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N935 Pathophysiology > Infectious Disorders > Flashcards

Infectious Disorders Flashcards

1
Q

antibiotic resistance

A

bacteria have become resistant to antibiotics designed to kill them (does NOT mean body is becoming resistant)

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2
Q

MDR (multi drug resistance)

A

organisms are responsible for increasing number of hospital acquired infections

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3
Q

PCN G route of admin and metabolism

A

IV, destroyed by stomach acid

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4
Q

PCN V route and need to know

A

PO, semi synthetic

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5
Q

1st generation cephalosporins and recommendations for challenge in PCN allergic patients
-R group side chain drugs and allergies

A

cefazolin, cephalexin

  • results are influenced by two large trials conducted when early cephalosspirn agents were contaminated with PCN
  • consistent definitions of allergic rx resulting in overestimation of cross reactivity
  • patients allergic to ampicillin should avoid cephalosporins with identical R group side chains (cephalexin and ceflacor)
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6
Q

2nd generation cephalosporins and recommendations for challenge in PCN allergic patients
-2 R group side chain considerations

A
  • patients allergic to PCN G should avoid using cephalosporins with identical R group side chains (cefoxitin)
  • patients allergic to amoxicillin should avoid cephalosporins with identical R group side chains (cefadroxil, cefprozil)
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7
Q

3rd generation cephalosporins and recommendations for challenge in PCN allergic patients

A

generally considered safe

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8
Q

4th/5th generation cephalosporins and recommendations for challenge in PCN allergic patients

A

minimal data avail

generally considered safe

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9
Q

monobactam (aztreonam) and recommendations for challenge in PCN allergic patients

A

cross reactivity highly unlikely, but patients allergic to ceftazidime should avoid aztreonam sue to side chain similarity

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10
Q

surgical site infection (SSI) definition

A

occur within 30 days of surgery or within 1 year of a prosthetic implant or organ

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11
Q

SSI prevention (6)

A
  1. preop antibiotics. time it so serum concentration is reached when incision is made
  2. glycemic control less than 200mg/dL
  3. maintain normothermia
  4. optimize oxygenation
  5. shower/bath prior to surgery with antimicrobial soap
  6. intraoperative skin prep with alcohol based antiseptic agent
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12
Q

catheter associated BSI

A

defined as bacteremia or fungemia in patient with IV catheter and at least one positive blood culture obtained from peripheral vein. CVC’s predominant cause of nosocomial blood stream infections.

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13
Q

Clostridium Difficile

A

spore forming bacterium. antibiotic associated diarrhea and pseudomembranous colitis due to production of toxins A and B

  • may lead to need for subtotal colectomy and ileostomy
  • tx is removal of causative antibiotic and oral antibiotics (vanc and metronidazole)
  • hemodynamic instability likely
  • contact and isolation precautions are essential
  • have to hand wash to remove spores
  • must use bleach germicidal wipes on equipment/in room
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14
Q

necrotizing soft tissue infections
type of emergency
what it includes
presentation

A

level 1 emergency because of threat to life and/or limb

includes: gas gangrene, TSS, fourniers gangrene (genital/peritoneal area), severe cellulitis, flesh eating infection
presentation: general infection, AMS, pain. infection begins deep in tissue so expect I&D, washout, wound vac

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15
Q

anesthesia management of necrosis

A
  • resuscitation often necessary r/t sepsis and fluid shifts
  • do not delay surgical treatment
  • hemodynamic instability (release of cytokines, good IV access, aline, maybe CVC, blood products may be needed)
  • at risk for organ failure, go to ICU
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16
Q

tetanus definition
early signs
treatment

A

neurotoxin tetanospasmin, produced by vegetative forms of clostridium tetani organisms, causes the clinical manifestations of tetanus. suppresses inhibitory neurons in spinal cord->generalized skeletal muscle contractions.

  • trusmus and neck rigidity are early signs
  • tx: control skeletal muscle spasm (benzodiazepines, muscle relaxants), neutralize exotoxin (human anti tetanus immunoglobulin), PCN
  • immunuzation available (huge worldwide problem, kills one newborn q9minutes)
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17
Q

types of pneumonia (4)

A

community acquired
aspiration
postoperative
ventilator associated

18
Q

community acquired PNA

A

streptococcus pneumoniae is the most common cause of bacterial pneumonia in adults (typical pneumonia). other organisms can be viral (RSV, SARS COV 2, influenza), or fungal (pneumoncystis, histoplasmosis, cryptococcus)

19
Q

aspiration PNA

A

clinical manifestations depend on nature and volume of aspirated material and can include filminating arterial hypoxemia, airway obstruction, atelectasis, PNA

20
Q

pneumonia presentation
patient history
exams/labs

A

fever, chest pain, dyspnea, fatigue, rigors, cough, sputum production

  • pt hx including travels, cave exploration, diving, contact with birds/sheep, immunocompromise)
  • chest radiograph
  • (+) cultuers
  • increased WBC’s
21
Q

management of anesthesia with PNA

A

delay surgery if possible, especially during acute PNA
avoid fluid overload
LPV, often PEEP dependent (consider same vent settings as ICU, lowest FiO2 possible)
-have suction available for sure
-maintain antibiotic/antiviral/antifungal schedule. look at MAR

