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Infectious Disease Flashcards

1
Q

First Line Treatment Chlamydia?

If Prego?

Neonate Conjunctivitis?

A
  1. Doxy 100 mg BID x 7 days
  2. Prego = Azithromycin 1g
  3. Neonate = Erythromycin
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2
Q

What is Gonorrhea?

A

Gram Negative Diplocci

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3
Q

Yellow Green Discharge of anus/vagina/penis/pharynx?

A

Gonorrhea

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4
Q

Gonorrhea Arthritis Dermatitis Syndrome?

A

Disseminated Gonorrhea

  1. Tendon/Joint pain
  2. Rash
  3. Septic Arthritis (knee most common)
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5
Q

Tender Grey/Neurotic center Halo papules?

A

Gonorrhea gone Septic!!!

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6
Q

Treatment of Gonorrhea:

1st Line Healthy?

Septic?

What else should you give?

A
  1. I.M. Ceftriaxone
  2. Septic = I.V. Ceftriaxone

You should give DOXY to cover Chlamydia!

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7
Q

What is Cat Scratch Fever?

A

Bartonella Henselae

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8
Q

Describe onset of Cat Scratch Fever

A

Brown/red ulcers (2-4 weeks)

Fever (7 weeks)

Lymphadenopathy (2-4 months)

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9
Q

Treatment for Cat Scratch Fever

Moderate vs Severe

A

Moderate : Doxy

Sever : Rifampin

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10
Q

What is Clostridium Botulinum

A

Gram + anaerobe with spores

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11
Q

Clostridium Botulinum: with what prevents AcH release causing issues on Cranial Nerves

A

The Snare Protein Cleaver

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12
Q

Clostridium Botulinum Test:

A

Toxin Assay

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13
Q

Clostridium Botulinum Treatment

A

If immediate, Active Charcoal and Antitoxin A/G within 72 hours / Human Botulinum immunoglobulin

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14
Q

Which direction does Clostridium Botulinum move?

A

Head down to Feet

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15
Q

Describe Campylobacter Jejuni

A

Gram Negative Rod
Oxidase Postive
Flagella + Curved corkscrew shaped

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16
Q

Bloody Stool with Ascending paralysis?

A

Campylobacter Jejuni

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17
Q

Most Common Acute Bacteria : Campylobacter Jejuni, where to get it from? (4)

A
  1. Raw Chicken
  2. Unpastorized Milk
  3. Puppy Poop
  4. Pigs
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18
Q

D/X: Campylobacter Jejuni

A

Camp in the Heat (42 Degree Agar)

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19
Q

T/X: Campylobacter Jejuni? (2)

A

Fluoroquinolone or Azithromycin

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20
Q

Describe Vibrio Cholera

A

Gram Negative
Oxidase Postive
Comma Shaped (curved)
Glucose Fermenting
NonLactose

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21
Q

Rice Water Diarrhea?

A

Vibrio Cholera

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22
Q

D/X: Vibrio Cholera

A

Dipstick or Stool

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23
Q

T/X: Vibrio Cholera

A

Fluids + Doxy

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24
Q

Describe Diphtheria?

