Trauma Flashcards
Signs of tension pneumothorax and Mx?
Respiratory distress, raised JVP with low BP, hyper resonant
Mx = large bore cannula 2ICS MCL
NEXUS criteria for clearing C-spine?
Fully alert No abnormal neurology No head injury / neck pain no drugs / alcohol No distracting injury
Massive transfusion - definition, Mx, criteria for end points?
Transfusion of whole blood volume within 24 hours
CRASH study = tranexamic acid
Ratio of 1:1:1 for FFP, platelets and RBC
Therapeutic endpoints: Hb 8-10 Platelets >100 INR < 1.5 Ca > 1 pH normal range
Thorax trauma:
Reduced BP, reduced chest expansion and breath sound on one side.
Stony dull to percuss
Cause, Mx?
Massive haemothorax
> 1.5L of blood in chest
Large bore chest drain ± thoracotomy
Thorax trauma:
Reduced sats, abnormal chest movements, crushing injury to chest
Cause, Ix, Mx?
Flail chest = anterior/lateral #’s of >2 adjacent ribs in > 2 places
Also will have pulmonary contusion
CXR + serial ABGS
Mx: Analgesia and oxygen
Thorax trauma:
Patient on mechanical ventilation
SOB, dropping BP ad JVP raised
Cause, Mx?
Tension pneumothorax
Large bore cannula, 2ICS, MCL
Thorax trauma:
CXR shows 2cm pneumothorax - Mx?
Aspirate anything > 2cm or symptomatic
Thorax trauma:
Patient in shock, muffled heart sounds.
JVP raised
Name of this triad, cause, Mx?
Becks triad
Cardiac tamponade
Pericardiocentesis = spinal needle in R subxiphoid space aiming for R tip of left scapula
Thorax trauma:
What symptoms might you see in blunt cardiac injury?
Can mimic MI
Also see arrhythmias, hypotension
Thorax trauma:
Deceleration injury, persistent hypotension
Likely cause, Ix, Mx?
Aortic disruption
Most die at scene
CXR = widened mediastinum and depression of L amino bronchus Diagnosis = CT angio
Mx = surgical repair
Thorax trauma:
CXR shows small bowel loops in lower semi-diaphragm?
Diaphragmatic rupture
Mx = surgical repair
Investigations for abdominal trauma?
Normotensive:
- USS to identify free fluid. But operator dependant and can miss retroperitoneal stuff
- CT abdo - most specific for identifying visceral injury, but time consuming and need contrast
- Hypotensive = diagnostic lavage to identify bleed. VERY sensitive but very invasive
Abdominal trauma:
Urine dip shows haematuria
Cause?
Kidney injury
Abdominal trauma:
Indications for laparotomy
Persistent unexplained hypotension Peritonitic Gunshot wound Evisceration Radiological evidence of free gas or diaphragmatic rupture
Abdominal trauma:
Liver trauma?
Suture lacération / partial hepatectomy
Abdominal trauma:
Bowel trauma?
Resection
Abdominal trauma:
Bladder trauma?
Intraperitoenal = laparoscopic repair and urethral and suprapubic drainage
Retroperitoneal = conservative with urethral drainage
Abdominal trauma:
what is Kehrs sign?
Shoulder tip pain, if on left side = ruptured spleen
Abdominal trauma:
Splenic tear classification?
1 = capsular tear 2 = + parenchymal damage 3 = tear up to hilum 4 = complete rupture
Abdominal trauma:
Splenic injury - when to Mx conservatively, preservative surgery and splenectomy?
conservatively = small sub-capsular haematoma, minor bleeding, no hilar involvement
Laparoscopic and conservation:
Increased intra-abdominal bleed
Moderate haemodynamic compromise
Tear / laceration affecting > 50%
Splenectomy:
Hilar involvement, major haemorrhage, major associated injury
What is the Monroe-Kelly doctrine?
Cranium is a box, contents must remain for ICP to remain. the same
If volume goes up somewhere, must go down elsewhere
Extra dural - where is the bleed, common artery (+nerve) affected + features?
Between dura mater and skull
Middle meningeal artery
Auriculotemporal nerve closely related to middle meningeal = supplies external ear and outermost tympanic membrane
Raised ICP, Lucid interval
Subdural - layer affected and lobes commonly affected, RF’s and onset?
Innermost meningeal layer
Parietal and frontal
Risk factors = old age and alcoholism
Slow onset
SAH - What is it, PC?
