Infectious diseases in the ER Flashcards
what is classic triad of bact. meningitis
- fever
- neck stiffness
- altered mental status
(4) headache
absence of all 3 eliminates diagnosis
what is usual presentation of Bmen
2/4 symptoms in 95% of cases
what are signs to looks for (3)
- papilledema
- brudzinski’s sign
- kernig’s sign
4 short term complications of Bmen
- altered mental status
- elevated ICP
- seizures
- focal neuro deficits
4 long term comp. of Bmen
- cerebrovasc. abnormalities
- intellectual impariment
- sensorineural hearing loss
- death
6 investigations to order for BMen
- labs - CBC, BUN
- ECG
- cultures
- urinalysis/culture
- CT head
- lumbar puncture
what to look for on CT head
space occupying lesion or elevated ICP
where to do lumbar puncture
b/w L3 and L4
what is taken in 4 vials of LP
- cell count and differential
- glucose, protein
- Gram stain, culture, special studies
- cell count and differential, xanthrochromia
what is abnormal cell count
elevated WBCs
what is abnormal glucose
what is abnormal protein
> 1 g/L
what is seen on gram stain
nothing in 60% - esp. if on antibiotics before LP
what is treatment key in BM
start if suspected
treatment of BM
- IV dexamthasone - stop host mediated inflammation
2. ampicillin, vancomycin, ceftriaxone
organisms in BM
strep pneumonia, listeria, menigococcus,
what is nec. fasc.
deep seated infection in the sub-cut tissues - runs in the fascial planes
risk factors for NF
drug use, DM, obesity, immunosupression
3 systemic findings in NF
- fever
- tachycardia
- hypotension
Sx of NF
tense edema, pain, blisters/bullae, crepitus, subcut. gas
2 types of NF
- polymicrobial
2. monomicrobial
def. of type 1
- at least on anaerobe
- one or more facultative anaerobe
- one of enterobactersiae family
what is usual cause of NF 1 above neck
oral anaerobes - fusobacteria, anaerobic strep, bacteroides
what is fourniers gangrene and what species
genital gangrene
- facultative org. – e.coli, kebsiella
- and anaerobe
what is type 2
hemolytical streptocuccal gangrene
- group A strep or other Beta-hemolytic strep
what are common NF investigations
labs - generally non-specific - high WBC, INR, lactate, creatinin
imaging - may see gas is soft tissues
what is seen in blood cultures in NF
- low yield
- ~60%
most reliable samples are those from surgery
**most important therapy of NF (3)
- early surgical debridement!!!
- antibiotics
- IVIG