A

Gram + Rod Anaerobe

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25
How does Diphtheria enter body?
Inhaled POOP
26
Diphtheria: 1. Pseudomemberous? 2. Lymphadenapathy? 3. Myocarditis? 4. Polyneuritis
1. Patchy grey/white exudate that bleeds when scraped 2. Bull Neck Cervical Lymph 3. EKG + Enzymes
27
D/X: Diphtheria?
Elek Test
28
T/X: Diphtheria?
Antitoxin + Erythromycin
29
Describe a Boil/Pustule on skin with Methicillin Res. Staph A. (MRSA) patient?
Pustules w/erythematous base
30
D/X: MRSA Normal Conditions? OutBreak?
Normal - Chromogen Agar or PCR Outbreak - PFGE
31
T/X MRSA: (Irrgate First) Small: Mod: Severe:
Small: Mupirocin Mod: Bactrim or Doxy Severe: Vanco
32
Immune Response to Strep Pyrogens, my immune response mimics Anti-Strep-tolysin and fucks shit up?
Rheumatic Fever
33
Jones Criteria: J. O. N. E. S.
Joints - (poly arthritis) Heart - Carditis Nodules Erythema Marginatum Sydenham Chorea
34
Involuntary hand/feet movement
Sydenham Chorea
35
Non-Puritic Trunk/Limb Rash
Erythema Marginatum
36
Rheumatic Fever: 1. Common Valve Issue? 2. Rhythm Issue? 3. Found on Heart?
1. Mitral Regurgitation 2. A-Fib 3. Aschoff Bodies
37
Direction of Joint Pain Rheumatic Fever?
Ankles/Knees moving up
38
Minor Criteria Jones? C A F P
CRP/ESR increased Arthralgia Fever Prolonged PR Interval
39
T/X Rheumatic Fever: 1st Line: Allergy:
PCN G or Amoxy If Allergy - Erythromycin
40
Dermacentor Tick causes?
Rocky Mountain Fever - Rickettsia Rickettsii
41
D/X Rocky Mountain Fever?
Fever/HA Wrist/Angle Rash that moves to Trunk
42
T/X: Rocky Mountain Spotted Fever
Doxy 200 mg x 7 Days
43
Describe Clostridium Tetani?
Gram + Rods Anaerobe
44
Clostridium Tetani, what does Tetanspasmin Exotoxin block on the pre synapse of motor nerves?
GABA and Glycine
45
S/S Clostridium Tetani 1. 2. 3.
1. Lockjaw (trismus) 2. Risus Sardonicus (raised eyebrow/grin) 3. Opisthotunus (Head/Neck/Back Hyperextension)
46
Risus Sardonicus (raised eyebrow/grin)
47
Opisthotonus (Head/Neck/Back Hyperextension)
48
T/X: Clostridium Tetani
Metronidozol
49
Gram Neg Oxidate Neg NonLactose White/HighPH (MaConkay) H2S producing
Salmella
50
Gram Neg Oxidate Neg NonLactose White/HighPH (MaConkay) NOT H2S producing
Shigellosis
51
Salmonella from contaminated food
S. Typhi
52
Salmonella from fecal matter on food that cause Gastroenteritis?
S. Typh / S. Enteritis
53
Invades Pyer Patch with PeaSoup Diarrhea? Another noticeable Sign? What if Sickle Cell?
Salmella Typhi Rose Spots (Trunk) Sickle = osteomyelitis
54
D/X Salmella?
Culture (Increased WBC but Decreased Platelets)
55
T/X Salmella?
Fluids DO NOT give ABX due to prolonging poop!
56
Inhibits 60s Ribosomes?
Shigellosis Sonnei (most common USA) Flexneri (developing country)
57
Daycare kids, crowded areas that causes watery, mucus bloody painful diarrhea?
Shigellosis
58
S/S Shigellosis (4)
1. Diarrhea (watery, mucus, bloody) painful 2. Cramps 3. Tenesmus 4. High Fever and Chills
59
D/X Shigellosis?
Culture Stool
60
T/X Shigellosis? 1. 2. >18 y/o 3. <18 y/o 4. Caution
1. Fluids 2. Bactrim 3. Azithromycin 4. Don't give meds that stop diarrhea
61
Four Areas for Candidiasis?
1. Vaginal 2. Esophageal 3. Oral 4. Intertrigo
62
Vaginal Candidiasis 1. Describe - 2. KOH - 3. T/X -
1. Itchy, erythema, CURD discharge 2. KOH - Hyphae Budding 3. Miconazole cream 1-7 days or Fluconazole
63
Esophageal Candidiasis 1. Most common? 2. EGD shows? 3. T/X?
1. AIDS 2. Linear erosion 3. Fluconazole
64
Dysphagia, Reflux, Nausea with or w/o pain. Patient is AIDs positive. What do you think it is?
Esophageal Candidiasis
65
T/X Oral Thrush (candidiasis)
Nystatin
66
Describe Intertrgo Candidiasis?
