Identifying Sepsis Flashcards
What do you need to consider when looking for infection in a patient?
What about the patient makes them susceptible to certain pathogens.
What the microorganism likes about the environment that causes them to colonise there.
A 55yr old diabetic was admitted fever, rigours, worsening abdo pain, recent constipation and confusion. CT Scan is consistent with perforated diverticulum.
What is the Diagnosis?
Peritonitis with Sepsis.
Diverticular Abscess has perforated to cause Peritonitis as the Bacteria Commensals from the Colon travel to the Sterile Peritoneum.
A 55yr old diabetic was admitted fever, rigours, worsening abdo pain, recent constipation and confusion. CT Scan is consistent with perforated diverticulum.
What is the Pathogen?
Polymicrobial Coliforms, Enterococci and Anaerobes
To put it simply; Gut Commensals
A 55yr old diabetic was admitted fever, rigours, worsening abdo pain, recent constipation and confusion. CT Scan is consistent with perforated diverticulum.
What is the Treatment?
Anaerobes are generally sensitive to Metronidazole.
Enterococci are generally sensitive to Amoxicillin but Testing is required!
Coliforms are generally sensitive to Gentamicin or Aztreonam.
Co-Amoxiclav covers all 3 Bacteria but is not given due to Clostridium Difficile Risk and Risk of Resistance
A 22yr old Student Teacher presents with 2 days of fever, malaise, dry cough, headache and runny, stuffy nose.
What is the Diagnosis?
Viral URTI
Temperature = 39 Pulse = 125bpm RR = 25 BP = 100/70mmHg Alert. WBC Count = 11,000 What is the SIRS Score?
3
Temperature = 39 Pulse = 125bpm RR = 25 BP = 100/70mmHg Alert. WBC Count = 11,000 What is the qSOFA Score?
2
A 22yr old Student Teacher presents with 2 days of fever, malaise, dry cough, headache and runny, stuffy nose.
What is the Treatment?
NO ANTIBIOTICS. If the Story does NOT indicate infection, even with high scores, the patient will not receive antibiotics.
Treatment is Supportive. However, do not forget to safety-net patient as ANY infection can become septic.
A 28yr old woman presents with 1/2day bloody diarrhoea, bruised flank and confusion. Took her son out to a nature park, petted llamas then tried some artisan cheese, buffalo burgers, chutney and pork sausages. What is the Diagnosis?
Gastroenteritis
A 28yr old woman presents with 1/2day bloody diarrhoea, bruised flank and confusion. Took her son out to a nature park, petted llamas then tried some artisan cheese, buffalo burgers, chutney and pork sausages.
What are the Potential Pathogens involved?
E.Coli 0157 = Petting Animals, Pork Sausages
Campylobacter = Sauces/Chutney
Listeria = Cheese, especially if Unpasteurised
A 28yr old woman presents with 1/2day bloody diarrhoea, bruised flank and confusion. Took her son out to a nature park, petted llamas then tried some artisan cheese, buffalo burgers, chutney and pork burgers.
What is the MOST likely pathogen to have caused the Bruising, Blood Diarrhoea and Confusion?
E.Coli 0157, with possible Haemolytic Uraemic Syndrome.
Main clue is the Bruised Flank while Confusion is a poor prognostic sign.
A 28yr old woman presents with 1/2day bloody diarrhoea, bruised flank and confusion. Took her son out to a nature park, petted llamas then tried some artisan cheese, buffalo burgers, chutney and pork burgers.
If causative pathogen is E.coli 0157, what is the treatment?
AVOID ANTIBIOTICS IN E.COLI 0157 AS IT CAN PRECIPITATE HAEMOLYTIC URAEMIC SYNDROME, WHICH IS FATAL
Temperature = 38.2 Pulse = 130bpm RR = 22 BP = 100/40mmHg Confusion. WBC Count = 14,000 What is the SIRS Score?
4
Temperature = 38.2 Pulse = 130bpm RR = 22 BP = 100/40mmHg Confusion. WBC Count = 14,000 What is the qSOFA Score?
3
If a Patient has been on the ANY of the following antibiotic therapy:
Co-Amoxiclav
Clindamycin
Ciprofloxacin (and other quinolones)
Cephalosporins
Which Bacteria should you consider for potential post-infection?
Clostridium Difficile Infection
