temp >38 or 90 RR>20 WCC>12000 or <4000

sepsis Flashcards by cara mcnaughton

colonisation

the presence of a microbe in the human body without inflammation (staph aureus on skin)

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infection

inflammation due to a microbe

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bacteraemia

presence of a viable bacteria in the blood

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sepsis

life threatening organ dysfunction caused by dysregulated host repsonse to infection

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septic shock

circulatory and cellular/ metabolic dysfunction associated with high risk mortailty
-attempt made at volume resus but still hypotensive
(due to low TPR and due to vasodilation)

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pathogen

any microorganisms that has the potential to cause disease

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virulence

likelihood of causing a disease

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prodome

little bit ill before proper illness

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what is SIRS?

Systemic inflammatory response syndrome

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SIRS criteria?

temp >38 or < 36
HR>90
RR>20
WCC>12000 or <4000

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what is SOFA?

sequential organ function assessment score

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qSOFA criteria?

RR>22
sBP<100
altered GCS

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What news score indicates infection?

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what is infection?

invasion and multiplication of micro organisms within the body

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symptoms of infection?

cough
dysuria
abdo pain
pain
ab bloods
confusion

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septic shock?

hypotension despite fluid resus (30ml/kg) and vasoopressors (adrenaline and noradrenaline)

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What is the sepsis 6?

GIVE 3 TAKE 3
give O2- aiming for 94-98%, if concerned measure ABG
give fluids- 0.9% NaCl saline solution (hartmanns) aiming for MAP >65mmHg
give antibiotics- broad spec, amoxicillin, metronidazole and gentamicin
take lactate- high lactate= sign of hypoperfusion
take urine output- marker of organ perfusion
take blood- for culture

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what do you do if MAP <65mmHg after resus?

add vasopressors (noradrenaline) via CVC

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How many blood cultures do you take?

1 (3 if suspected endocarditis)

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what do you do it there is an abscess present?

Drain it

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what is empirical management?

very educated guess

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how do you assess pnuemonia?

curb 65

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how do you assess endocarditis?

dukes criteria

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what do toxins from bacteria cause?

vasodilation

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what is ascites a sign of?

peritonitis

what indicated secondary bacterial peritonitis

history of trauma/perforated bowel

what is amoxicillin used for?

gram +ve (enterococci)

what is gentamicin used for?

gram -ve (coliforms)

what is metronidazole used for?

anaerobes

where are anaerobes most likely to be found?

in places with little o2 (ie bowel)

what grows on Mckonkey agar?

E.coli

vibro shaped?

cholera

what colonises in the mouth?

strep virdans neisseria anaerobes

what colonises in the colon?

e.coli klebsiella enterobacter (coliforms)

what colonises in the colon?

e.coli klebsiella enterobacter (coliforms)

what colonises on the skin?

staph. aureus

describe gram +ve bacteria wall

thick peptiglycan layer (purple)

describe gram -ve bacteria wall

thin peptiglycan layer (pink)

what to phagocytes target?

bacteria | fungi

what do T lymphocytes target?

viruses | parasites

what do antibodies and B lymphocytes target?

viruses

what do eosinophils target?

fungi parasites worms

what do mast cells target?

worms

what cells does HIV target?

CD4+ CELLS

describe alpha haemolysis?

partial green -virdans pneumoniae

describe beta haemolysis?

complete white -GAS -strep pyrogenes

describe gamma haemolysis?

no haemolysis red -enterococci

what do sebaceous glands secrete?

antimicrobial peptides

what are the main APC of the body?

langerhan cells

Staphlcocci

catalase positive - staph epidermis - staph aureus

Staphylcocci

catalase positive - staph epidermis (no haemolysis, coagulase -ve) - staph aureus (golden on blood agar)

streptococci

strep virdans and strep pneumoniae (alpha haemolysis) GAS- strep pyrogenes (beta haemolysis) GBS-strep agalactaiae (beta haemolysis)

Enterococci

``` often in pairs intestine commensals -e.faecalis -e.faecium VRE- vancomycin resistant enterococci ```

Gram +ve bacilli organisms:

- listeria monocytogenes (GI, cheeses) - Clostridia (c.diff, c.perfringens- wound infections) - corynebacterium (diphtheroids) - bacillus cereus

Enterococci

``` often in pairs intestine commensals -e.faecalis -e.faecium VRE- vancomycin resistant enterococci (Tx: linezolid, daptomycin, tigecycline) ```

penicillin binds to step pneumoniae enzymes that are required to synthesis peptidoglycan layer- inhibits it

if recent travel to areas with penicillin resistant strep then IV vancomycin

Strep Bovis

typical endocarditis pathogen | requires colonoscopy due to risk of colon cancer

Enterococci- in GI tract, UTI, endocarditis, bacteriaemia | how is it Tx?

AmoxicillinIV - amoxicillin/ co-trimoxazole oral = step down - vancomycin if amoxicillin resistant

Tx of staph aureus?

Flucloxicillin IV in sepsis | Vancomycin in allergy or MRSA

C.diff

Faecal-oral transmission | must wash hands after being in contact as spore forming and gel = not effective

4 C's

ciprofloxacin co-amoxiclav clindamycin cefrazidime

Tx of c.diff

oral vancomycin

Tx of c.diff

oral vancomycin

Gram -ve bacterias are mostly which shape?

bacilli

what are antibiotics for Gram -ve bacteria?

beta lactams - azatreonam (monobactam) purely active against gram -ve aminogllycosides -gentamicin (only if kindeys are ok) macrolides, tetracyclines, chloramphenicol, cotrimoxazole, polumixins

what are gram -ve cocci

neiserrria | gonorrhoea

H.influenzae

``` gram -ve coccobacillus aerobic will not grow on chocolate agar vitro growth factors required (x factor- hemin and v factor) Tx: amoxicillin and doxycycline TYPE B CAPSULAR ANTIGEN ```

What are some atypical pnuemonias?

all except strep.pnuemonia

Tx of atypical pneumonias?

doxycyline or tetracycline or clarithromycin | levofloxacin if penicillin allergic

Tx of atypical pneumonias?

doxycyline or tetracycline or clarithromycin | levofloxacin if penicillin allergic

Tx of legionella

co-amoxiclav and levofloxacin

what is legionella assoc w/

luke warm water and aerosolised water (showers, aircon)

how do you diagnose legionella

urine antigen

what are coliforms?

gram -ve rods eg E.coli, klebsiella, enterobacter

treatment for coliforms

Gentamicin

what is the likely causitive organism in endocarditis after a prosthetic valve?

strep virdans

sepsis Flashcards

(76 cards)