Pruritic BEEFY red rash w/distinct scalloped borders and satellite region
67
T/X Intertrigo Candidiasis: 1. 2. *If in blood?
1. Keep Dry 2. Ketoconazole w/ Hydrocortisone 2.5% If in blood, treat with I.V. AmpB
68
AIDs/immunocomprimised / Acne like ulcers
Cryptococcosis
69
How to contract Cryptococcosis?
Inhaled budding yeast in soil/bird poop
70
Cryptococcosis will cause what most of the time?
Meningoencephalitis
71
Meningoencephalitis Cryptococcosis symptoms? (3)
AMS HA meningismus
72
India Ink Cyst? What does CSF tapping show? 1. 2.
Cryptococcosis 1. increased pressure, protein, lymph 2.decreased glucose
73
T/X Cryptococcosis? 1. 2. If CD4 < 100 prophylaxis 3. Pneumonia
1. AmpB + Flucytosine 2 week followed by Fluconazole 10 weeks 2. Fluconazole 3. Fluconazole
74
Caseous Necrosis granulmoa?
histoplasmosis capsulatum
75
S/S (4)
1. Cough 2. Low grade Fever 3. Tongue Ulcerations 4. Huge Spleen
76
D/X histoplasmosis capsulatum? 1. Takes long time but GOLD Standard What would you see?
1. Urine Cultures Increasing Alkaline Phosphatase LDH postive
77
T/X histoplasmosis capsulatum: 1. Weeks/Months? 2. IF systemic?
Itraconazole weeks/months If Systemic AmpB
78
Interstitial pneumonia with ground glass opacities HIV patient?
pneumocystis jiroveci pneumonia
79
pneumocystis jiroveci pneumonia 3 common symptoms
Dyspnea Fever Non-productive Cough
80
D/X pneumocystis jiroveci pneumonia?
Respiratory Tract tissue sample or Broncho alveoli levaage
81
T/X pneumocystis jiroveci pneumonia? 1. 2. If allergy?
1. Bactrim 2. Pentamidine
82
Atypical Mycrobacterials 1. 2. 3. 4.
1. Mycobacterium avium complex MAC 2. Mycobacterium avium intracellulare MAI 3. Mycobacterium Kansasii 4. Mycobacterium Marinum
83
Most common Atypical Mycobacterial? Location most common?
Mycobacterium Avium complex Lungs
84
85
Treatment: 1. MAC 2. Kensasii 3. TB
1. Clarithromycin + Ethambutol 12 months 2. Rifampin + Ethambutol 3. R.I.P.E. Rifampin Isoniazid Pyrazinamide Ethambutol
86
R.I.P.E. Adverse Effects Rifampin Isoniazid Pyrazinamide Ethambutol
Rifampin - Red/Orange Fluids Isoniazid - I-so-numb = Peripheral Neuropathy GIVE Pyridoxine Pyrazinamide - Pyramid = stones (hyperuicemia) and Sun rash (photo sensitive) Ethambutol
87
Microbacterium Marinum
Aquarium = puncture = Fisherman/Seafood handlers
88
Enterobius
Pinworm
88
Nightime Anal itch? T/X?
Enterobius (Pinworm) Whole family Mebendazole or Albendazole
88
Nematods? (2) Cestode? Trematode?
Pinworm/Roundworm Tapeworm Flukes
89
Ascaris Lumbricoids
Roundworm
90
Ascaris Lumbricoids (RoundWorm) s/s: Small amount? Moderate Amount? Large Amount? T/X
Small = Asymptomic Moderate = Vague Abdomen symptoms Large = Pancreatic/Bile/Appendix issues Mebendazole
90
Patient has vague GI symptoms and unexpected weight loss? D/X T/X
Tapeworm Praziquantel
91
Treatment of Mammal Schistosomes Flukes (swimmers itch)?
Praziquantel
92
Describe Zika Virus?
Tropical Aedes Mosquito that is single RNA Flava virus that infect skin cell.
93
Most Zika virus resolves in 10 days, but what are two complications for a pregnant person needs to be concerned about?
Miscarriage Congenital Microcephaly
93
Patient travels to a tropical area and developed a low grade fever, itchy rash and a mild case of watery eyes. She is pregnant and is concerned for her unborn baby. Describe what you would see if the baby has a congenital microcephaly of the disease above?
1. Intercranial Calcifications 2. Cerebral Malformations
94
A mosquito in Africa carries what type of Parasite?
Plasmodium Parasites
95
Once a Anopheles Mosquito from Africa injects a Plasmodium Parasite into a human, how does it feed and where does it live?
