Final Questions Flashcards
For SIRS, what does it need at least two or more of?
Temp > 38C or < 36C. HR > 90. RR > 20 or PaCO2 < 32 mmHg. WBC > 12,000 or < 4,000, or > 10% immature bands
What are the goals of initial resuscitation of hypoperfusion (first 6h) for sepsis/septic shock?
**MAP: > 65. CVP: 8-12. Urine output > 0.5 ml/kg/hr. Central venous oxygen saturation > 65
When giving hypoperfusion in sepsis/septic shock, when should you reduce the fluid administration rate?
If cardiac filling pressures increase w/o concurrent hemodynamic improvement
When are vasopressors used for severe sepsis/septic shock?
Only given after the patient fails to respond to fluid therapy. They are used to achieve a minimal perfusion pressure and maintain adequate flow. Goal MAP > 65
What are the two best vasopressor choices for septic shock?
Norepinephrine (1st) or Dopamine. These are both good at increasing MAP
Which corticosteroid is the best choice for septic shock when patient fails both fluid therapy AND pressor therapy?
Hydrocortisone IV < 300mg/day
What is a general assessment of meningitis CSF vs. normal CSF?
Higher pressure. Lower glucose (b/c of decreased oxygenation). Protein higher (b/c of edema). WBCs are high (b/c of infection)
What is the main type of bacteria causing meningitis in < 2 months of age?
GBS
What are the common causes of meningitis in patients 2-23 months of age?
Strep. pneumoniae. Some GBS and N. meningitidis
What are the common causes of meningitis in patients 2-34 years of age?
About the same between S. pneumoniae and N. meningitidis
What are the common causes of meningitis in patients 35+ years of age?
Primarily S. pneumoniae
Which antibiotics do not need inflammation to penetrate into CSF?
Rifampin, INH, Pyrazinamide (RIP). Metronidazole, Linezolid, Bactrim (MLB). Before choosing treatment, always check to see if there is inflammation or not
When treating empirically for meningitis in age < 1 month (covering GBS, E. coli, Listeria, Klebsiella), what are some choices?
Ampicillin + Gentamycin. OR. Ampicillin + Cefotaxime
When treating empirically for meningitis in patients 1-23 months, what are your primary choices?
Vancomycin + Cefotaxime/Ceftriaxone
When treating empirically for meningitis in patients 2-50 years, what are your primary choices?
Vancomycin + Cefotaxime/Ceftriaxone
When treating empirically for meningitis in patients 50+ years, what are your primary choices?
Vancomycin + Cefotaxime/Ceftriaxone +/- Ampicillin
What is the definitive therapy for meningitis caused by Strep pneumoniae?
If susceptible: Pen G or Ampicillin. Cefotaxime/Ceftriaxone. Vanco + Cefotaxime/Ceftriaxone. 10-14 days
What is the definitive therapy for meningitis caused by N. meningitidis?
Cefotaxime/Ceftriaxone. 7-10 days
What is the definitive therapy for meningitis caused by H. influenzae?
Cefotaxime/Ceftriaxone. 7-10 days
What is the definitive therapy for meningitis caused by GBS?
Pen G or Ampicillin +/- Aminoglycoside. 14-21 days
What is the o Abx prophylaxis (for family members, dorm-mates who are around an infected person) for meningitis?
Rifampin x2 days. Cipro x1 dose. Ceftriaxone x1 dose
What is the role of Dexamethasone as adjunctive therapy in meningitis treatment?
When you kill bacteria, all the junk inside the bacteria gets released and your immune system mounts a response to this and causes more inflammation. In the case of meningitis, this will cause more swelling/edema which is really bad. Therefore, give dexamethasone (steroid) to prevent this secondary response
How is Dexamethasone dosed in meningitis treatment?
Adults: 10mg Q6h x4 days. Kids: 0.15-0.25 mg/kg Q6h x2-4 days
What is Latent TB like?
Doesn’t feel sick. Not contagious. Needs LTBI treatment + PPD test