Spontaneous ruptured cerebral aneurysm
Sudden onset, severe headache
Basal skull # - common features?
CSF rhinorrhoea and otorrhoea
Battle sign = mastoid busing
Panda sign = bilateral orbital bruising
Intraventricular haemorrhage - who gets it, Mx?
Spontaneously In neonates
Mx conservative unless raised ICP/hydrocephalus = shunt
Criteria for performing a CT?
GCS <13 GCS <15 2 hours after injury Open or depressed skull # >1 episode of vomiting Focal neurology Any signs of basal skull # Post-traumatic seizure
When to contact neurosurgeon in head injury?
GCS persistently <8 Ongoing worsening confusion > 4 hours Progressive neurology CSF rhinorrhoea Reducing GCS post-admission
When do we need to be measuring ICP?
GCS 3-8 with abnormal CT = mandatory
GCS 3-8 with normal CT = appropriate
Minimum cerebral perfusion In adults?
70mmHg
What is bushings reflex and what does it mean?
Bradycardia, HTN + irregular breathing
Means imminent herniation
Pupillary finings In head injury:
- Unilaterally dilated, sluggish
- Bilaterally dilated, sluggish
- Marcus Gunn
- Bilat constricted
- 3rd nerve palsy (down and out), secondary to tectorial herniation
Mx = temporal-parietal craniotomy on ipsilateral side - Bilateral 3rd nerve, OR reduced CNS perfusion
- When swing light from normal to affected eye, it does not constrict as well = APPARENT dilation
Due to a defect inn the afferent pathway
So light in the normal eye still constricts both okay
Cause = Optic nerve lesion or severe retinal disease - Opiates or pontine lesion
Criteria for paediatric head CT?
LOC or amnesia > 5 mins
>3 episodes of vomiting
Focal neurology / abnormal confusion + drowsiness
Suspected NAI or traumatic cause e.g. RTA
GCS <14, or if under 1 <15
Signs of basal skull #, or depressed / open #
If < 1 any bruise, swelling or laceration >5cm
Stroke Oxford classification - TACS?
Region involved
Symptoms
what else can it cause
Highest mortality
Region involving carotid / MCA and ACA
All 3 of: Contralateral motor / sensory deficit, contralateral homonymous hemianopia + higher dysfunction
Can get cerebral oedema = raised ICP. Will need neurosurgical review for ? hemi-craniectomy
Indications - <60, MCA territory, reduced consciousness + >50% infarct territory
Stroke Oxford classification - PACS?
2/3 of TACS ones
Usually higher dysfunction and motor/sensory loss
Stroke Oxford classification - Posteiror circulation storke?
Area affected
Symptoms
Vertebrobasillar territory
Any of: Cerebellar syndrome Brainstem syndrome LOC Contralateral homonymous hemianopia
Stroke Oxford classification - Lacunar strokes?
Where are the infarcts?
What infarct location corresponds to which symptoms
Small infarcts around basal ganglia, internal capsule, thalamus and pons
Pure motor = posteiror internal capsule
Pure sensory = Thalamus
Mixed = internal capsule
Ataxic hemiparesis = Anterior limb of internal capsule
Stroke dysphasia - which region is it always?
MCA
Stroke dysphasia Brocas vs Wernickes?
Wernickes is receptive
- Speak fluently, but doesn’t make sense and word substitution / new words
superior frontal gyrus
Brocas is expressive
Can understand, but have halted laboured speech
ACA vs MCA motor and sensory signs?
ACA = Legs > arms, face spared
MCA = arms and face > legs
Brainstem infarcts: Paresis Gaze palsies Facial weakness (LMN) Vertigo and nystagmus Dysphagia and dysarthria
Paresis = Corticospinal tract Gaze palsies = CN6 Facial weakness (LMN) = CN7 Vertigo and nystagmus = CN8 Dysphagia and dysarthria = CN9/10
Lateral medullary syndrome / Wallenbergs - area affected and symptoms?
PICA or vertebral artery = lateral medulla
A-HAND Ataxia Horners Anaesthesia: Ipsilateral face pain and heat loss Contralateral in body Nystagmus + vertigo Dysphagia
Webers syndrome - area affected and signs?
Branches of posterior cerebral artery to midbrain
Ipsilateral CN3 + contralateral hemiparesis
Millard-Gubler syndrome:
Where is the infarct
Symptoms?