Feeds on RBC's and lives in the Liver
96
S/S of M.A.L.A.R.I.A.?
Malaria Anemia Liver Failure AMS Round n Round Fever Infant Death (miscarriage) Abnormal Large Spleen
97
Malaria: 1. Daily on/off fever? 2. Every other day Fever? 3. Every three days fever?
1. Falciparum 2. Vivax/Ovale 3. Malariae
97
D/X Malaria?
Thick/Thin Smears and Blood cultures
98
T/X Malaria: Normal: Resistant: Chemoprophylaxis:
Normal = Chloroquine Resistant = ACT prophylaxis follow above
99
Ring Enhanced Legions Aids Patient
Toxoplasmosis
100
Group of diseases that can be passed from mother to baby in womb? ToRCH
Toxoplasmosis Rubella Cytomegalovirus Herpes
101
Inflammation of the brain, post-infection, that causes fever, headaches and neck pain?
Encephalitis
102
Inflammation of the (thin pigmented vascular coat of the eye) and the eye itself post-infection of Toxoplasmosis?
Chorioretinitis
103
S/S Toxoplasmosis? 1. 2. 3.
1. Encephalitis 2. Chorioretinitis 3. Intercranial Calcifications
104
T/X Toxoplasmosis: First Line Tx? If CD4 < 100 then?
Pyrimethamine + Sulfadiasine HIV CD4 <100 = Bactrim prophylaxis
105
Pregnant mother that was discovered to have Toxoplasmosis, baby was born,,, what would you notice if the baby has a congenital defect? (2)
Blue berry rash + hearing loss
106
Type of Tick that causes Lyme Disease? Type of parasite that travel with tick to cause Lyme disease?
1. Ixodes scapularis 2. Borrelia Burgdorferi
107
Lyme Disease Stages: Stage 1 (7-10 days): Stage 2 (1-12 weeks): (3) Stage 3 (Late): (3)
Stage 1: Bullseye Rash Stage 2. Flu-Like, Bells palsy CN VII, AVBlock Stage 3. Polyarthritis/polyneuropathy/encephalopathy
108
D/X Lyme disease Two Tiers?
Tier 1 = EIA or EFA Tier 2 = Western blot IgG/IgM
109
T/X Lyme disease: Normal? Prego? Late Stage?
1. Doxy 2. Amoxicillin 3. 3rd Gen Cephalosporin or PCN G
110
Most common non-viral STD?
Trichomoniasis Vaginalis
111
S/S of Trichomoniasis Vaginalis? (3)
1. Malodorous green/gray discharge 2. Frothy petechiae cervix (strawberry) 3. Burn/itch/pain sex
112
D/X Trichomoniasis Vaginalis smear shows?
pear-shaped protozoa with flagella and pH >4.5
113
T/X Trichomoniasis Vaginalis?
Metronidazole (also treat partner)
114
Congenital Varicella: Fetus infect 8-28 weeks 30% fatal w/in 1 month of birth 15% Herpes w/in 4 years of life S/X (5)
1. Scars w/ dermatomal patterns 2. Neuro/ocular deficits 3. Limb deficits 4. GI issues 5. Decrease birth wt.
115
D/X Congenital Varicella?
PCR baby blood or amniotic fluid for VzV DNA
116
Congenital Varicella what not to give to mother? and what to do if the mother has immunity?
NO live vaccine Reassurance that its going to be ok
117
You conduct a Direct viral test of a lesion from a pregnant mother testing positive for Herpes Virus. How should you treat? New Onset? To surpress? If shedding?
Aclylovir 400 mg x 7 days Acyclovir 400 mg TID C-Section
118
Extremely rare to pass on this STD from mother to baby, and only c-section is recommended if obstruction?
Perinatal Human Papillomavirus (HPV)
119
D/X HPV Colposcopy will show? 1. 2.
Colposcopy will show 1. Low-grade squamous 2. ASCUS HPV positive
120
HSV 1 - Oral Lesions (cold sore)
121
HSV 2 Genital Lesions
122
HSV 2 Genital Lesions
123
Most common form of herpes that leads to Viral Meningitis?
HSV 2 Genital Lesions
124
What? Describe?
1. HHV 3 - VZV Varicella Zoster Chicken Pox 2. Dewdrop on a rose pedal
125
What? Describe?
1. HHV 3 - VZV Varicella Zoster Shingles 2. Unilateral Dermatomal pattern
126
HHV 4 - EBV Epstein Barr
127
HHV 5 - CMV Cytomegalovirus
127
HHV 6 - Roseola Virus a.k.a. 6th disease
128
HSV - Herpetic Whitlow
129
Herpes Labials
