SEPSIS & DM LE INFECTION Flashcards
What are the two type of variables involved in systemic inflammatory response syndrome?
General or Inflammatory
Leukocytosis (WBC greater than 12), normal WBC (with left shift or greater than 10% neutrophils), CRP is more than 2 standard deviations – are examples of what?
Inflammatory variables of SIRS
What are some of the main general variables of SIRS?
Temp 100.9+ or less than 96.8
HR 90+
Tachypnea (RR 20+)
What is sepsis?
SIRS + Infection
What are some of the common bacterial infections of sepsis?
UTI, cellulitis, and pneumonia
What are some of the common viral infections of sepsis?
Influenza, viral meningitis, and severe shingles
Is diagnosing someone with sepsis good enough?
NO! We must communicate if it Severe or Shock Sepsis
What would constitute as severe sepsis?
2+ SIRS criteria + Infection + [one of the following]:
End organ damage = hypotension, renal failure, shock liver, coagulopathy, respiratory failure, or elevated lactic acid
What is considered hypotension of Severe Sepsis?
MAP less than 65
SBP less than 90
***AT ANY ONE CHECK
What would indicate renal failure?
What would indicate elevated lactic acid?
Renal Failure = Cr greater than 2.0
Lactic acid = 2+
***Know this! Lactic acid levels are a VERY good indicator of sepsis
What lab would indicate severe shock of the liver?
Bili 2+
What is Septic Shock?
Severe sepsis via Hypoperfusion PERSISTENT that continues for longer than 1 HOUR AFTER aggressive fluid resuscitation
*Sys BP less than 90 x2 checks (or MAP less than 65 x2), worsening BP, lactate level is 4+
Does SIRS mean you have an infection?
Nope!
Septic shock has what percentage of mortality?
46%
If the lactic acid is 3 – what’s the status? What’s the risk this person could die?
Severe Sepsis
Risk = 20%
If a patient with pancreatic CA presents with fatigue; his temp is 100F, HR 101, RR 21, and BP 110/70. His labs come back with WBC 17, CRP 12. UA and CXR are negative – what does he have?
SIRS
The patient with SIRS is started on fluids and blood cultures and BMP are obtained. His blood culture show growth and Cr comes back with a 2.1 – what is going on?
Severe Sepsis
How do we treat Severe Sepsis?
Start broad spectrum Abx:
Monotherapy – Cephalosporins or Floroquinolones
Combo Tx – Cipro + Vanco
Your patient was treated for MRSA, he finished his Abx, and was readmitted to the hospital. He has a fever and tiny maroonish/blackish spots on toes and the blood cultures grow GPC 2/2 – what do you think of now?
Endocarditis
What are the spots his feet known as?
Janeway lesions or Oslar nodes
What is the Duke criteria used for?
Major & Minor criteria for Endocarditis
What are some of the common bacteria associated with Endocarditis?
Strep veridans
Staph aureus
Enterococcus
Positive blood cultures x2, persistent (+) blood cultures after/during treatment, and TTE shows a vegetation are all a part of what in the Duke criteria?
MAJOR criteria
Presence of a valvular heart disease, Hx IV drug use, fever, and unexplained vascular phenomenon (conjunctival or intracranial hemorrhage, petechiae, or emboli) are all a part of what in the Duke criteria?
MINOR criteria
When you have endocarditis – who do you call?
The ID doc!
What’s the secondary imaging you should get for endocarditis?
TEE
How do you typically treat endocarditis?
Vancomycin
So, in summary, what lab should we always follow with SIRS or Sepsis?
Blood culture before Abx!! Follow them until Tx finalized
Always remember Endocarditis!!
What are the 2 components of osteomyelitis?
Hematogenous or Contiguous
If the cause of the osteomyelitis is bacteremia (from anywhere in the body), is monomicrobial, with blood/bone cultures that match – what type is it?
Hematogenous
If the cause of the osteomyelitis is bacteria from adjacent tissues, is polymicrobial, and blood cultures are no positive – what type is it?
Contiguous
What types of patients develop contiguous osteomyelitis?
Diabetics
If a diabetic patient has slow onset of a wound that heal slowly and is either non-healing or recurrent ulcer – what do we worry about?
Contiguous Osteomyelitis
What labs do we order for osteomyelitis?
WBC, ESR, CRP, Probe the bone
When you probe the ulcer and you see bone and touch bone – what is it?
Assume osteo until proven otherwise
What type of diagnostics should you when you suspect osteomyelitis?
MRI (is best)*****
XR, CT, Nuclear med bone scan
How do you treat contiguous osteomyelitis?
Involve ID!!
Start broad spectrum Parenteral (IV) Abx = Metronidazole +
Cefepime (or Floro) + Vanco
Follow Bone Cultures DAILY
How long is treatment for osteomyelitis typically?
6 weeks
So, if we have a diabetic with a foot ulceration – what do we think of?
Osteomyelitis
What’s the best imaging for osteo?
XR is good, but MRI is better
