Mehlman: SIRS, Cirrhosis, referred pain Flashcards
SIRS - vital to know mehlman table on 2 CK.
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SIRS. mechanism?
- In the setting of stress (i.e., due to trauma, surgery, autoimmune flare, infection), catecholamines and
sympathetic activity might shift the patient’s vitals out of the normal range.
SIRS. - The reason knowing SIRS is important is because the patient can have abnormal vitals without having an infection.
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SIRS. criterion?
2 or more of the following:
- Temperature <36C or >38 (<96. 8F or >100.4).
- HR >90.
- RR >20.
- WBCs <4,000 or >12,000.
SIRS. sepsis?
- SIRS + source of infection.
SIRS. septic shock?
Sepsis + low BP.
SIRS.
Sometimes you will see a patient’s vitals slightly out of the normal range in the setting of trauma, surgery, or autoimmune flares, and you have to be able to say, “There’s no infection. That’s just SIRS from sympathetic activation.”
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SIRS. Knowing if a patient is septic is important for management of patients on 2CK, where sometimes antibiotic
regimens are stepped up.
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SIRS. 2CK example.
For example, when treating PID, if the patient is septic –> tx?
intravenous ceftriaxone
and azithromycin is correct on one of the 2CK NBMEs
IM ceftriaxone and oral azithromycin is wrong.
This is because the latter is for most patients who have PID but aren’t septic.
SIRS. Ceftriaxone is frequently an answer on 2CK for in-hospital patients who are septic from a variety of
community-acquired conditions, e.g., pneumonia, pyelonephritis, prostatitis.
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SIRS. For instance, communityacquired pneumonia is empirically treated …. (if not septic)
with azithromycin
SIRS. For instance, community acquired pneumonia + patient is septic ….. tx?
but if patient is septic, we can go straight to ceftriaxone (have seen this more than once on 2CK NBMEs).
SIRS. For hospital-acquired infections in which patients are septic, ……. NBME goes hard-hitting with what abs?
NBME goes hard-hitting with vancomycin
PLUS ceftazidime or cefepime. This regimen covers MRSA and Pseudomonas.
Cirrhosis. Small, shrunken, burnt out liver due to chronic disease.
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Cirrhosis. HY causes?
HY causes are alcoholism, HepB/C, Wilson disease, hemochromatosis, NASH, a1-antitrypsin deficiency etc.