Pons infarct C6+7 and corticospinal tracts affected - Diplopia - LMN facial palsy - loss of corneal reflex - Contralateral hemiplegia
Locked in syndrome - Causes, clinical picture?
Vental pons infarct = Basilar artery, central pontine demyelinosis
Patient is aware and cognitively intact but completely paralysed except from upwards gaze and upper eyelids
These are preserved as midbrain tectum is spared
Cerebellopontine angle syndrome - causes, symptoms?
Acoustic neuroma, mets, meningioma, cerebellar astrocytoma
Cerebellar signs + CN5/6/7/8
= absent corneal reflex, gaze palsies, LMN facial, hearing problems + DANISH
Le Fort # - grade 1?
starts at nasal septum, extending to pyriform rim
Travels horizontally across apices of teeth, and crosses BELOW the zygomaticofacial junction
Traverses the pterygomaxillary junction
Le Fort # - Grade 2 + symptoms?
From nasal bridge not septum this time, extends through the frontal process of maxilla
Travels inferolaterally involving the lacrimal does and is near the inferior orbital fissure
Travels under the zygoma, across the pterygomaxillary fissure and through pterygoid plates
Features: Infraorbital paraesthesia Palatal mobility Malocclusion of teeth If severe = enophthalmos
Le Fort # - grade 3 + classical features
Dish pan / flattened face
Starts at nasofrontal junction, extends posteriorly along medial orbit wall and through ethmoid bones
(Thicker sphenoid bones prevent fracture into orbital canal)
Fracture continues along floor of orbit, through inferior orbital fissure + through lateral orbital wall
Then through zygomatic arch
Superior orbital fissure syndrome?
Severe force to lateral wall = compression of neurovascular
Features:
complete ophthalmoplegia and ptosis = CN3,4,6 and nerve to levator palpebrae superioris
RAPD
Dilation of pupil and loss of accommodation + corneal reflex
Altered sensation
Orbital blow out?
Bone fragment displaced downwards, attached to periosteum still though
Periorbital fat may herniate through defect = interfere with oblique and inferior rectus = Diplopia on upwards gaze
Mx = orbital floor reconstruction
In nasal fracture what does CNS rhinorrhoea imply?
Cribiform plate has been breached = need antibiotics
Retrobulbar haemorrhage - symptoms + Mx?
4 P’s and a V
Proptosis, pain, pupil reaction loss, paralysis
Vision loss - colour first
Mx = osmotic diuretic, steroids, acetazolamide
Likely need cantholysis prior to definitive surgery
Pathology of burns?
Haemolysis - due to damage of erythrocytes
Loss of capillary membrane = plasma leakage into interstitial space
Oedema = Due to Protein loss
Shock = due to Extravasation of fluids up to 48 h after
Pathology of burns healing?
Superficial = keratinocytes form new layer over bur site = epithelial migration
Deep burns = Dermal scarring
- need keratinocytes from skin graft to provide optimal coverage
Burns classification - Superficial?
Just epidermis
Erythema and painful e.g. sunburn
Blanching
Burns classification - Partial thickness?
Epidermis and part of papillary dermis
Dry white skin, blanching
If deep = loss of dermis too, but adnexae remain = very painful
Usually nil surgical Mx
Burns classification - Deep partial thickness?
Epidermis and whole papillary dermis
Mottled red, non-blanching
needs surgical Mx usually
Burns classification - full thickness?
Complete loss of dermis, and subcut. tissue affected
Charry waxed, leathery skin
non-blanching
Heals from the edge in = scar
Management in burns centre
Complications of burns - early, intermediate and late?
Early = infection, shock, compartment syndrome, curling ulcers in kids, metabolic disturbances
Intermediate = Pressure sores, oedema, VTE
Late = Scarring, contractures and psych
Mapping out burns %?
What to use in kids?
Wallace rule of 9's: Head and neck = 9% Each arm = 9% Back and front torso 18% EACH Each leg = 18% Perineum and palm = 1% each
In kids use a Lund Browder chart
Management of burns?
A - consider early intubation
B - 100% 02
- watch out for signs of carbon monoxide poisoning:
Headache, nausea, cherry red appearance
C - massive fluid losses
Parkland formula = 4 x weight x % burns
= ml of Hartman’s in first 24 hours. Give half of this within 8 hours
Referral to burns centre if needed
When do we refer to a burns centre?
Any deep dermal / full thickness Adults >10%, kids >5% Any burns to face or perineum Inhalation injury Electrical / chemical / NAI
When do we use escharotomies In burns?
