Sepsis is an infection accompanied by a systemic inflammatory response. It ranges in severity from sepsis to septic shock. Common signs include fever, increased heart rate, respiratory rate, and white blood cell count. Sepsis is most often caused by gram-negative bacteria like E. coli or gram-positive bacteria like Staphylococcus aureus. Diagnosis involves assessing for infection signs, locating the infection source, and testing like blood cultures and lactate levels. Treatment focuses on early antibiotics, fluid resuscitation, vasopressors if needed, and treating the infection source. Outcomes depend on severity, with septic shock carrying higher mortality.
This document provides an overview of pneumonia, including its definition, classifications, predisposing factors, pathophysiology, clinical manifestations, diagnostic tests, medical management, complications, and prognosis. Pneumonia is an acute respiratory illness associated with lung inflammation and accumulation of secretions in the alveoli. It is commonly classified based on location (e.g. community-acquired), anatomy (e.g. lobar), or cause (e.g. bacterial, viral). Common predisposing factors include smoking, age, and underlying lung diseases. Diagnosis involves tests like chest x-rays, sputum analysis, and bloodwork. Treatment focuses on oxygenation, antibiotics, and supportive care. Complications can include
This document provides an overview of pneumonia, including its definition, epidemiology, etiology, clinical features, diagnosis, severity assessment, management, and treatment guidelines. It discusses community-acquired pneumonia and outlines 4 patient categories based on risk factors and symptoms. Key points include that pneumonia has many potential causes, symptoms often include cough and fever, and treatment involves antibiotics with consideration of atypical pathogens and severity of illness. Hospitalization is recommended for higher-risk patients or those not improving after 2 days.
This document discusses sepsis diagnosis and management. It provides historical context on defining sepsis and outlines diagnostic criteria. Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated response to infection. Common infections that cause sepsis include those of the lung, abdomen, and urine. Management involves initial resuscitation, administering appropriate intravenous antibiotics within 1 hour, and controlling the infection source when possible through procedures like drainage or debridement. Vasopressors, fluid resuscitation, and inotropes may be needed to support blood pressure and organ perfusion.
This document provides information on pneumonia, including its definition, classification, infectious agents, host defenses in the lungs, routes of infection, community-acquired pneumonia, symptoms, diagnosis, treatment, and complications. It defines pneumonia as an infection of the lungs that causes consolidation and filling of alveoli. Community-acquired pneumonia is most often caused by Streptococcus pneumoniae, Haemophilus influenzae, or Mycoplasma pneumoniae. Diagnosis involves assessment of severity, consideration of possible causes, chest imaging, and microbiological testing of sputum or blood. Empiric antibiotic therapy depends on location of treatment and severity of illness. Duration of treatment typically ranges from 7 to 14 days depending on the causative
SEPSIS AND SEPTIC SHOCK PRESENTATION.pptxmainhamza411
1) Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Diagnosis involves identifying infection and meeting criteria for systemic inflammatory response or organ dysfunction.
2) Management of sepsis involves early antibiotic therapy and source control, as well as fluid resuscitation, vasopressors if needed to maintain blood pressure, and inotropes for myocardial dysfunction.
3) Goals of initial resuscitation within 6 hours include central venous pressure of 8-12 mmHg, mean arterial pressure of at least 65 mmHg, urine output of 0.5 mL/kg/hr or more, and normalization of lactate if elevated.
This document discusses fever in the intensive care unit. It begins with definitions of terms like fever and hypothermia. It then discusses the pathogenesis and significance of fever. Fever can both enhance immune function but also lead to poor outcomes in some cases like stroke patients. In the ICU, fever often complicates many admissions and can be caused by infectious or non-infectious etiologies. Common infectious causes are discussed like ventilator-associated pneumonia, catheter-associated bloodstream infections, and urinary tract infections. Non-infectious causes such as drug reactions, adrenal crisis, and blood transfusions are also outlined. The document concludes with a discussion of antibiotic use and strategies to optimize treatment in the ICU.
This document provides information on community-acquired pneumonia (CAP). It discusses the epidemiology, clinical presentation, diagnosis, treatment, and pathogens associated with CAP. Key points include: CAP affects millions annually in North America, with Streptococcus pneumoniae being the most common pathogen. Clinical features may include cough, fever, sputum production, and dyspnea. Diagnosis is made clinically with chest imaging showing infiltrates. Treatment involves antibiotic selection based on severity and risk factors for multidrug-resistant organisms.
