Flashcards in Urosepsis Deck (18):
Most common infections in patients older than 65 years?
Risk factors for UTIs?
Incontinence, prior UTIs, neurologic impairment, anti-cholinergics
In symptomatic patients how much bacteria is typically found in the urine?
10^5 colony forming units from a clean catch specimen
10^2 from catheterization
Leukocyte esterase versus nitrites?
Pyuria versus bacteriuria
Clinical syndromes of UTIs?
Acute uncomplicated cystitis – lower tract infection
Acute uncomplicated pyelonephritis – upper tract infection
Complicated UTI – associated with urinary catheter or functional abnormalities
Symptoms of cystitis Versus pyelonephritis?
Dysuria, frequency, urgency, hematuria versus Fevers, chills, and nausea, with or without symptoms of cystitis
Suspected UTI, begin treatment when?
Immediately (before results of cultures)
Treatment for uncomplicated UTIs? In patients presenting with clinical picture of sepsis?
Fluoroquinolones (ciprofloxacin and gatifloxacin)
Gentamicin, imipenem, Bactrim
Hypovolemic shock results with how much loss of fluid?
20 to 40% blood volume
Treatment of cardiogenic shock?
1. Maintain blood pressure dopamine or norepinephrine
2. Relieve pulmonary edema with diuretics
3. Reduce cardiac afterload with intrathoracic balloon pump
Increase in cardiac output with inability to maintain vascular resistance (inappropriately vasodilation)
Phases of distributive shock?
1. Initially, extremities are warm and well perfused
2. Cardiac output falls causing intense vasoconstriction (cold things)
Causes of distributive shock?
1. Septic shock
2. Neurogenic shock from spinal cord injury or adrenal crisis
Treatment of Distributive shock?
1. Isotonic volume repletion
2. Vasopressors support (dopamine)
3. Mechanical ventilation
Mortality from all types of shock?
Only type of patient to benefit from asymptomatic bacteriuria? Why?
Pregnant patients. Prevents upper tract infection, preterm delivery, fetal loss
Dose regimens for UTIs?
Acute uncomplicated cystitis – Single-dose ciprofloxacin or 3 Day dose bactrim useful
Pyelonephritis – 14 day course of IV then oral gatifloxacin