If full thickness circumferential burns to torso / limbs
Aim is to either help ventilation, or relieve compartment syndrome
What is ARDS?
Increased permeability of alveolar capillaries, leading to fluid accumulation in alveoli
Non-cardiogenic pulmonary oedema
What happens to surfactant and elastase in ARDS?
Reduced surfactant
Increased elastase from neutrophils
Criteria for ARDS?
3 of:
Onset with 1 week, on background of pneumonia
Bilateral opacities on CXR
Pa02:Fi02 < 200 (basically low sats despite oxygen)
Pulmonary oedema excluded. = clinically or CVP < 18mmHg
2 stages of ARDS?
Early = exudative phase, oedema
Late = reparative fibroproliferative stage ± scarring
causes of ARDS?
Sepsis (chest infection commonest) DIC Massive blood transfusion Burns / trauma / inhalation injury Aspiration Pancreatitis
ARDS - clinical features and Mx?
Dyspnoea and hypoxic
RR raised
Bilateral crackles
CXR = bilateral infiltrate
Mx: ITU - mortality 40% Ventilation, PEEP 5-10mmHg, low tidal volume Inotropes Treat cause
What is compartment syndrome?
Raised pressure within. closed anatomical compartment
Often following a fracture
What are the classical injuries leading to compartment syndrome?
Supracondylar and tibial shaft #’s
Clinical features and diagnosis of compartment syndrome?
Pain, paraesthsia, pallor and paralysis
Arterial pulsate felt
Dx = compartment pressure > 40mmHg
> 20 is abnormal
Compartment syndrome Mx?
Prompt and extensive fasciotomies
Lower limb deep muscle - small incisions will not suffice
Post-fasciotomy = myoglobinuria > renal failure
= need aggressive IV fluids
If notable necrosis already = amputate
Hypothermia stages?
1 / mild = 35-32
Shivering, tachycardia, vasoconstricted
Stage 2 / moderate = 32-28
Not shivering, J-waves on ECG, hypotensive, bradycardia, dysrhythmias
Reduced GCS and reflexes
Stage 3 / severe = 28-20
Unconscious, not shivering.
Cardiogenic shock, oliguria, coagulopathy, apnoea, no-reactive pupils
Stage 4/ severe = <20
No vital signs
Hypothermia Mx?
Mild = rewarm with external devices
> moderate = warmed intraperitoneal fluid / haemodialysis
Slowly rewarm. 0.5 degrees / hour
what is shock?
Insufficient output to meet tissue perfusion needs
Sepsis and septic shock definitions?
Sepsis = life threatening organ dysfunction, due to host dysregulated response to infection
Septic shock = persisting hypotension requiring vasopressors to maintain MAP 65mmHg, and serum lactate >2 despite adequate fluid resuscitation
SVR and CO in sepsis?
SVR decreased
CO normal / raised
categories of the SOFA score?
Lungs = Pa02:Fi02 coag = platelets Liver = bilirubin neuro = GCS CVS = MAP Kidneys = Creatinine
> 2 = 10% mortality in hopsital
Resuscitation goals in sepsis?
CVP 8-12 UO > 0.5ml/kg/hour SVC sats >70% MAP > 65mmHg Lactate normal
SVR and CO in haemorrhage shock?
How does it affect urine specific gravity?
SVR increased, CO low
Increased
What is cardiac index?
numerical value for the tissue oxygen delivery
CO divided by total body surface area
neurogenic shock - cause, SVR and CO, Mx?
Spinal cord transection, usually high
Causes decreased sympathetic / increased parasympathetic. = decreased peripheral vascular tone = LOW SVR
Because of this you have reduced pre-load > Low CO
Mx unlike most shock is with peripheral vasoconstrictors to return normal vascular tone
Mian causes of cardiogenic shock?
IHD
If trauma - blunt trauma usually affects right side of heart = needs surgery
Doses used in anaphylaxis - adrenaline, hydrocortisone then chlorphenamine
<6 months = 0.15mg/ml of 1/1000, 25, 250mcg/kg
6 months - 6 years = 0.15mg, 50mg, 2.5mg
6-12 years = 0.3mg, 100mg, 5mg
> 12 years = 0.5mg, 200mg, 10mg
How can the arterial trace against the ventilation phase be useful?
If systolic pressure varies with intrathoracic pressure = need more IV fluids
Where does CVP sit, what does it measure.
If adequate fluid volume what happens with a fluid challenge?
