SEPSIS & DM LE INFECTION

Question 1

What are the two type of variables involved in systemic inflammatory response syndrome?

Answer 1

General or Inflammatory

Question 2

Leukocytosis (WBC greater than 12), normal WBC (with left shift or greater than 10% neutrophils), CRP is more than 2 standard deviations – are examples of what?

Answer 2

Inflammatory variables of SIRS

Question 3

What are some of the main general variables of SIRS?

Answer 3

Temp 100.9+ or less than 96.8
HR 90+
Tachypnea (RR 20+)

Question 4

What is sepsis?

Answer 4

SIRS + Infection

Question 5

What are some of the common bacterial infections of sepsis?

Answer 5

UTI, cellulitis, and pneumonia

Question 6

What are some of the common viral infections of sepsis?

Answer 6

Influenza, viral meningitis, and severe shingles

Question 7

Is diagnosing someone with sepsis good enough?

Answer 7

NO! We must communicate if it Severe or Shock Sepsis

Question 8

What would constitute as severe sepsis?

Answer 8

2+ SIRS criteria + Infection + [one of the following]:

End organ damage = hypotension, renal failure, shock liver, coagulopathy, respiratory failure, or elevated lactic acid

Question 9

What is considered hypotension of Severe Sepsis?

Answer 9

MAP less than 65
SBP less than 90
***AT ANY ONE CHECK

Question 10

What would indicate renal failure?

What would indicate elevated lactic acid?

Answer 10

Renal Failure = Cr greater than 2.0

Lactic acid = 2+

***Know this! Lactic acid levels are a VERY good indicator of sepsis

Question 11

What lab would indicate severe shock of the liver?

Answer 11

Bili 2+

Question 12

What is Septic Shock?

Answer 12

Severe sepsis via Hypoperfusion PERSISTENT that continues for longer than 1 HOUR AFTER aggressive fluid resuscitation

*Sys BP less than 90 x2 checks (or MAP less than 65 x2), worsening BP, lactate level is 4+

Question 13

Does SIRS mean you have an infection?

Answer 13

Nope!

Question 14

Septic shock has what percentage of mortality?

Answer 14

46%

Question 15

If the lactic acid is 3 – what’s the status? What’s the risk this person could die?

Answer 15

Severe Sepsis

Risk = 20%

Question 16

If a patient with pancreatic CA presents with fatigue; his temp is 100F, HR 101, RR 21, and BP 110/70. His labs come back with WBC 17, CRP 12. UA and CXR are negative – what does he have?

Answer 16

SIRS

Question 17

The patient with SIRS is started on fluids and blood cultures and BMP are obtained. His blood culture show growth and Cr comes back with a 2.1 – what is going on?

Answer 17

Severe Sepsis

Question 18

How do we treat Severe Sepsis?

Answer 18

Start broad spectrum Abx:
Monotherapy – Cephalosporins or Floroquinolones
Combo Tx – Cipro + Vanco

Question 19

Your patient was treated for MRSA, he finished his Abx, and was readmitted to the hospital. He has a fever and tiny maroonish/blackish spots on toes and the blood cultures grow GPC 2/2 – what do you think of now?

Answer 19

Endocarditis

Question 20

What are the spots his feet known as?

Answer 20

Janeway lesions or Oslar nodes

Question 21

What is the Duke criteria used for?

Answer 21

Major & Minor criteria for Endocarditis

Question 22

What are some of the common bacteria associated with Endocarditis?

Answer 22

Strep veridans

Staph aureus

Enterococcus

Question 23

Positive blood cultures x2, persistent (+) blood cultures after/during treatment, and TTE shows a vegetation are all a part of what in the Duke criteria?

Answer 23

MAJOR criteria

Question 24

Presence of a valvular heart disease, Hx IV drug use, fever, and unexplained vascular phenomenon (conjunctival or intracranial hemorrhage, petechiae, or emboli) are all a part of what in the Duke criteria?

Answer 24

MINOR criteria

Question 25

When you have endocarditis – who do you call?

Answer 25

The ID doc!

Question 26

What’s the secondary imaging you should get for endocarditis?

Answer 26

TEE

Question 27

How do you typically treat endocarditis?

Answer 27

Vancomycin

Question 28

So, in summary, what lab should we always follow with SIRS or Sepsis?

Answer 28

Blood culture before Abx!! Follow them until Tx finalized

Always remember Endocarditis!!

Question 29

What are the 2 components of osteomyelitis?

Answer 29

Hematogenous or Contiguous

Question 30

If the cause of the osteomyelitis is bacteremia (from anywhere in the body), is monomicrobial, with blood/bone cultures that match – what type is it?

Answer 30

Hematogenous

Question 31

If the cause of the osteomyelitis is bacteria from adjacent tissues, is polymicrobial, and blood cultures are no positive – what type is it?

Answer 31

Contiguous

Question 32

What types of patients develop contiguous osteomyelitis?

Answer 32

Diabetics

Question 33

If a diabetic patient has slow onset of a wound that heal slowly and is either non-healing or recurrent ulcer – what do we worry about?

Answer 33

Contiguous Osteomyelitis

Question 34

What labs do we order for osteomyelitis?

Answer 34

WBC, ESR, CRP, Probe the bone

Question 35

When you probe the ulcer and you see bone and touch bone – what is it?

Answer 35

Assume osteo until proven otherwise

Question 36

What type of diagnostics should you when you suspect osteomyelitis?

Answer 36

MRI (is best)*****

XR, CT, Nuclear med bone scan

Question 37

How do you treat contiguous osteomyelitis?

Answer 37

Involve ID!!

Start broad spectrum Parenteral (IV) Abx = Metronidazole +

Cefepime (or Floro) + Vanco

Follow Bone Cultures DAILY

Question 38

How long is treatment for osteomyelitis typically?

Answer 38

6 weeks

Question 39

So, if we have a diabetic with a foot ulceration – what do we think of?

Answer 39

Osteomyelitis

Question 40

What’s the best imaging for osteo?

Answer 40

XR is good, but MRI is better