Surgical Infections Flashcards
(113 cards)
1
Q
Temperature
A
<36 C or >38 C
2
Q
HR
A
> 90 beats per minute
3
Q
RR
A
> 20 breaths per minute
4
Q
PaCO2
A
< 32 mmHg
5
Q
WBC Count
A
<4000 or >12000 cells/mm3 or >10% immature forms
6
Q
UTI
A
3-5 days
7
Q
Pneumonia
A
7-10 days
8
Q
Bacteremia
A
7-14 days
9
Q
Penetrating gastrointestinal trauma
A
12-24 hours
10
Q
Perforated or gangrenous appendicitis
A
3-5 days
11
Q
Peritoneal soilage secondary to perforated viscus with moderate contamination
A
5-7 days
12
Q
Extensive peritoneal soilage (feculent peritonitis) in the immunocompromised host
A
7-14 days
13
Q
Only skin microbiota
A
Class I: Clean
14
Q
Opened w/o significant spillage
A
Class II: Clean contaminated
15
Q
Open accidental wounds
A
Class III: Contaminated
16
Q
Traumatic wound + significant treatment delay
A
Class IV: Dirty
17
Q
Necrotic tissue, purulent discharge
A
Class IV: Dirty
18
Q
Introduction of bacteria due to major breaks in sterile technique (open cardiac massage)
A
Class III: Contaminated
19
Q
Perforated viscus high degree of contamination
A
Class IV: Dirty
20
Q
Hernia repair
A
Class I: Clean
21
Q
Perforated diverticulitis
A
Class IV: Dirty
22
Q
Breast biopsy specimen P device (mesh, valve)
A
Class I: Clean
23
Q
Cholecystectomy
A
Class II: Clean contaminated
24
Q
Elective GI surgery (not colon)
A
Class II: Clean contaminated
25
Penetrating abdominal trauma
Class III: Contaminated
26
Necrotizing soft
| tissue infections
Class IV: Dirty
27
Large tissue injury
Class III: Contaminated
28
Enterotomy during bowel obstruction
Class III: Contaminated
29
Occurs when microbes invade normally sterile peritoneal cavity via hematogenous dissemination from distant source of infection or direct inoculation
Primary microbial peritonitis
30
Common among patients who retain large amounts of peritoneal fluid due to ascites and those treated for renal failure via peritoneal dialysis
Primary microbial peritonitis
31
Diffuse tenderness
Primary microbial peritonitis
32
Guarding without localized findings
Primary microbial peritonitis
33
Absence of pneumoperitoneum
Primary microbial peritonitis
34
Occurs subsequent to contamination of the peritoneal cavity due to perforation or severe inflammation and infection of an intra-abdominal organ
Secondary microbial peritonitis
35
Poorly understood entity that is more common in immunosuppressed patients
Tertiary (Persistent) Peritonitis
36
Peritoneal host defences do not effectively clear or sequester the initial secondary microbial peritoneal infection
Tertiary (Persistent) Peritonitis
37
Develops in the absence of original visceral organ
Tertiary (Persistent) Peritonitis
38
Caused by manipulation of the biliary tract to treat a variety of diseases but nearly 50% of patients have no identifiable cause
Pyogenic liver abscess
39
Should be sampled and treated with a 4 to 6 week course of antibiotics
Small (< 1 cm), multiple abscesses
40
Parameters for antibiotic therapy and drain removal for larger abscesses:
1. Clear evidence cavity collapse
2. Output <10 - 20 mL/d
3. No evidence of ongoing source of contamination
4. Clinical condition improved
41
Dosage of metronidazole for amoebic liver abscess:
750 mg TID x 10 days
42
Current care includes staging with dynamic, contrast material enhanced helical CT scan to evaluate the extent of pancreatitis coupled with the use of one of several prognostic scoring systems.
Severe Acute Pancreatitis
43
Placed past the ligament of Treitz, associated with decreased development of infected necrosis → decreased gut translocation of bacteria
Nasojejunal feeding tubes
44
Dilation of the retroperitoneal drain tract
VARD (Video-Assisted Retroperitoneal Drainage)
45
Debridement of pancreatic bed
VARD (Video-Assisted Retroperitoneal Drainage)
46
Repeat debridement are performed as clinically indicated with most patients requiring multiple debridement.