This document provides information on community-acquired pneumonia (CAP). It defines CAP and differentiates it from healthcare-associated pneumonia. The clinical presentation of CAP is described, including common symptoms like cough and fever. Diagnostic testing for CAP including imaging, cultures, and antigen tests is outlined. The document reviews the typical and atypical bacterial causes of CAP and how comorbidities can influence pathogen selection. Guidelines for empiric antibiotic therapy for outpatient and hospitalized CAP patients are provided, including considerations for multidrug resistant pathogens. Treatment of influenza pneumonia is also summarized.
This document provides an overview of pneumonia, including its definition, classifications, predisposing factors, pathophysiology, clinical manifestations, diagnostic tests, medical management, complications, and prognosis. Pneumonia is an acute respiratory illness associated with lung inflammation and accumulation of secretions in the alveoli. It is commonly classified based on location (e.g. community-acquired), anatomy (e.g. lobar), or cause (e.g. bacterial, viral). Common predisposing factors include smoking, age, and underlying lung diseases. Diagnosis involves tests like chest x-rays, sputum analysis, and bloodwork. Treatment focuses on oxygenation, antibiotics, and supportive care. Complications can include
This document provides an overview of pneumonia, including its definition, epidemiology, etiology, clinical features, diagnosis, severity assessment, management, and treatment guidelines. It discusses community-acquired pneumonia and outlines 4 patient categories based on risk factors and symptoms. Key points include that pneumonia has many potential causes, symptoms often include cough and fever, and treatment involves antibiotics with consideration of atypical pathogens and severity of illness. Hospitalization is recommended for higher-risk patients or those not improving after 2 days.
This document discusses sepsis diagnosis and management. It provides historical context on defining sepsis and outlines diagnostic criteria. Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated response to infection. Common infections that cause sepsis include those of the lung, abdomen, and urine. Management involves initial resuscitation, administering appropriate intravenous antibiotics within 1 hour, and controlling the infection source when possible through procedures like drainage or debridement. Vasopressors, fluid resuscitation, and inotropes may be needed to support blood pressure and organ perfusion.
This document provides information on pneumonia, including its definition, classification, infectious agents, host defenses in the lungs, routes of infection, community-acquired pneumonia, symptoms, diagnosis, treatment, and complications. It defines pneumonia as an infection of the lungs that causes consolidation and filling of alveoli. Community-acquired pneumonia is most often caused by Streptococcus pneumoniae, Haemophilus influenzae, or Mycoplasma pneumoniae. Diagnosis involves assessment of severity, consideration of possible causes, chest imaging, and microbiological testing of sputum or blood. Empiric antibiotic therapy depends on location of treatment and severity of illness. Duration of treatment typically ranges from 7 to 14 days depending on the causative
SEPSIS AND SEPTIC SHOCK PRESENTATION.pptxmainhamza411
1) Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Diagnosis involves identifying infection and meeting criteria for systemic inflammatory response or organ dysfunction.
2) Management of sepsis involves early antibiotic therapy and source control, as well as fluid resuscitation, vasopressors if needed to maintain blood pressure, and inotropes for myocardial dysfunction.
3) Goals of initial resuscitation within 6 hours include central venous pressure of 8-12 mmHg, mean arterial pressure of at least 65 mmHg, urine output of 0.5 mL/kg/hr or more, and normalization of lactate if elevated.
This document discusses fever in the intensive care unit. It begins with definitions of terms like fever and hypothermia. It then discusses the pathogenesis and significance of fever. Fever can both enhance immune function but also lead to poor outcomes in some cases like stroke patients. In the ICU, fever often complicates many admissions and can be caused by infectious or non-infectious etiologies. Common infectious causes are discussed like ventilator-associated pneumonia, catheter-associated bloodstream infections, and urinary tract infections. Non-infectious causes such as drug reactions, adrenal crisis, and blood transfusions are also outlined. The document concludes with a discussion of antibiotic use and strategies to optimize treatment in the ICU.
This document provides information on community-acquired pneumonia (CAP). It discusses the epidemiology, clinical presentation, diagnosis, treatment, and pathogens associated with CAP. Key points include: CAP affects millions annually in North America, with Streptococcus pneumoniae being the most common pathogen. Clinical features may include cough, fever, sputum production, and dyspnea. Diagnosis is made clinically with chest imaging showing infiltrates. Treatment involves antibiotic selection based on severity and risk factors for multidrug-resistant organisms.