22
Q

Severe acute respiratory viral illness
examples
s/sx
precautions

A
  • highly virulent, high mortality
  • includes H5N1 influenza a aka bird flu and coronavirus strains
  • s/sx are nonspecific including fever, HA, diarrhea, resp distress, hemoptysis
  • precautions: airborne v airborne/droplet/contact
23
Q

tx of viral infections

A

prevent spread, vaccinate

  • neuraminidase inhibitors (zanamivir, peramivir, oseltamivir (tamiflu), decrease severity. only can give in first 48 hours of symptoms
  • supportive care
24
Q

anesthesia management of severe acute respiratory viral illness

A

LPV symptom management
barrier precautions (full body suits, double gloves, goggles, N95)
-filters placed on both limbs of breathing circuit, protect the ventilato
-clean room with alcohol
-if possible, wait 48h before another case in the room

25
Q

what should a provider be wearing as PPE for airborne

A

goggles, face shields, gowns, gloves, masks, shoe covers

26
Q

are OR’s positive or negative pressure

A

positive pressure boi, be careful

27
Q

ultraviolet germicidal irradiation

A

works against multiple organisms including bola, coronavirus, bacteria

  • different types of wavelengths, hospitals use UV-C, also called germicidal UV
  • can be installed into HVAC systems
  • needs to be direct line of site to the surface. blind spots like underside of tables won’t be exposed
  • can cause burns
  • ex:TruD is effective against COVID19 and up to 14 other organisms
28
Q

HEPA filters

A
  • high efficiency particulate HEPA filters can theoretically remove 99.97% of dust, pollen, mold, bacteria, any airborne particles .3microns or greater
  • in HVAC systems for isolation rooms
  • available for AGM breathing circuits (exp and inspirartoyr limbs)
  • portable: filters the air in a room when its not an isolation room (useful in OR’s which are positive pressure rooms)
29
Q

HMEF

A

consist of head and moisture exchange medium together with an electrostatic filter (which is the filtration method utilized). big deal that it has humidification

30
Q

tuberculosis

A

mycobacterium tuberculosis is an obligate aerobe responsible for TB, which survives most successfully in tissues with high oxygen concentrations (pulmonary and extra pulmonary).

  • most likely in HIV infected person
  • s/sx: cough, anorexia, weight loss, night sweats, chest pain. CXR show apical or scuba-ical infiltrates, or bilateral upper lobe infiltration with presence of cavitation. TB vertebral osteomyelitis (Potts disease) is a common manifestation of extra pulmonary TB
  • most common test for TB is mantoux’s test
31
Q

TB treatment

A

tb can be resistant to second line therapeutic agents (fluoroquinolones and at least one of three injectable (amikacin, kanamycin, capreomycin)

  • chemo with isoniazid
  • delay case until treatment if possible, esp if case is elective
  • negative pressure rooms
  • patients and staff should wear N95
  • HEPA filters, use
  • caution to avoid spine injury during airway manipulation
32
Q

AIDS

A

acute seroconversion illness occurs with high viral load soon after infection

  • after several months, there is a decrease in viremia as patients immune response is stimulated. then gradual involution of lymph nodes occurs, with concomitant decrease in T helper lymphocytes (CD4 T cells) and increase in viral load as the inexorable onset of AIDS occurs)
  • pneumocystitis pneumonia does not usually occur until CD4 count is less than 200cells/mL
33
Q

aids dx

A

nucleic acid testing of HIV RNA is most specific and sensitive
dx of aids in HIV positive patient is established when one of the AIDS defining diagnoses is present

34
Q

anesthesia considerations for patients with AIDS

A

patients are subject to long term metabolic complications, including lipid abnormalities and glucose intolerance, which may result in development of diabetes, CAD, and cerebrovascular disease

  • want CBC, metabolic panel, RFT’s, liver function tests, coags, also CXR, EKG
  • focal neurologic lesions may increase intracerebral pressure, precluding neuraxial anesthesia. neurologic involvement may make succinylcholine use hazardous r/t fasciculations and increased ICP
35
Q

prions

A

proteinaceous infective particles (prions) are infectious proteins without known nucleic acid genomes. preferentially target neurologic tissue, causing spongiform encephalopathies

  • universally lethal neurodegenerative diseases
  • not contagious in typical sense, use standard precautions. transmission seems to require direct inoculation of brain or nervous system with infective tissue
36
Q

types of prions

A

creutzfeldt jakob disease (CJD), gerstmann straussler scheinker syndrome, kuru in humans. also mad cow disease in cows, scrapie in sheep

37
Q

standard precautions guidelines

A

applies to care of all patients, regardless of suspected of confirmed infection or colonization status. hand hygiene, safe injection practices, respiratory hygiene and cough etiquette, environmental cleaning and disinfection, reprocessing of reusable medical equipment

38
Q

contact precautions guidelines

examples of diagnoses that warrant contact precautions

A

known or suspected infections that represent an increased risk for contact transmission

  • one type of transmission based precaution that are used when pathogen transmission is not completely interrupted by standard precautions alone
  • intended to prevent transmission of infectious agents, like MDRO’s (use of gown and gloves, dedicated equipment, private room)
  • ex: norovirus, c diff, scabies, MSSA, MRSA
39
Q

enhanced barrier precautions

A

expand use of PPE beyond situations in which exposure blood and body fluids is anticipated. care activities requiring gown and glove. toilet, airway care, wound care

40
Q

droplet precautions

A

pathogens transmitted by respiratory droplets that are generated by a patient who is coughing, sneezing, or talking
-ex: meningitis, TB, rash, petechial/with fever, RSV, adenovirus, influenza, SARS-COV, avian influenza

41
Q

airborne precautions

airborne precautions diagnoses examples

A

known or suspected to be infected with pathogens transmitted by airborne route (TB, measles, chickenpox, disseminated herpes zoster, varicella zoster, herpes simplex, variola (smallpox), rubeola (measles)

42
Q

precautions from least to most

A

standard, contact, enhanced, droplet, airborne

N935 Pathophysiology (12 decks)

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