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Medicine

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Respiratory

Question
23 out of 26
 

Feature of SIRS are all except (LQ)



A Fever
B Tachypnea

C Leukopenia
D Hypotension

Ans. D

Hypotension

Table: Definitions used to describe the condition of septic patients (Ref. Hari-18th ed., Table 271.1 Pg- 2223)

Bacteremia

Presence of bacteria in blood, as evidenced by positive blood cultures

Septicemia

Presence of microbes or their toxins in blood

Systemic inflammatory response syndrome (SIRS)

(May be infectious or non -infectious etiology) (MCQ, AIPG 09)

Two or more of the following conditions

1). fever (oral temperature >38oC) or hypothermia (<36oC)

2). tachypnea (>24 breaths/min)

3). tachycardia (heart rate >90 beats/min)

4). (4) leukocytosis (>12,000/mL), leukopenia (<4000/mL), or >10% bands; may have a noninfectious etiology.

Sepsis

SIRS that has a proven or suspected microbial etiology

Severe sepsis (similar to *sepsis syndrome)

Sepsis with one or more signs of organ dysfunction – for example:

1). Cardiovascular: BP ≤90 mmHg or mean arterial pressure ≤70 mmHg that responds to administration of intravenous fluid.

2). Renal: Urine output <0.5 mL/kg per hour for 1h despite adequate fluid resuscitation

3). Respiratory: Pao2/FlO2 ≤250 or, if the lung is the only dysfunctional organ, ≤200.

4). Hematologic: Platelet count <80,000/mL

5). Unexplained metabolic acidosis:

6). Adequate fluid resuscitation: Pulmonary artery wedge pressure ≥12 mmHg or central venous pressure ≥8 mmHg.

Septic shock

Sepsis with hypotension BP <90 mmHg systolic or 40 mmHg less than patients normal blood pressure) for at least 1 h despite adequate fluid resuscitation; or Need for vasopressors to maintain systolic blood pressure ≥90 mmHg or mean arterial pressure ≥70 mmHg

Refractory septic sock

Septic shock that lasts for >1 h and does not respond to fluid or pressor administration.

Multiple-organ dysfunction syndrome (MODS)

Dysfunction of more than one organ, requiring intervention to maintain hemostasis.

Treatment of Sepsis

Table : Initial Antimicrobial Therapy for Severe Sepsis with No Obvious Source in Adults with Normal Renal Function

(Ref. Hari-18th ed., Table 271.3 Pg- 2229)

Clinical Condition

Antimicrobial Regimens (Intravenous Therapy)

Immunocompetent adult

1). ceftriaxone or ticarcillin-clavulanate or piperacillin-tazobactam

2). imipenem-cilastatin or meropenem or cefepime.

3). Gentamicin or tobramycin may be added to either regimen.

4). ciprofloxacin or levofloxacin plus clindamycin.

Neutropenia (<500 neutrophils/mL)

1). imipenem-cilastatin or meropenem or cefepime

2). ticarcillin-clavulanate or piperacillin-tazobactam plus tobramycin.

3). vancomycin should be added

a. if the patient has an infected vascular catheter,

b. if staphylococci are suspected,

c. if the patient has received intensive chemotherapy that produces mucosal damage,

d. if the institution has a high incidence of MRSA infections,

Splenectomy

a. Cefotaxime or ceftriaxone b. vancomycin plus ciprofloxacin c. levofloxacin or aztreonam

IV drug user

Nafcillin or oxacillin plus gentamicin. If the local prevalence of MRSA is high or if the patient is allergic to beta-lactam drugs, vancomycin with gentamicin should be used.

AIDS

a. Cefepime, ticarcillin-clavulanate, or piperacillin-tazobactam plus tobramycin

b. Ciprofloxacin or levofloxacin plus vancomycin plus tobramycin.

Table 152-2 Antibiotic Treatment of Infections Due to Pseudomonas Aeruginosa

Infection - Bacteremia

1). Non-neutropenic host –

i. Ceftazidime

ii. Cefepime

iii. Piperacillin / tazobactam

iv. imipenem

v. meropenem

vi. Doripenem

vii. Amikacin.

2). Neutropenic host – Cefepime or all other agents (except doripenem) as mention above.

3). UTI – Ciprofloxacin or levofloxacin.

4). Multidrug – resistant P. aeruginosa infection – Colistin for the shortest possible period to obtain a clinical response.

Recent Advances:

1). Ceftaroline is a 5th Generation cephalosporine. It is being used in the treatment of Skin and soft tissue infections; MRSA, community acquired bacterial pneumonia. (It is not given in 18th edition of Harrison!!!)

2). Doripenem / Faropenem / Ertapenem are the new carbapenems, they are being used in Serious infections

Respiratory Flashcard List

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