TSS Flashcards
Q: What is Toxic Shock Syndrome (TSS) and its causative agents?
A: TSS is a rare form of septic shock caused by bacteria like Streptococcus pyogenes or Staphylococcus aureus. It is divided into two main types: streptococcal TSS and non-streptococcal TSS.
Q: What are common causes of TSS?
A: TSS typically results from a skin and soft tissue infection or a contaminated foreign body, such as retained surgical packing.
Q: How do bacteria cause TSS?
A: Bacteria produce toxins that enter the bloodstream, activate T lymphocytes, and trigger the release of inflammatory cytokines, leading to fever, hypotension, and multiple organ failure.
Q: What is the first step when a patient presents with symptoms of TSS?
A: Perform an ABCDE assessment and initiate acute medical management to stabilize the airway, breathing, and circulation.
Q: What steps should be taken after initial stabilization of a TSS patient?
A: Admit the patient to the ICU, initiate continuous vital sign monitoring, obtain IV access, and consider placing invasive hemodynamic monitoring catheters (arterial line and central venous catheter).
Q: How is hypotension managed in TSS patients?
A: Begin IV fluid resuscitation and add vasopressors if necessary to maintain a mean arterial pressure (MAP) of 65 mm Hg or above.
Q: What are the components of the 1-hour sepsis bundle?
A: Achieving hemodynamic stability, obtaining blood cultures, and starting broad-spectrum IV antibiotics within the first hour of patient presentation.
Q: Why is it important to obtain a blood lactate level in TSS patients?
A: To check for organ hypoperfusion; high initial levels suggest the need for aggressive hemodynamic support, while declining levels with treatment indicate recovery.
Q: What should be done after stabilizing a TSS patient?
A: Perform a focused history and physical examination, and order labs including CBC and CMP.
Q: What are common symptoms and physical exam findings in TSS?
A: Symptoms: fever, myalgias, headache, nausea, vomiting, diarrhea, and rash. Physical exam: hypotension, macular erythroderma, and possible desquamation.
Q: What lab findings are typical in TSS?
A: Elevated lactate, leukocytosis, low hemoglobin and hematocrit, thrombocytopenia, elevated creatinine, and hepatic transaminases (AST and ALT).
Q: How do you identify the source of infection in TSS?
A: Through detailed history, physical examination, and sometimes imaging to locate the focus of infection, especially if retained foreign bodies are suspected.
Q: What cultures should be collected in suspected TSS cases?
A: Cultures from the suspected source of infection, which could include throat, sputum, genitourinary tract, skin lesion or wound, or cerebrospinal fluid.
Q: What should be done if a necrotizing soft tissue infection is suspected in TSS?
A: Consult the surgical team for emergent operative exploration, debridement, and wound cultures.
Q: How is TSS diagnosed?
A: TSS is a clinical diagnosis based on a combination of clinical and laboratory findings. Use CDC’s case definitions for streptococcal and non-streptococcal TSS to aid diagnosis.
Q: What are the criteria for diagnosing streptococcal TSS?
A: Hypotension (systolic BP < 90 mm Hg), evidence of multiorgan involvement (renal, coagulopathy, hepatic, respiratory distress, erythematous rash, soft-tissue necrosis), and lab isolation of group A streptococcus.
Q: What are the criteria for diagnosing non-streptococcal TSS?
A: Fever, diffuse macular erythroderma, desquamation, hypotension, and evidence of multisystem dysfunction involving at least three organ systems, with negative cultures for other infections.
Q: What is the treatment protocol for both streptococcal and non-streptococcal TSS?
A: Remove the focus of infection, administer targeted IV antibiotics based on culture results, include clindamycin or linezolid, consider IVIG, and provide supportive care for affected organ systems.
Q: What supportive care might be needed for patients with TSS?
A: Dialysis for renal failure, mechanical ventilation for ARDS, and continued vasopressor support for hemodynamic instability.
Q: Summarize the management steps for TSS.
A: Stabilize hemodynamics, collect blood cultures, start broad-spectrum antibiotics, identify the infection source, obtain cultures, remove the infection source, and provide targeted antibiotics and supportive care.
