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10 Cards in this Set
- Front
- Back
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Which is not true for blood culture? (Dunn723)
a) Adult cultures should contain at least 10ml of blood b) Antibiotic should be delay for blood culture in serious sepsis c) Positive culture in anaerobic bottleis always true positive d) 5% contamination rate e) low yield 9% |
b) ABs should not be delay by BC
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Non-infective cause of fever? (Dunn 723)
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Neoplasms
- Hodgkins disease - Lymphoma - Renal Carcinoma - Leukaemia - Hepatoma - Atrial myxoma Drugs: - salicylates, isoniazid, methyl dopa, phenytoin Others: - sarcoidosis - SLE - IBD - PEs - Pheaochromocytoma - Kawasakis disease |
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Which is not a features suggesting contamination? (Dunn 724)
a) Coagulase negative Staphylococci b) Corynbacterium c) Multiple bacterial isolated d) Bacteroides e) Propionibacterium acne |
d) which is an anaerobic, usually true positive
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Resuscitation goal in early goal direct therapy in sepsis?
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CVP 8-12mmHg
MAP > 65mmHg Urine output >0.5ml/hr Central venous saturation >70% or mixed venous >65% |
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If venous O2 saturation target is not achived (<70%), what will you do?
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- consider further fluid
- transfuse PRBC if required to haematocrit >30% - doubutamine infusion (max 20ug/kg/min) - A higher target CVP of 12-15mmHg in mechanical ventilation |
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Problem with early goal direct therapy?
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- Show improve survival in US study, mortality in the control group is much higher than that of patients admitted to ICU in Australasia with septic shock
- several guidelines are supported by only a single centre trial, others by a subgroup analysis from a large trial |
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Definition of severe sepsis, septic shock, multiple organ failure? (Dunn 124)
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Severe sepsis: infection induced organ dysfunction or hypoperfusion
Septic shock: Hypotension not reversed with fluid resuscitation associated with hypoperfusion Multiple organ failure: Altered organ function in an acutely ill patient severe enough that homeostasis unable to be maintained without intervention |
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Definition of Systemic inflammatory response syndrome (SIRS)? (Dunn 124)
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2 or more of the following:
- Temp >38c or < 35c - HR > 90bpm in adults or >150 in infants - Respiratory rate > 20/min or PaCOw <32mmHg WCC >12 or <4 or > 10% immature band form |
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Which is not ture for early goal direct therapy?
a) Recombinant human activated protein C (rhAPC) is consider in multiple organ failure and APACHE II >25 b) Hb aim between 7-9 c) IV hydrocortisone in septic shock with hypotension poor respond to fluid d)Use of bicarbonate to improve lactic acidemia e) PPI is a 1B evidence in stress ulcer prophylaxis |
d) Bicarbonate is not recommended with ph >7.15
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Aim for ARDS/ Mechanical ventilation of sepsis-induced lung injury (ALL)?
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- TV 6ml/kg
- upper limited f plateau pressure <30mmHg - accepted moderate hypercapnia - Use of PEEP to prevent lung collapse - Use semi-recumbent position/ head of bed elevated 45 degree - Consider prone position ventilation |