Herpes of the mouth
130
Herpes Gladiaturum
Westler trunk Herpes
131
Blanching dendritic lesion around the Eye caused by herpes?
Keratoconjunctivitis Herpes
132
Herpes, why is PCR assay better than Tzank? What would the Tzank test show?
Because PCR assay is better! Multinucleated Giant Cells
133
Double stranded DNA virus that is leaner? What is this pattern called?
Herpes Simplex Virus Cowdry Bodies
134
Hutchinson Sign
Varicella Zoster Shingles
135
T/X Varicella Zoster: 1. Normal and Prego 2. < 12 y/o 3. > 12 y/o Bonus: What not to give if child has VZV? What should you give instead?
1. Acyclovir 2. Nothing 3. Valacyclovir DONT GIVE salicylate because risk of Reys Syndrom Instead give them Acetaminophen
136
VSV Vaccine schedule:
1st dose at 12-15 months 2nd dose at 4-6 y/o
137
To prevent shingles if older than 50 y/o, give? If active shingles give?
Shingrex 2 does 6 months apart Valaclovir
138
If you have a 21 y/o pregnant women with not history of have vaccine or chickenpox, what should you do for her?
Give her Varcilla-Zoster immuneglobin
139
Classic Triad for the KISSING disease (Epstein Barr)?
Fever Pharyngitis Lymphadenopathy
140
Patient was complaining of symptoms that lead the Practitioner to give an antibiotic thinking it was a bacterial disease. The patent soon after developed a macular rash and now you believe the patient might have a virus instead. What virus and what antibiotic was given that caused the rash?
Epstein Barr Virus and the patient must have received Ampicillin
141
D/X Epstein Barr Virus EBV HHS 4? (2)
Blood Smear showing atypical lymph Monospot showing heterophiles antibodies
142
T/X Epstein Barr Virus EBV HHS 4?
Support (fluids, gargle salt, no sport 4 week)
143
Why no sport for 4 weeks with a Epstein Barr Virus EBV HHS 4 patient?
Patients can develop splenomegaly
144
Cytomegalovirus CMV 5 (ToRCH): Where does it go dormant? Who does it develop in?
Dormant in B/T cells and macrophages Immunocompromised
145
Most common Viral Fetal Infection?
Cytomegalovirus CMV 5 (ToRCH)
146
Describe congenital Cytomegalovirus CMV 5 (ToRCH)? (5)
Blueberry rash Jaundice Seizures Deaf Perintercrainal calcifications
147
You received back a Tissue biopsy that shows Owls eye inclusion, what do you suspect it is?
Cytomegalovirus CMV 5 (ToRCH)
148
T/X Cytomegalovirus CMV 5 (ToRCH)?
Ganciclovir
149
Roseola Infantum HHV 6, occurs in?
Children less than 2 years old
150
S/S Roseola Infantum? (3)
1. Extremly High Fever 2. Lacy blanching body rash (trunk to arms) 3. Nagayama's Spots
151
Patients develops a rash that started at the trunk after a few days of a very high fever. The rash has now moved to the extremities. What disease?
Roseola Infantum HHV 6
152
Treatment?
Support (fluids, rest, NSAIDS)
153
Fifths Disease or Parvovirus B19?
Erythema Infectiosum (Slap Cheek)
154
Fun Fact about the rash for Roseola infantum HHV 6?
The only rash that start at the trunk and moves to the extremities
154
Patients has a low grade fever, then devlopes a rash that began in the face but has moved to the body. What do you expect this to be?
5ths Disease Erythema Infectiosum (slap cheek)
155
As a concerned practitioner, what type of patients can have a aplastic crisis with 5ths Disease Erythema Infectiosum (slap cheek)?
Sickle Cell G6PD Thalassemia
156
D/X and T/X for 5ths Disease Erythema Infectiosum (slap cheek)?
Clinical and Supportive care
157
1. HPV Stereotype that causes Cutaneous Warts? 2. HPV Stereotype that causes Genital Warts? 2. HPV Stereotype that causes Cervical Cancer?
1. Cutaneous = 1,2,4 2. Genital = 6,11 3. Cervical Cx = 16, 18 (USA)
158