VARD (Video-Assisted Retroperitoneal Drainage)
47
Culture of postoperative UTI SYMPTOMATIC patients:
>104 CFU/mL microbes
48
Culture of postoperative UTI ASYMPTOMATIC patients:
>105 CFU/mL microbes
49
Due to prolonged mechanical ventilation
Nosocomial Pneumonia
50
Infection associated with indwelling intravascular catheters
Bacteremia
51
Selected catheter infections due to low-virulence microbes such as Staphylococcus epidermidis can be effectively treated in approximately 50% to 60% of patients with a __________ course of an antibiotic, which should be considered when no other vascular access site exists
14- to 21-day
52
Central Venous Pressure (CVP)
8-12 mmHg
53
Mean Arterial Pressure
| MAP
≥ 65 mmHg
54
Urine Output
≥ 0.5 mL/kg/h
55
Mixed Venous Oxygen
| Saturation
65%
56
IV antibiotic therapy
1st hour after sepsis recognition
57
Broad spectrum
Penetration into presumed
| source
58
Discontinue antibiotic
7-10 days
59
1 L; CVP = 8-12 mmHg
Crystalloid
60
First line of choice
Centrally administered
| norepinephrine
61
Setting of myocardial
| dysfunction
Dobutamine
62
Intravenous hydrocortisone dose
<300 mg/d
63
Septic shock hypotension
Intravenous hydrocortisone
64
Poor response to fluids and
| vasopressors
Intravenous hydrocortisone
65
Hgb < 7.0 g/dL
RBC
66
Acute lung injury
VT 6 mL/kg body weight
Plateau pressure ≤ 30 cm H2O
67
Avoid lung collapse
Positive end-expiratory
| pressure
68
Discontinue mechanical
| ventilation
Weaning protocol
69
Prevent stress ulcer
Proton pump inhibitor
| H2 blocker
70
Prevent DVT
Low does fractionated
| heparin
71
Hospital-associated infection
MRSA
72
More common in chronically ill patients receiving multiple
| courses of antibiotic
MRSA
73
MRSA produce a toxin knowns as:
Panton-Valentin leukocidin
74
make up an increasingly high percentage of surgical
site infections since they are resistant to commonly
employed prophylactic antimicrobial agents.
Panton-Valentin leukocidin
75
Produce a plasmid-mediated inducible β-lactamase.
Extended spectrum β-lactamase (ESBL)
76
Sensitive to first-, second-, or third- generation
| cephalosporins with resistance to others
Extended spectrum β-lactamase (ESBL)
77
Use of this seemingly active agent leads to rapid induction of
resistance and failure of antibiotic therapy.
Extended spectrum β-lactamase (ESBL)
78
Treatment for ESBL:
Carbapenem
79
Resistance is transposon-mediated
Vancomycin-resistant strain of Enterococcus (VRSE)
80
Can transfer genetic material to S aureus in a host coinfected
with both organisms which can lead to
Vancomycin resistance in S aureus (VRSA)
81
Needlestick from a source with HIV-infected blood
0.3% estimated risk of transmission
82
Significantly decreased the risk of seroconversion
Antiretroviral Therapy (ART)
83
2-3-drug regimen
Raltegavir
| Tenofovir/emtricitabine
84
develops in 75% to 80% of patients with
| the infection
Chronic carrier state
85
occurs in three-fourths of patients who
| develop chronic infection
Chronic liver disease
86
Seroconversion rate after accidental needlestick
1.8%
87
Treatment for HCV:
Ribavirin + Pegylated gamma interferon
88
United States halted BWA programs
Presidential Decree in 1971
89
Inhalational anthrax develops after a _________________.
1- to 6-day incubation period
90
Chest roentgenographic findings in Anthrax:
Widened mediastinum
| Pleural effusions
91
Post exposure prophylaxis for anthrax:
Ciprofloxacin
Doxycycline
Amoxicillin
92
Treatment for anthrax:
ciprofloxacin, clindamycin, and
| rifampin
93
To block production of toxin
Clindamycin
94
Penetrates into the central nervous system and
| intracellular locations
Rifampin
95
Epidemic pneumonia with blood-tinged sputum if aerosolized
| bacteria are used
Plague
96
Individuals who develop the following are suspected with
| Bubonic plague:
1. Painful enlarged lymph node lesions "bubo"
2. Fever
3. Severe malaise
4. Exposure to fleas
97
Post exposure prophylaxis for plague:
Doxycycline
98
Treatment of the pneumonic or bubonic/septicemic form:
1. Streptomycin
2. Doxycycline
3. Ciprofloxacin
4. Levofloxacin
5. Chloramphenicol
99
Prolonged viability has been demonstrated in scabs up to
| _______ after collection
13 years
100
Incubation period for small pox:
10 to 12 days
101
Postexposure prophylaxis for smallpox:
Cidofovir
102
After inoculation, the organism proliferates within
| macrophages
Tularemia
103
Treatment of inhalational tularemia
Aminoglycoside
| Doxycycline and ciprofloxacin (Second-line agents)
104
Cardiovascular surgery
Cefazolin
| Cefuroxime
105
Gastroduodenal areal small intestinel nonobstructed
Cefazolin
106
Biliary tract; open procedure, laparascopic high risk
```
Cefazolin
Cefoxitin
Cefotetan
Ceftriaxone
Ampicillin-sulbactam
```
107
Biliary tract; laparascopic low risk
None
108
Appendectomy, uncomplicated
Cefoxitin
Cefotetan
Cefazolin + Metronidazole
109
Colorectal surgery, obstructed small intestine
```
Cefazolin or Ceftriaxone
Metronidazole
Ertapenem
Cefoxitin
Cefotetan
Ampicillin-Sulbactam
```
110
Head and neck; clean contaminated
Cefazolin or cefuroxime
Metronidazole
Ampicilin-Sulbactam
111
Neurosurgical procedures
Cefazolin
112
Orthopedic surgery
Cefazolin
| Ceftriaxone
113
Breast, hernia
Cefazolin