This document provides information on community-acquired pneumonia (CAP). It defines CAP and differentiates it from healthcare-associated pneumonia. The clinical presentation of CAP is described, including common symptoms like cough and fever. Diagnostic testing for CAP including imaging, cultures, and antigen tests is outlined. The document reviews the typical and atypical bacterial causes of CAP and how comorbidities can influence pathogen selection. Guidelines for empiric antibiotic therapy for outpatient and hospitalized CAP patients are provided, including considerations for multidrug resistant pathogens. Treatment of influenza pneumonia is also summarized.
This document discusses the pharmacotherapy of septic shock. It begins with a case presentation of a 59-year-old female admitted with septic shock secondary to pyelonephritis. It then covers the epidemiology, pathogenesis, diagnosis, goals of treatment which include identifying the infection source and providing hemodynamic support. Therapeutic alternatives discussed in detail include antimicrobial therapy, hemodynamic monitoring, fluids, inotropes and vasopressors.
Newly Approved Agents: Lefamulin, the first systemic pleuromutilin antibiotic, was approved by the FDA in August 2019 (after the societies’ approval of the guidelines) for the treatment of adults with CAP caused by S pneumoniae, methicillin-susceptible S aureus (MSSA), H influenzae, Legionella pneumophila, M pneumoniae, and C pneumoniae.11,12 Lefamulin acts as a bacterial protein synthesis inhibitor by targeting the peptidyl transferase center of the 50S bacterial ribosomal subunit. It may be given either IV or orally at a dosage of 150 mg IV every 12 hours or 600 mg orally every 12 hours, with dosage adjustment required for patients with hepatic impairment. Lefamulin may prolong the QT interval, and its use should be avoided in patients who have known QT prolongation or are taking other QT-prolonging agents. Lefamulin has several other drug interactions. Its use should be avoided (because of potential for reduced efficacy) with strong or moderate CYP3A inducers or P-glycoprotein (Pgp) inducers. The oral formulation of lefamulin should not be used with agents that are that are strong CYP3A inhibitors or Pgp inhibitors or with CYP3A4 substrates that prolong the QT interval. Lefamulin may cause fetal harm, and females should be counseled to use effective contraception during treatment and for 2 days after completion of therapy.11-13
Delafloxacin, a fluoroquinolone antibiotic, was approved in October 2019 (after the guidelines were published) for treatment of adults with CAP caused by S pneumoniae, MSSA, selected gram-negative pathogens (Klebsiella pneumoniae, Escherichia coli, P aeruginosa, H influenzae, Haemophilus parainfluenzae), and atypical microorganisms (C pneumoniae, L pneumophila, M pneumoniae).14 It may be given either IV or orally at a dosage of 300 mg IV every 12 hours or 450 mg orally every 12 hours, with adjustment required for patients with severe renal impairment. Delafloxacin has the same warnings and precautions as other agents in the fluoroquinolone antimicrobial class.14,15
Directed Treatment
The patient’s clinical response should be evaluated after initiation of antimicrobial therapy. In cases where blood and/or sputum cultures are recommended, once microbiology culture and sensitivity results are available, antibiotic coverage should be deescalated and therapy should be directed at the pathogen(s) causing disease.4,9
Duration of Therapy
The recommended duration of antibiotic therapy has not changed from previously published guidelines. Patients with CAP should be treated for a minimum of 5 days, with antibiotic therapy continued until the patient achieves clinical stability. Validated measures of clinical stability include resolution of vital sign abnormalities (heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature); ability to eat; and normal mental status. Given that most patients achieve clinical stability within 48 to 72 hours after therapy initiation, a 5-day course typically is sufficient
The document provides information on common hospital-acquired infections including fever, sepsis, urinary tract infections, soft tissue infections like cellulitis, pneumonia, and Clostridium difficile infection. It discusses definitions, risk factors, clinical presentations, diagnostic testing, and treatment recommendations for each condition based on clinical severity and patient risk factors.
abscess advanced trauma life support anterior open bite antibiotics braces csf leaks dental diseases doxycycline dr dr shabeel drshabeel’s face eye trauma gingival infection medical medicine periodontal gum surgery pharmacy pn
This document provides an overview of sepsis and septic shock. It defines the clinical syndromes related to sepsis including systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock. It outlines the goals of treating septic shock which include initial fluid resuscitation, stabilizing hemodynamics with pressors, administering antibiotics, and interrupting inflammatory mediators. It discusses early goal directed therapy for septic shock patients, which aims to achieve specific goals regarding central venous pressure, mean arterial pressure, and central venous oxygen saturation within the first 6 hours in order to decrease mortality.
