Phys And Pathophys - Infectious Diseases

Front 1

ring around the rosy is about

Back 1

the bubonic (black) plague

Front 2

sneezing in ring around the rosy is about

Back 2

internal hemorrhaging and nasal mucosa bleeding causing sneezing

Front 3

infectious diseases are different than other comorbidities because

Back 3

natural body defenses are down making respiratory, blood, urinary tract very susceptible, may acquire infection during surgery, may be hidden infection, affects all care, may be passed to other people

Front 4

penicillin was discovered in

Back 4

1928

Front 5

problems with infectious disease and the pharmaceutical companies

Back 5

drug companies prefer to make chronic condition drugs because more money, also tend to make antibiotics for gram + drugs, but the gram - bacteria are the ones that are becoming more difficult to kill

Front 6

surgical site infections account for what % of nosocomial infections

Back 6

16%

Front 7

in 10/2008 medicare

Back 7

will no longer pay for 11 hospital acquired conditions that are reasonably preventable - surgical infections, wrong site surgeries, incompatible blood types, PE's following knee replacements

Front 8

Semmelweis noted

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that midwife patients didn't die, and med student patients did (after childbirth) - instituted hand washing for doctors

Front 9

surgery should be postponed if

Back 9

a patient has an infection

Front 10

contributors to infection

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poor diet, diabetes, hypothermia, inadequate analgesia, fluid imbalance, central line placement, hypocapnea (vasoconstriction - decreased perfusion)

Front 11

periop antibiotics should be given

Back 11

within a half hour - lots of places are shooting for 10 minutes - from incision

Front 12

prophylactic antibiotics are given with

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dirty surgeries such as, colon, vaginal, oral surgeries, or device insertions

Front 13

most common prophylactic antibiotic strain

Back 13

cephalosporins

Front 14

why do we give cephalosporins

Back 14

broad spectrum, low incidence of side effects, tolerable to patients, and can push it!

Front 15

if patient allergic to cephalosporins, 2nd round of drugs is

Back 15

vancomycin

Front 16

give vanco over

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1 hr

Front 17

if give vanco too fast pt experiences

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red man syndrome

Front 18

side effect of vanco

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nephrotoxic, not effective fro gram - bacteria

Front 19

side effect of gentamycin

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nephrotoxic (very), tinnitus

Front 20

gentamycin given for

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gram - bacteria

Front 21

mortality rate with infection

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0 - 10 %

Front 22

mortality rate with sepsis

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10 - 25%

Front 23

mortality rate with severe sepsis

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25-50%

Front 24

mortality rate with septic shock

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50 - 60%

Front 25

indicators of SIRS

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WBC > 11K or <4K (or 20% are immature), HR >90, temp >38 or <36, RR > 20 or paCO2 < 32

Front 26

SIRS stands for

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systemic inflammatory response syndrome

Front 27

SIRS occurs

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with end organ failure, usually occurring after shock if the initial shock doesn't do them in

Front 28

definition of infection

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pathogens detected in blood or tissue

Front 29

definition of sepsis

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infection plus SIRS

Front 30

definition of severe sepsis

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sepsis plus organ disfunctions - lactic acidosis, oliguria, confusion, hepatic dysfunction

Front 31

septic shock definition is

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severe sepsis plus hypotension despite adequate fluid volume

Front 32

signs of severe sepsis

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lactic acidosis, oliguria, confusion, hepatic dysfunction

Front 33

examples of necrotizing infections

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gas gangrene, toxic shock syndromes, severe cellulitis, flesh eating infections (are a subclass of sepsis)

Front 34

treatment for necrotizing infections

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broad spectrum antibiotic and immediate surgical intervention

Front 35

alternative treatments for necrotizing infections

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honey, hyperbaric chamber if anaerobic bacteria

Front 36

anesthetic challenges for necrotizing infections

Back 36

very septic patients so - hypotension, central lines, catecholamine depletion, multiorgan failure (decreased urine output), blood products given, and risk of SIRS, DIC, coagulopathies (remember some drugs act through steroids - so may not work in severe sepsis) - phenylephrine works direct

Front 37

tetanus is caused by

Back 37

gram negative bacillus clostridum tetani

Front 38

tetanus is

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the most powerful poison known to humans - aside from botulism

Front 39

tetanus works by

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tetanospasms spread centrally along motor nerves to the spinal cord or enters the circulation and proceeds to the CNS, supresses inhibitory pathways producing severe muscle spasms and lock jaw - all skeletal muscles affected, including laryngeal, pharyngeal, and diaphragm

Front 40

triggers for tetanic spasm

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light, loud noise, suctioning, ANYTHING

Front 41

tetanus seizures are

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spasms or tonic/clonic and extremely painful

Front 42

tetanus causes the sympathetic system to

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release large amounts of catecholamines causing tachycardia, arrhythmias, hypertension, labile blood pressure

Front 43

anesthesia response for tetanic patietn

Back 43

intubation, supportive airway measures, valium drip or NDMR, beta antagonists (propanolol, esmolol) to tachy arrhythmias, penicillin, art line, volatile anesthetics are good if you have a pressure, lidocain, esmolol, magnesium, nicardipine, nitroprusside (anything to treat everything!)

Front 44

most common nosocomial infection in the ICU

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VAP - 1/3 of total nosocomial infections

Front 45

VAP mortality rate

Back 45

50%

Front 46

what % of patients vented will develop VAP

Back 46

10 - 20 %

Front 47

prevent VAP by

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meticulous hand washing, aspiration of secretions (especially during extubation), early extubation, and appropriateness of ventilatory support

Front 48

people at high risk for latex allergies are

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chronic exposure to latex products, spina bifida, urologic reconstruction, >9 surgical procedures, latex intolerance to other products (balloons, condoms, etc), allergy to bananas, uncertain intraop anaphylaxis, works in health care with history of eczema

Front 49

fruit allergies that cross over to latex

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banana, kiwi, avocado, mango, peach, passion fruit, celery, chestnuts

Front 50

procedure for latex allergic patient

Back 50

remove all latex items from room, wipe down room so dust settles, ideally have room empty for an hour, watch rubber caps on vials, use stopcocks not ports, tell pharmacy, housekeeping, etc.

Front 51

most fatal anaphylactic drug reactions are caused by

Back 51

penicillin

Front 52

if someone has a penicillin allergy they are

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3-4 times more likely to have an allergic reaction to any drug

Front 53

commonality between penicillin and other cephalosporins

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beta lactam ring

Front 54

drug reactions usually manifest within

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5 - 10 minutes after exposure

Front 55

latex reactions usually manifests around

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30 minutes after exposure

Front 56

cross sensitivity of penicillin allergy with other cephalosporins is

Back 56

0.02% for life threatening cross reactions