ER infections 2 Flashcards
Presenting symptoms of Bacterial meningitis include
Classic triad - fever, neck stiff, altered Mental status
- 2/4 symptoms - present in 95% of patients
complications of BM
1- altered mental status 2- Elevated ICP, and cerebral edema 3- seizures 4- focal neurologic deficits 5- sensorineural hearing loss 6- cerebrovascular abnormalities
Spinal needle for an LP is inserted between
3rd and 4th vertebrae
Pink tinge to CSF fluid could indicate
Subarachnoid hemorrhage
CSF analysis of Tube 1,2,3,4
1: Cell count and diff
2: Glucose protein
3: Gram stain, extra fluid for viral etc.
4: repeat cell count,
if blood in 1 and 4 –> likely a hemorrhage
If viral meningitis what do you expect in cell count
Lymphocytosis
If bacterial meningitis what do you expect in cell count
High neutrophils or normal count
- protein usually elevated
When do you treat for bacterial meningitis
RIGHT AWAY
Treatment for Bacterial meningitis
1- Dex (IV - before or with Abx)
- every 6 hours for 2 days to 4 days
- to blunt inflammatory response
causative organisms of bacterial meningitis
1 - strep pneumo
2- listeria
3- gram neg bacilli
Abx to give for BM adults >50
- Ampilicillin, Vanco, Cetriaxone or Cefotaxime
alternate is menopenem and vanco
Abx for BM if 1 month to 50 years
- Vanco, Ceftraixone or Cefotaxime, +/- ampicillin
same as before -
Neonates with BM
high chance of it being group B strep
How do you treat neonates with bM
Ampicillin - IV, and cefotaxime or gentamycin
Which abx treats listeria
AMPICILLIN
Moratility associated with necrotizing fasciitis
25%
Systemic findings of necrotizing fasciitis
- fever
- tachycardia
- hypotension
Necrotizing fasciitis can be of 2 types
Type 1- polymicrobial - aerobes and anaerobes
Type 2 - often GAS
Anaerobic species associated with Type NF
- Bacteroides
- Clostridum
- Peptostrep
- anaerobic strep
- Enterobacteriaceae family
If Type 1 NF of head and neck suspect
Fusobacteria Anerobic strep Bacteroides Spirochetes - ALL ORAL ANAEROBES
Fournier’s gangrene - type 1 NF
- E coli, klebsiella, enterococci
- anaerobes: bacteroides, clostridium, anaerobic strep
Type 1 fresh and salt- water lesions
- aeromonas hydrophila
- or vibrio vulnificus
Type 2 NF also called
Hemolytic Strep gangrene - BETA hemolytic
Treatment Abx for NF
Clindamycin -
Penicillin G Na -
IVIG
EARLY AND COMPLETE SURGICAL DEBRIMENT