This 67-year-old woman with mild Alzheimer's disease presents with community-acquired pneumonia based on symptoms of productive cough, fever, confusion and exam findings of crackles in both lower lung fields and CXR infiltrates. She meets 3 CURB-65 criteria (confusion, RR≥30, age≥65) and 4 IDSA-ATS minor criteria (RR≥30, confusion, BUN>20, PaO2/FiO2<250) warranting consideration of ICU admission given risk of deterioration. Based on her nursing home residence and recent hospitalization, she also meets criteria for possible healthcare-associated pneumonia and should receive broad-spectrum antibiotics with MRSA and Pseudomonas coverage along with diagnostic
Sepsis and septic shock definitions have evolved over time. Sepsis is now defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock presents as circulatory and metabolic abnormalities with fluid-refractory hypotension requiring vasopressors and signs of hypoperfusion. The pathophysiology involves an excessive inflammatory response and imbalance between coagulation and fibrinolysis. Treatment involves early antibiotics, fluid resuscitation, vasopressors if needed, and source control. Scoring systems like SOFA and qSOFA can help identify those at highest risk.
Current Strategy in Management of Severe Sepsis.pptxHoKimWah
This document provides current guidelines for the management of severe sepsis. It outlines definitions of sepsis, severe sepsis, and septic shock. For initial resuscitation within the first 6 hours, goals include a central venous pressure of 8-12 mmHg, mean arterial pressure above 65 mmHg, urine output of 0.5 mL/kg/hr, and lactate clearance. Fluid resuscitation should begin immediately for hypotension or lactate above 4 mmol/L, administering 30 mL/kg of crystalloids. Antibiotics should be given within 1 hour as broad-spectrum therapy. Vasopressors like norepinephrine should target a MAP above 65 mmHg. Steroids are recommended for septic shock
Neutropenia is defined as an absolute neutrophil count (ANC) below specific thresholds, with severe neutropenia being an ANC below 500/microL. The risks of infection are related to the duration and degree of neutropenia as well as other factors that compromise immunity. Febrile neutropenia is diagnosed based on temperature thresholds and requires prompt evaluation and treatment with broad-spectrum intravenous antibiotics to cover common bacterial and fungal pathogens. Fluid resuscitation is the initial treatment for shock in febrile neutropenic patients, while vasopressors may be needed if the patient does not respond to fluids alone.
This document discusses sepsis without a known focus of infection. It outlines common pathogens that can cause sepsis and clinical signs of sepsis. It defines sepsis, severe sepsis, and septic shock. It discusses treatment approaches including empiric antibiotic therapy and source control. It also covers catheter-related bloodstream infections, risk factors, prevention, and management strategies. Special populations that may have different common pathogens are highlighted.
Sepsis & septic shock an updated managementahad80a
1) Sepsis and septic shock are systemic inflammatory responses to infection that can lead to organ dysfunction and death. The management involves recognizing the condition, administering antibiotics and fluids, controlling the infection source, and providing supportive organ care.
2) Diagnostic criteria include signs of infection along with dysregulated inflammatory response and organ dysfunction. Management goals within 3-6 hours include antibiotics, fluid resuscitation, lactate measurement, vasopressors for hypotension, and in some cases steroids and glucose control.
3) Common infection sites include the lungs, urinary tract, abdomen, and intravenous lines. Antibiotics should have appropriate spectrum and be given quickly based on likely pathogens. Other supportive therapies
Septic shock is a life-threatening condition that arises when sepsis leads to dangerously low blood pressure and problems in organ function. It results from an infection that causes changes throughout the body. Early recognition and treatment are important, including administering antibiotics within an hour, aggressive fluid resuscitation, and monitoring for organ dysfunction. Goals of management are restoring blood pressure, reversing signs of low perfusion, and treating the underlying infection while avoiding additional organ injury.
