrosis Edema Hemorrhage Acute inflammatory changes

Answer 20

If we see desquamation, what's the bacteria? Strept TSS

Answer 21

S aureus Blood cultures classically are negative because symptoms are due to the effects of the toxin and not to the invasive properties of the organism C sordellii Tachycardia, severe hypotension, capillary leak syndrome with edema Profound leukocytosis, hemoconcentration

Answer 22

Rapid rehydration, antistaphylococcal antibiotics (eg, parenteral nafcillin or oxacillin or, in the penicillin allergic patient, clindamycin), management of kidney or heart failure, and most importantly removal of sources of toxin (eg, removal of tampon, drainage of abscess) Intravenous immune globulin may be considered, although there are limited data compared to streptococcus TSS

Answer 23

β-Lactam, such as penicillin, plus clindamycin, (potent inhibitor of toxin production) 600 mg every 8 hours intravenously Consider giving immune globulin as source of specific antibody to streptococcal exotoxins

Answer 24

Early recognition Aggressive resuscitation from shock Immediate surgical debridement with hysterectomy Administration of an antimicrobial active against C sordellii, including: Penicillin Ampicillin Macrolide Clindamycin Tetracycline Metronidazole

Answer 25

Brush summarized this shit in five seconds, figure out a way to do the same for studying

Sepsis Flashcards

(49 cards)