Sits in SVC, via IJV
Measures right atrial filling pressure
Adequate intra-vascular volume, fluid challenge should raise CVP by 6-8mmHg for a prolonged period
How do you monitor cardiac output?
How does it work?
What else can it measure?
Swan Ganz catheter
Demonstrates left atrial pressure , via inflations of ball distally = PAOP
Can calculate: Stroke volume SVR Pulmonary artery resistance Oxygen delivery and consumption
Inotropes: Receptor affecting and action?
- Noradrenaline
- Adrenaline
- Dopamine
- Dobutamine
- Milrinone
- Alpha agonist
Vasopressor, minimal effect on CO - Alpha and B
Increases CO and PVR - B1 = contractility and rate
- B1 and B2 = Increase cardiac output and decrease SVR
- Phosphodiesterase inhibitor
Elevates cAMP levels = increases muscle contractility
Vasodilator
Staphylococcus aureus:
Key features
What exo vs enterotoxins cause
How are they resistant to penicillins
Anaerobe, G+ve
Haemolysis on blood agar
Catalase +ve
Exotoxins = Toxi shock syndrome Enterotoxins = Gastroenteritis
Mec operon
Streptococcus pyogenes:
Key features
what proteins it releases
G+ve, chain like colonies
Group A strep
Beta haemolysis on blood agar
Catalase negative
Proteins released = hyaluronidase and streptokinase = rapid tissue destruction
E. coli:
Key features
3 types and what they cause
G-ve rod, anaerobe, non spore-forming
- Enterotoxic = large volumes of fluid into the gut via cAMP
Small intestine affected, travellers diarrhoea - Enteroinvasive = dysentry, large bowel necrosis and ulcers
- Enterohaemorrhagic = 0157
HUS, TTP + haemorrhage colitis
Campylobacter jejuni:
Key features
PC
Mx?
curved G-ve, non spore forming
Diffuse and bloody enteritis
RIF + bloody diarrhoea
Self limiting = no Abx
H. Pylori:
Key features
Gene for duodenal ulcers
How it neutralises acid
G-ve, helical rod.
Microaerophilic
Flagellated and mobile
If carry Cag A gene = duodenal ulcers
Secretes urease = breaks down gastric urea to CO2 and ammonia > Ammonium > bicarb = neutralises acid
Whats streptococcus bovis associated with?
Bowel cancer and infective endocarditis
Gastroenteritis:
Staph aureus?
no fever or abdo pain
Severe vomiting
Incubation = 6 hours
Gastroenteritis:
B. Cereus
Vomiting first, then diarrhoea
NO FEVER
Gastroenteritis:
Salmonella
How does typhoid fever present?
nausea, vomiting and fever
Relative bradycardia
Typhoid = constipation, splenomegaly and rose spots
Typhoid needs ceftriaxone
Gastroenteritis:
E Coli
Watery stools and cramps
No fever
Gastroenteritis:
Listeria - key features and PC
B-hameolyticc, aesculin +ve with tumbling motility
Fever
Watery diarrhoea, cramps and headaches
Little vomiting
Gastroenteritis:
Shigella
Kids at nursery
Watery diarrhoea > Bloody mucoid
Vomiting + abdo pain
Fever
Gastroenteritis:
Campylobacter
Resevoir and complications?
Severe RIF abdo pain
Bloody diarrhoea
Birds are a recognised resevoir
Complications = GBS
Gastroenteritis:
Giardiasis
Key features and PC
Pear shaped trophozoite, Africa / Eastern Europe
Resistant to chlorination = swimming pools
Prolonged steatorrhoea
Flatulence and cramps
NO FEVER
Gastroenteritis:
Amoebiasis
Mobile trophozoite, Flask shape ulcers
Gradual onset bloody diarrhoea, abdo pain
Can last for weeks
C. diff: Associated Abx PC severe progression? Mx
Cephalosporin, ciprofloxacin, also co-amoxiclav and tazocin
Mild diarrhoea
Pseudomembranous colitis = severe systemic features such as dehydration and fever
Abdo pain, bloody mucoid diarrhoea
Can even. become paralytic ileus
Mx = Metro then vancomycin
If toxic megacolon, raised LDH or clinically worsening = colectomy
GI parasitic infections:
Threadworm - parasite name, PC, Dx and Mx?
Enterobius vermicularis
Pruritus ani
Dx = scotch tape at anus over night
Mx = mebendazole
GI parasitic infections:
Hookworm - parasite name, life cycle, PC, Dx and Mx?