This document discusses antibiotic strategy in community-acquired pneumonia (CAP). It begins by classifying different types of pneumonia, such as CAP, HCAP, HAP, ICUAP, and VAP. It then discusses definitions, clinical diagnosis, bacteriological diagnosis, pathogenesis, severity scoring using PSI and CURB-65, treatment recommendations based on location and severity, special considerations, treatment duration, and prevention strategies for CAP. The overall document provides guidance on evaluating and managing antibiotic treatment for CAP.
Community-acquired pneumonia is usually caused by Streptococcus pneumoniae and presents with fever, cough, and dyspnea. Diagnosis involves chest x-ray and culture. Treatment depends on severity and includes macrolides or fluoroquinolones for outpatients and fluoroquinolones plus azithromycin for inpatients. Hospital-acquired pneumonia has a higher risk of Gram-negative bacteria. Ventilator-associated pneumonia requires combination therapy including antipseudomonal drugs. Pneumocystis pneumonia affects those with AIDS and presents as hypoxia; treatment is TMP/SMX with steroids for severe cases.
Diagnosis & Mangement of Community-Acquired Pneumonia, Hospital Acquired Pneu...Riaz Rahman
Clinical overview of Community Acquired Pneumonia, Hospital Acquired Pneumonia, Aspiration Pneumonia. Covers pathophysiology, clinical management, prevention, risk stratification (pneumonia severity index), prognostic factors, complications. Includes case studies, comprehension questions. Given at Jackson Park Medical Center on 12/1/2013. Includes references.
This document discusses pneumonia, including its classification, pathophysiology, risk factors, diagnosis, treatment, and complications. Pneumonia is an infection of the lungs that can be community-acquired, hospital-acquired, or ventilator-associated. It results from microbial pathogens in the lungs and the body's immune response. Common symptoms include fever, cough, and difficulty breathing. Diagnosis involves chest x-ray and culture of sputum samples. Treatment is usually initial empirical antibiotics but may require adjustment based on severity and failure to improve. Complications can include respiratory failure, shock, and lung abscesses.
1. Pneumonia is an inflammation of the lung parenchyma that presents with recent radiological shadowing. It can be misdiagnosed, mistreated, and under estimated.
2. Pneumonia is classified by aetiology (community acquired, hospital acquired, aspiration) and anatomy (lobar, bronchopneumonia).
3. Risk factors include age, comorbidities, respiratory conditions, lifestyle factors, and immunosuppressant therapy.
This document provides information on sepsis for EMS providers, including causes and risk factors, signs and symptoms, treatment guidelines, and case studies. Sepsis is a serious condition that can lead to septic shock and organ failure if not treated quickly. The guidelines describe identifying septic patients in the field using specific criteria and initiating fluid resuscitation and transport to the hospital for early goal directed therapy to improve outcomes. Case studies demonstrate application of the guidelines and emphasize importance of early recognition and treatment.
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...DrDevTaneja1
Digital India will need a big trained army of Health Informatics educated & trained manpower in India.
Presently, generalist IT manpower does most of the work in the healthcare industry in India. Academic Health Informatics education is not readily available at school & health university level or IT education institutions in India.
We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
Health informatics has huge employment potential and provides a big business opportunity for the healthcare industry. A big pool of trained health informatics manpower can lead to product & service innovations on a global scale in India.
This document discusses the pharmacotherapy of septic shock. It begins with a case presentation of a 59-year-old female admitted with septic shock secondary to pyelonephritis. It then covers the epidemiology, pathogenesis, diagnosis, goals of treatment which include identifying the infection source and providing hemodynamic support. Therapeutic alternatives discussed in detail include antimicrobial therapy, hemodynamic monitoring, fluids, inotropes and vasopressors.
