Infectious Dz Flashcards
RF for MRSA
hospitalization
indwelling catheter
recent abx
reside in LTC
close contact sports
close living quarters (eg prison)
MSM
IVDU
day care attendance
gram + cocci with mecA gene?
MRSA
botulism organism
clostridium botulinum
presenting symptoms of botulism and mechanism behind it
-often starts with GI symptoms.
descending (ie starting with cranial nerves flaccid paralysis with mydriasis, ptosis, eventual resp paralysis, endo toxin block release of Ach at NMJ
3 broad categories of botulism
infant (72%) , food-borne (25%), wound (rare)
test and tx of botulism
test: toxin in blood, stool or food or bacteria grown from wound
tx: supportive + immunoglobulin
tetanus organism
clostridium tetani
presenting symptom of tetanus
spastic paralysis and tetany
due to blockage of inhibitory neurotransmitters.
4 types of tetanus
local, generalized, neonatal, caphalic
(say a few things about each), pg 481 FA
ddx for tetansu
strychine poisoning –> found in pesticides, homeopathic meds etc. tx is benzos
presenting symptoms of generalized tetanus
trismus
sardonic smile
opisthotonus
resp failure
tx of symptomatic tetanus
tetanus IG (TIG), 3000 U IM and Td vax at seperate site, dont debride wounds until TIG given
can consider flagyl, but limited evidence
what is a high risk wound for tetanus
> 6h old, contaminated (dirt, saliva, feces), puncture, crush, avulsion, fb, burns, frostbite
tetanus wound proh: high risk wound
-if 3 or more vax – > update vax >5 years from last dose
-if unknown or 2 or less –? give TIG (250 U IM) and give Tdap
tetanus wound proph: low risk wounds
-if 3 or more vax – > update vax >10 years from last dose
-if unknown or 2 or less –update with Tdap
define sepsis
is a condition of life-threatening organ dysfunction (such as hypotension, altered mentation, oliguria, & others) due to
a dysregulated host response to infxn (confirmed or suspected)
define septic shock
Septic shock is characterized by refractory hypotension & vasopressor requirement (40 mL/kg of crystalloids) to maintain an MAP ≥65 mmHg
& having a serum lactate level >2 mmol/L
1st and secoond pressor in sepsis with doses
nor epi : start 0.1 up to max of 0.4 mcg/kg/min
vasopressin: 0.03 U/min
map and urine goals in sepsis
65 and >=0.5 ml/kg/hr
qSOFAt is it, how to use it?
2 or more of:
RR ≥22
Systolic BP ≤100
Any altered mental status (or Glasgow Coma Scale [GCS] ≤13 if established)
For pt with a diagnosed or suspected infxn, the dx of sepsis should be established by the presence of organ dysfunction as
reflected by a ≥2 points increase from their baseline score in their qSOFA score if they are outside of the ICU (or in the absence of lab data enabling the use of the more detailed
SOFA score)
preffered fluid in sepsis and minimum resucitation in forst 4-6 hours
RL and 30 mL/kg
surviving sepsis 3 and 6 hour bundles
To be completed within 3 hr of presentation:
1. Measure lactate level
2. Obtain blood cx before abx administration
3. Administer broad-spectrum abx (administer within 1 hr)
4. Administer 30 mL/kg crystalloid (minimum) for hypotension or for lactate >4 mmol/L … USE PRESSORS IF MAP <65 DURING FLUID RESUSCITATION
To be completed within 6 hr of presentation:
1. Apply vasopressors if unresponsive to appropriate fluid resuscitation (goal MAP ≥65 mmHg)
2. If hypotension is sustained after initial fluid resuscitation
a. Measure & follow CVP trend
b. Measure & follow ScvO2
3. 3. If lactate is elevated, remeasure & aim for normalizing lactate
uncomplicated vs disseminated gonorrhea
uncomplicated = GU or oropharyngeal infection with no bactermia or ascending infection
2 locations for disseminated GC
septic arthritis
tenosynovitis/dermatitis/polyarthalgia syndrome
