EM Infectious Emergencies Flashcards
what is a life-threatening organ dysfunction due to dysregulated host response to infection
sepsis
what is lactate an indication of
hypoperfusion
- increased mortality
What are initial orders for sepsis
IV/O2/Monitor
IV fluids
CBC, CMP, PT/PTT, Lactate, cultures, procalcitonin, ABG/VBG
what does elevated procalcitonin correlate with
bacterial infections and sepsis
-acute phase reactant
What is a scoring tool for sepsis
qSOFA (Quick SOFA)
- AMS
- RR
- SBP < 100
What are exclusions for simple cellulitis
bite wounds
water exposure
post op wounds
immunocompromised wounds
locatoin
perianal/perirectal
What is a collection of purulent discharge, may be associated with opening in skin or from entry through hair follicle
abscess
what are exam findings for abscess
area of fluctuance
erythema
pain
US findings
pretty much always MRSA
What are risk factors for MRSA
IVDU
health care
homelessness
nursing home
incarceraton
multiple lesions
what covers MRSA
abx
Bactrim
Doxycycline
Clindamycin
Vanco
what is toxic shock associated with
tampon use
nasal packing
surgical wounds
postpartum infections
how does toxic shock present
erythematous rash which will dequamate on hand/feet
- sunburn-like rash
febrile and hypotensive
how is toxic shock treated
remove source of infection and start abx with CLindamycin and Vanco
- admit
how does necrotizing fasciitis spread
through muscle fascia, may have anesthesia of skin prior to necrosis
can extend into muscle or skin
how is necrotizing fasciitis diagnosed
a
air on imaging
finger test (numb area finger into wound)
check electrolytes
What is Fourniers Gangrene
necrotizing fascitits of perineum and most commonly involving scotum
what is the presentation of fourniers gangrene
severe pain that typically starts along anterior abdomen and can migrate to gluteus and genitals
what is erysipelas
infection of epidermis, upper dermis and lymphatics
m/c on face or LE
what is the presentation of anaplasmosis and ehrlichiosis
acute illness with fever, malaise, HA, chills, N/V, arthralgias
non-specific maculopapular rash, strawberry tongue, conjunctivitis, hepatosplenomegaly, neurologyic symptoms
when do symtpoms of ehrlichiosis (HME) occur
1-2 weeks after the bite
when do symptoms of anaplasmosis (HGA) occur
5.5 days
what is the treatment of anaplasmosis and ehrlichiosis
Doxycycline 100mg BID 5-7 days
how long does RMSF usually last
10-20 days
- pt becomes sick within 1 week after inoculation
what is the presentation of early disseminated Lyme
2-4 weeks after erythema migrans
can develop lymphocytic meningitis, carditis (AV nodal block), MSK invovlement, multiple erythema migrans lesions, lymphadenopathy, conjunctivitis, LFT abnormalalitis, proteinuria
what is the presentation of late/chronic lyme
intermitten monoarticular arthritis, neurologic disease (neuropathy, or encephalomyelitis)
what is the most common pathogen with infective endocarditis
streptococci or staphylococci
what are risk factors for infective endocardidits
IVDU
immunocompromised
dental or surgical procedures
congenital or acquired heart disease
what are janeway lesions
non-tender erythematous macules on palms or soles
what are osler nodes
tender subQ nodules on finger/toes
what is the diagnostic criteria for infective endocarditis
Duke Criteria
- 1 major, 3 minor
what diagnostic test is necessary for dx of infective endocarditis
TEE
what is the treatment of infective endocarditis
broad spectrum abx
- i.e. Vanco
What is the presentation of infective carditis
fever, anorexia, malaise, HA, arthralgias, nigh wears, murmurs, petechiae, splinter hemorrhages, janeway lesions, oslers node
what is the most common pathogen with UTI
E. coli
what is the treatment of uncomplicated UTI
abx 3-5days
(Nitrofurantoin, Bactrim, Keflex)
what are symptoms of upper urologic infection?
fever
severe pain
AMS
PG
Comorbiditis
N/V
flank pain
what should be considered if a patient presents with UTI with fever or CVA tenderness
pyelonephritis
what is the treatment of pyelonephritis
ciprofloxacin x 7d
consider one time IM dose ceftriaxone followed by Bactrim, augmentin, cefpodozime
what is the presentation of prostatitis
pain with BM
difficulty with urination, frequency
pain with DRE
what is the treatment of prostatisis
limited abx penetrate prostate tissue, will need longer course (4-6 weeks)
if non STI: Bactrim BID or Ciprofloxacin
if inpt: IV Cipro
How is PEP started
3 drug regimen for 4 weeks
- start within first few hours after exposure
what is the most common STI in the US
chlamydia
what is the presentation of chlamydia
first - cath urine (m or f), or endocercial or urethral swab
what is the treatment of chlamydia
doxycycline
what is the treatment of Gonorrhea
High dose Ceftriaxone IM
what is the presentation of herpes
genital ulcers, fever, lymphadenopathy, HA, dyuria
how is herpes dx
clinical can confirm with viral swab
what is the treatment of herpes
sitz baths for pain so they are able to urinate
acyclovir or valacyclovir
how long after exposure will syphilis chancre form
4-12 weeks after exposure
resolves in 4-6 weeks
what is the treatment of syphilis
penicillin G IM
for PCN allergic: doxyclicline
What is the treatment of Neutropenic fever
empiric abx
fluids
admit
What are do not miss back pain
cancer
AAA
Fracutre
infection
cord syndrome
What are risk factors for spinal infections
IVDU, immunocompromised
what is the presentation of spinal infection
fever + back pain, midline tenderness
what is a inflammatory disease affecting leptomeninges
bacterial meningitis
m/c strepto and meningitides
what is the presentation of bacterial meningitis
fever
nuchal rigidity
severe HA
AMS
N/V
seizures
aphasia
petechiae
what is the treatment of bacterial meningitis
Rocephin
Vanco
Dex
What is the classic triad of bacterial meningitis
fever
stiff neck
change in Mental status
what is the diagnostic procedure of choice for bacterial meningitis
lumbar puncture
What is the presentation of viral meningitis
febrile
no neurological dysfunction
HA
stiff neck
maculopapular rash
muscle aches
N/V
pharyngitis
fatigue
What is the presentation of brain abscess
HA
fever
neck stuffness
focal neuro deficit
seizures
CN6 palsy secondary to elevated ICP
what is the treatment of brain abscess
Vanco + Metronidazole(IV) + Ceftriaxone(IV)
4 - 8 weeks
what happens if brain abscess ruptures
patient dramatically declines