Most patients never realize they have HPV, what test should you order if PAP smear came back showing Stage II dysplasia?
Colposcopy and HPV test
159
HPV Gardasil vaccine Schedule 1. 2.
1. 11-12 y/o x 2 doses 2. 13-26 y/o to catch-up
160
Condyloma Acumination = Condyloma Lata =
Condyloma Acumination = HPV genital warts Condyloma Lata = Secondary Syphilis white lesions
161
Koilocytic squamous clumps
HPV Human Papillomavirus
162
Patient develops a rash that started at the trunk after a few days of a very high fever. The rash has now moved to the extremities. What disease?
Roseola Infantum HHV 6
162
Influenza Prophylaxis Vaccine Starts at what age?
> 6 months old
163
Influenza treatment: 1. Neuraminidase inhibitors Dr. OZ P.hD
Oseltamivir, Zanamivir, and Peramivir
164
Gold Standard D/X influenza?
RT-PCR
165
1. MMR vaccine protect against? 2. Frist dose? 3. Second dose?
1. Measles, Mumps, RubeLLa 2. 12 months 3. 15-16 months
166
Macular-Papular blanching rash
Rubeola (Measles) virus
167
Bright Red spots w/blue/white center like GRAINS of Sand
Koplik Spots
168
Phases of Rubeola (Measles) Virus Phase 1: 1-3 days ... 3c's Phase 2: 48 hours later Phase 3: 2-4 days later
Phase 1: Cough, Coryza, Conjunctivitis with Fever Phase 2: Rash + Koplike spots Phase 3: brick red rash maculopapular blanching rash face down
169
D/X Rubeola (measles)?
Fever x 3 days + Koplik spots + one of the 3 c's
169
T/X Rubeola (measles)
Isolate for 1 week if Rash + support
169
Mumps
170
Mumps can cause whats in males?
Orchitis (swollen testes)
171
Mumps can make you testes as big as POP Poms
Parotitis Orchitis Mengitits (aseptic) Pancreatitis
171
TX for Mumps
Isolate 5 days + Support
172
Pinpoint Red Macula's on soft palate
Forchheimer spots
174
What is Rubella (German mumps) called the 3 day version of measles?
Rash in gone within 3 days
175
Patients comes in with a rash that started in the face and moved down the body. After 3 days, the rash was gone. You notice pinpoint red macula's on the soft palate. What is you D/X?
Rubella (German mumps)
176
What can Rubella (German mumps) cause in the 1st Trimester of pregnancy?
Deaf, Dumb and Blind + PDA baby
177
T/X Rubella (German Mumps)?
Support
178
What virus most commonly in bats cause Rabies?
Ribonucleic RNA rhabdovirus
179
Incubation of RNA rhabdoviurs (Rabies)? Symptoms?
1 to 3 months Hydrophobia (can't swallow water) Fear of draft fresh air
180
Before rabies death, test? After rabies death, test?
Before = RT-PCR + Skin + CSF After = Negri Bodies
181
AIDS = CD4 counts <
200
182
Protocol for CD4 < 350 HIV patient?
HAART 1. NNRTI + 2 NTRIs or PI + 2NTRIs 2. INSTI + 2 NTRIs
183
CD4 < 250
Coccidioidomycosis = Annual Testing + Fluconazole
184
CD4 < 200
Pneumocystis = Bactrim
185
CD4 < 150
Histoplasmosis = test only
186
CD4 < 100
Toxoplasmosis/Cyptococcus only treat Toxoplasmosis TMP-SMX (Bactrim)
187
CD4 < 50
MAC = ART treatment
188
Sepsis is life threatening, what 3 areas are disfunctioning?
Circulatory Cellular Metobolic
189
Indirect marker of tissue Perfusion?
Lactate
190
Most common cause of sepsis?
Pneumonia
191
Criteria for sepsis SIRS (old) SOFA and NEWS, what information does this give?
Mortality predicition
192
Gram + Septic shock? (2) Gram - Septic Shock? (4) KEPP
Gram + : Staph/Strep Gram - : Klesbella, E. coli, Proteus, Pseudomonas
193
Sepsis biomarkers (2)
Procalcitonin (increased w/in 4 hours) Lactate (>18)
194
Treatment for Sepsis 1. 2. 3. 4. 5.
1. Remove cause of infection! 2. NormSaline fluids 30 ml/kg x 3 hours 3. Empiric Antibiotics 4. NoriEpi to get MAP > 65 5. Remove all existing catheters

PANCE k.i.s.s. (2 decks)

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