Infection Lecture Flashcards
what are the 6 “general” variables seen in SIRS?
1) temp greater than 100.9 or less than 96.8
2) HR greater than 90 BPM
3) tachypnea RR greater than 20 breaths/min
4) altered mental status
5) significant edema or positive fluid balance
6) hyperglycemia (plasma glucose greater than 140)
what are the 4 “inflammatory” variables seen in SIRS?
1) leukocytosis (greater than 12,000) or leukopenia (less than 4000)
2) normal WBC with greater than 10 percent immature form
3) plasma CRP 2+ SD above normal
4) plasma procalcitonin 2+ SD above normal
SIRS + infection (or possible infection) is called what?
sepsis
in order to be classified as severe sepsis, how many SIRS criteria must you have? what must you have in addition to regular sepsis?
need 2+ SIRS criteria
in addition you have end organ damage
what are some examples of end organ damage in severe sepsis?
1) Hypotension: MAP less than 65, SBP less than 90 at any ONE check
2) Renal failure: Cr greater than 2.0 or oliguria
3) Shock liver: Bili greater than 2
4) Coagulopathy: platelets less than 100, INR greater than 1.5, PTT over 60 seconds
5) Respiratory failure
6) Elevated lactic acid greater than 2
what is septic shock characterized by?
severe hypoperfusion in the first hours AFTER aggressive fluid rescucitation
what are the 3 additional criteria used to diagnose septic shock?
1) severe hypotension (SBP less than 90 x 2 checks or MAP less than 65 x 2 checks)
2) worsening baseline pressure over 40 mmHg SBP compared to previous reading
3) lactate level greater than 4
mortality rate of SIRS vs. septic shock?
SIRS = 7 percent
septic shock = 46 percent
how do we manage SIRS?
start gentle fluid resuscitation, admit patient, get blood cultures (peripheral and central)
what are our options when treating severe sepsis?
monotherapy: carbapenems OR cephalosporins OR fluoroquinolone OR extended spectrum PCN IV
combo therapy: ciprofloxacin (covers pseudomonas) AND vancomycin (covers MRSA)
what is the name of the criteria that we use for diagnosing endocarditis?
duke criteria
what are the major criteria for diagnosing endocarditis? (4)
1) + blood cultures x 2 with common offenders and no clear primary focus
2) persistently + blood cultures after or during tx
3) TTE evidence of vegetation or good auscultation of NEW valvular regurgitation
4) other imaging shows possible intracardiac abnormality
what are the most common etiologies of endocarditis? (3)
strep viridans, staph aureus, enterococcus
minor criteria for endocarditis?
1) presence of valvular heart disease NOS
2) IV drug use
3) fever
4) unexplained vascular phenomenon
what are examples of unexplained vascular phenomenons seen in endocarditis?
conjunctival hemorrhage, cutaneous petechiae, evidence of major or minor arterial emboli, intracranial hemorrhage
