MedU Clipp 23

Question 1

When is Fever an emergency?

Answer 1

• Infants, younger than 6 - 8 weeks of age

Question 2

What factors go into determing the Severity of Illness?

Answer 2

• Are they still perfusing major organ systmes
  
  • Brain
  • Skin
  • Kidneys
  • Lungs
• Any Underlying condition –> Increased Risk
  
  • Sickle cell disease
  • HIV
  • Neutropenia
  • DM

Question 3

(4) Emergency Conditions Causing Altered Mental Status?

Answer 3

• Hypoxia
• Shock
• Hypoglycemia
• Poisoning (Toxic Ingestion)

Question 4

(5) Causes of Altered Mental Status?

Answer 4

• Intussusception
• Sepsis
• DKA
• Renal Failure
• CNS Problems

Question 5

(5) CNS causes of Altered Mental Status?

Answer 5

• Seizures
• Tumor
• Subarachnoid hemorrhage
• Meningitis
• Trauma

Question 6

(4) Physical Exam Findings for Bacterial Meningitis?

Answer 6

• Neck Stiffness (57 - 92%)
• Fever (66 - 100%)
• Altered Mental Status (44 - 96%)
• Kernig’s or Brudzinski’s sign (61%)
• Children
  
  • Bulging Fontanelle
  • Focal Seizures

Question 7

What is Shock?

Answer 7

• Inadequate delivery of Substrates and Oxygen to meet the Metabolic needs of Tissues:
• Cells can no longer sustain aerobic oxygen production
• Cellular metabolism/respiration is no longer able to generate enough energy to power the components of cellular homeostasis, leading to disruption of cell-membrane ionic pumps
• Cell Swells, cell membrane breaks down, cell death occurs

Question 8

How does the body compensate for Shock?

Answer 8

• Increased Heart Rate (Tachycardia)
• Increased Systemic Vascular Resistance (Vasoconstrict)
• Increased Heart Contractility
• Increased Venous Tone
• Increased Respiratory Rate (Tachypnea)

Question 9

(4) What are the Types of Shock?

Answer 9

• Disruptive
  
  • Neurogenic
  • Anaphylactic
• Hypovolemic
• Cardiogenic
• Septic

Question 10

What is the ABX Tx for Meningococcemia?

Answer 10

• Penicillin G
  
  • Pediatric Dose
    
    • 250k - 300k units/kg/day q(4-6) hrs
  • Adult Dose
    
    • 12M - 24M units/day q(4-6) hrs

Question 11

Close contacts w/ Meningococcal Prophylaxis?

Answer 11

• Close Contacts Warrant Prophylaxis
  
  • Adults
    
    • Ciprofloxacin (preferred)
    • Rifampin, Ceftriaxone, Azithromycin (Alt)
  • Pregnant Women
    
    • NOT Rifampin
    • NOT Ciprofloxacin
  • < 18 y.o.
    
    • Oral Rifampin
    • IM Ceftriaxone

Question 12

When is the Tetravalent
Meningococcal Congugate Vaccine given?
(MCV4)

Answer 12

• Children Ages 11 - 18
• Normally IM administration; Normally 11 - 12 y.o.
• Booster at 16 y.o.
• If 1st does after 16 y.o., No Booster is recommended
• College Freshman living in Dorms, Living in the Military are considered at Increased Risk and should recieve a Booster Dose

Question 13

What is the Morbidity and Mortality of
Meningococcal Disease?

Answer 13

• Fatality
  
  • All Ages 10 -15%
  • Adolescents 21%
• Complications 11% - 19%
  
  • Hearing Loss
  • Neurologic disability
  • Digit or Limb amputations
  • Skin scarring

Question 14

(9) DDx of Lethargy?

Answer 14

• Sepsis
• Meningitis
• Encephalitis
• Toxic Ingestion
• Pneumonia
• CNS Tumor
• DKA
• HYpoglycemia
• Renal Failure

Question 15

(5) DDx of Fever and Petechiae?

Answer 15

• Meningococcal Sepsis
• Kawasaki Disease
• Toxic Shock Syndrome
• RMSF
• Scarlet Fever

Question 16

What is the Tx for RMSF?

Answer 16

• Doxycycline for loading dose
• Ceftriaxone daily