infectious disease Flashcards
Tests if you are suspicious of Epstein Barr virus
full blood count looking for leucocytosis and lymphocytosis
heterophil antibody tests: Paul Bunnell monospot test
limitation can happen because of infection in the early 2 weeks
blood film? atypical T lymph or lycocytosis.
What not to prescribe in glandular fever
amoxicillin or ampicillin
if you suspect a patient has TB what should you do?
- call micro and double check that they look for acid fast bacilli (ziehl-Nielson)
- TB is notifiable therefore contact public health services
- place patient in isolation
- test her for HIV
- look for signs of spread to other organs, pain in the joints (potts fracture) genitourinary infection or ab pain
- refer to TB service
carbapenemase producing enterobacterales spread by
contact (hand)
what are some of the resistant organisms?
gram neg
gram positive
MDRO
CPE species
gram neg
bacilli= klebsiella spp.
e. coli
enterobacter spp
CPe is resistant to what antibiotic?
meropenem
exa,pales of enterobacterales
E.coli
k pneumoniae
k oxytocin
e cloacae
treatment of CPE
amoxicillin
co-amoxiclav
ceftriaxone
ciprofloxacin
gentamicin
what is the enzyme that predominate in this hospital with CPE resistance
OXA48
why does the strain matter?
because if it is CPE different strains cannot be in contact… otherwise will produce vertical transmission
when are the patients still considered contacts
before 4 negative fecal screen for CPE
what infecting organism would you suspect in a women who traveled from Ghana and has diarrhoea with RIF pain?
Yersinia enterocolitica
what is most important in the management of a patient with diarrhoea
fluid resus and oral rehydration salts
what is a fluid challenge and what are the three possible outcomes of it?
A fluid challenge is 250-500 ml of crystalloid solution given Iv over 30 minutes to a patient who is hypovolemic (dry mucous membranes, increased skin turgor, and thirsty and tachycardia narrow pulse pressure or low blood pressure)
- no improvement- patient is wither still hypovolemic or patient was not hypovolemic to begin with reassess to make sure hypo and then another fluid challenge.
- transient response in blood pressure= patient is hypo but either not enough fluid given or they are haemorrhaging. give more fluids and think clinically about explanation
- sustained response with increased blood pressure. YAY it worked
what are maintenance fluids? How much fluids does a person lose a day?
2.5 L
100 microM Na
70 microM K
need to replace if a patient can’t drink or eat
what are replacement fluids?
maintenance fluids are good, but what is the patient is losing more fluids than normal due to abnormally high fluid loss?
This is where replacement fluids come in
How much replacement fluids does a patient with a fever need?
extra 500ml for every 1C over 37
How much replacement fluid does a burns patient need?
use the Parkland formula
How much replacement fluids do the stoma patients need?
measuring and recording the amount of excess fluid is being lost as the stoma bag is drained. Normal loss is only 200ml a day, so anything in excess needs to be replaced.
How much fluid replacement does a patient with a third space need? What is a third space?
the third space is an area of the body that accumulates fluid only in disease, resulting in fluids draining from the first and second spaces. it is hard to calculate fluid lost, will have to fluid replace and then keep reassessing patient.
signs of hypovolemia
dry mucous membranes, patient thirsty, increased skin turgor tachycardia, narrow pulse pressure, hypotension
signs of fluid overload
oedematous face or legs
raised JVP
crep at the lung bases
What must you always do in a patient receiving IV therapy for fluid resus
document fluid input and output
and take bloods for biochemistry (hyponatremic, hyperkalemia)
what volume should a patient be getting a day?
25-30ml/kg/day
how much e- should they be getting a day?
1mmol/ kg/day K Na CL
how much glucose a day?
100 g/day to prevent starvation