Ancylostoma duodenale
- hookworm that attaches to proximal small bowel
Skin penetration > lungs > coughed up > swallowed
Most asymptomatic, although can cause iron deficiency
Larvae can be seen in stool left at ambient temperature… although hard to diagnose
Mx = mebendazole
GI parasitic infections:
Strongyloidiasis - parasite name, life cycle, PC, Dx and Mx?
Strongyloidiasis stercoralis
nematode living in duodenum
Skin penetration > lungs > coughed up > swallowed
Asymptomatic generally
Dx = stool microscopy Mx = mebendazole
GI parasitic infections:
Roundnworm - parasite name, life cycle, PC, Dx and Mx?
Ascariasis lumbricoides
begins in gut + penetrates duodenal wall > lungs > coughed up > swallowed
Dx = identify worms / eggs in faeces
Mx = mebendazole
Hepatitis A: Type of virus Course PC Immunisation?
RNA virus
Benign self limiting course
Faeco-oral transmission
Prodromal flu like features, then jaundice and hepatomegaly
Immunisation available
Hep A long term marker in blood following infection?
IgG
Hepatitis LFT pattern?
ALT>AST
AST:ALT <2
Hepatitis B: Type of virus Course PC Mx
Double strand DNA virus
Can be acute or chronic
PC = Fever, jaundice and hepatomegaly
Mx = antivirals e.g. tenofovir
Hepatitis B - complications?
10% get chronic infection
5% get cirrhosis
Hepatocellular carcinoma
Fulminant disease
Hepatitis B - Vaccine course and PEP?
HbsAg - given over three doses
>100 = adequate
10-100 = suboptimal = 1 further dose
<10 = check for previous infection /. current infection
PEP:
If know responder give booster
Known non-responder = vaccine course and HBIG
current course ongoing = accelerate and HBIG
Hepatitis B - serology?
Surface antigen appears first (HBsAg) = Anti-HBs production
HbsAg = acute infection
HbeAg results from breakdown of core antigen, seen in early infection only = HIGHLY INFECTIVE
Anti-HBc =. previous or current infection
- IgM is only in acute infection
- IgG persists
Anti-Hbs = immunity (from exposure or vaccine). -ve in chronic disease
Hep B + C transmission?
Bodily fluids, vertical transmission too
Breastfeeding ok
Hep C - Virus type, P, complications and Mx?
RNA flavivirus
PC = most asymptomatic
30% get jaundice, arthralgia and fatigue
- Complications 60-80% get chronic disease. = cirrhosis and rheumatological manifestations
- IFN. related depression
- Hepatocellular carcinoma
Mx = Protease inhibitor e.g. ribavirin + IFN alpha
Hep C - treatment SE’s?
Ribavirin = haemolytic anaemia + cough
IFN-alpha = depression, flu-like symptoms, leucopenia, thrombocytopaenia
Hepatitis D - type of virus, what it needs to replicate, two types and Mx?
Single stranded RNA virus
needs Hep B surface antigen to replicate
- co-infection = get the at the same time
- Superinfection = Get D whilst already have hep B = big risk of cirrhosis, chronic disease and fulminant disease
Liver flukes / Fasciola hepatica - Classic resevoir, two phases, Ix and Mx?
Water cress
1 = immature worm penetrates gut:
- Fever, nausea
- severe. abdominal pain
- Hepatomegaly
- Rash
2 = Worm matures in bile duct
- Jaundice
- intermittent pain
- anaemia
Ix = hyper echoic on USS within middle dilated bile ducts
Mx = Triclabendazole
What bacteria might you see in severe peritoneal infections, pungent pus
Bacteroides fragilis
An example of alpha haemolytic strep?
What it causes?
Strep pneumoniae
Pneumonia, meningitis and otitis media
Example of Beta haemolytic strep group A and what it causes
Strep pyogenes = impetigo, cellulitis, type 2 nec fac, tonsillitis / pharyngitis
Immune reaction can cause post-strep glomerulonephritis
Example of Group B, beta haemolytic strep?
Agalacticae = neonatal meningitis + septicaemia
Which bug. colonises plastic implants and forms a biofilm?
Staph epidermidis
MRSA screen. - who and where, what happens if positive?
All elective and emergency admissions
Nose and skin swabs
Nose +ve = Mupirocin 2% TDS for 5 days
Skin +ve = chlorhexidine solution OD for 5 days