Newly Approved Agents: Lefamulin, the first systemic pleuromutilin antibiotic, was approved by the FDA in August 2019 (after the societies’ approval of the guidelines) for the treatment of adults with CAP caused by S pneumoniae, methicillin-susceptible S aureus (MSSA), H influenzae, Legionella pneumophila, M pneumoniae, and C pneumoniae.11,12 Lefamulin acts as a bacterial protein synthesis inhibitor by targeting the peptidyl transferase center of the 50S bacterial ribosomal subunit. It may be given either IV or orally at a dosage of 150 mg IV every 12 hours or 600 mg orally every 12 hours, with dosage adjustment required for patients with hepatic impairment. Lefamulin may prolong the QT interval, and its use should be avoided in patients who have known QT prolongation or are taking other QT-prolonging agents. Lefamulin has several other drug interactions. Its use should be avoided (because of potential for reduced efficacy) with strong or moderate CYP3A inducers or P-glycoprotein (Pgp) inducers. The oral formulation of lefamulin should not be used with agents that are that are strong CYP3A inhibitors or Pgp inhibitors or with CYP3A4 substrates that prolong the QT interval. Lefamulin may cause fetal harm, and females should be counseled to use effective contraception during treatment and for 2 days after completion of therapy.11-13
Delafloxacin, a fluoroquinolone antibiotic, was approved in October 2019 (after the guidelines were published) for treatment of adults with CAP caused by S pneumoniae, MSSA, selected gram-negative pathogens (Klebsiella pneumoniae, Escherichia coli, P aeruginosa, H influenzae, Haemophilus parainfluenzae), and atypical microorganisms (C pneumoniae, L pneumophila, M pneumoniae).14 It may be given either IV or orally at a dosage of 300 mg IV every 12 hours or 450 mg orally every 12 hours, with adjustment required for patients with severe renal impairment. Delafloxacin has the same warnings and precautions as other agents in the fluoroquinolone antimicrobial class.14,15
Directed Treatment
The patient’s clinical response should be evaluated after initiation of antimicrobial therapy. In cases where blood and/or sputum cultures are recommended, once microbiology culture and sensitivity results are available, antibiotic coverage should be deescalated and therapy should be directed at the pathogen(s) causing disease.4,9
Duration of Therapy
The recommended duration of antibiotic therapy has not changed from previously published guidelines. Patients with CAP should be treated for a minimum of 5 days, with antibiotic therapy continued until the patient achieves clinical stability. Validated measures of clinical stability include resolution of vital sign abnormalities (heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature); ability to eat; and normal mental status. Given that most patients achieve clinical stability within 48 to 72 hours after therapy initiation, a 5-day course typically is sufficient
The document provides information on common hospital-acquired infections including fever, sepsis, urinary tract infections, soft tissue infections like cellulitis, pneumonia, and Clostridium difficile infection. It discusses definitions, risk factors, clinical presentations, diagnostic testing, and treatment recommendations for each condition based on clinical severity and patient risk factors.
abscess advanced trauma life support anterior open bite antibiotics braces csf leaks dental diseases doxycycline dr dr shabeel drshabeel’s face eye trauma gingival infection medical medicine periodontal gum surgery pharmacy pn
This document provides an overview of sepsis and septic shock. It defines the clinical syndromes related to sepsis including systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock. It outlines the goals of treating septic shock which include initial fluid resuscitation, stabilizing hemodynamics with pressors, administering antibiotics, and interrupting inflammatory mediators. It discusses early goal directed therapy for septic shock patients, which aims to achieve specific goals regarding central venous pressure, mean arterial pressure, and central venous oxygen saturation within the first 6 hours in order to decrease mortality.
This 67-year-old woman with mild Alzheimer's disease presents with community-acquired pneumonia based on symptoms of productive cough, fever, confusion and exam findings of crackles in both lower lung fields and CXR infiltrates. She meets 3 CURB-65 criteria (confusion, RR≥30, age≥65) and 4 IDSA-ATS minor criteria (RR≥30, confusion, BUN>20, PaO2/FiO2<250) warranting consideration of ICU admission given risk of deterioration. Based on her nursing home residence and recent hospitalization, she also meets criteria for possible healthcare-associated pneumonia and should receive broad-spectrum antibiotics with MRSA and Pseudomonas coverage along with diagnostic
Sepsis and septic shock definitions have evolved over time. Sepsis is now defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock presents as circulatory and metabolic abnormalities with fluid-refractory hypotension requiring vasopressors and signs of hypoperfusion. The pathophysiology involves an excessive inflammatory response and imbalance between coagulation and fibrinolysis. Treatment involves early antibiotics, fluid resuscitation, vasopressors if needed, and source control. Scoring systems like SOFA and qSOFA can help identify those at highest risk.
Current Strategy in Management of Severe Sepsis.pptxHoKimWah
This document provides current guidelines for the management of severe sepsis. It outlines definitions of sepsis, severe sepsis, and septic shock. For initial resuscitation within the first 6 hours, goals include a central venous pressure of 8-12 mmHg, mean arterial pressure above 65 mmHg, urine output of 0.5 mL/kg/hr, and lactate clearance. Fluid resuscitation should begin immediately for hypotension or lactate above 4 mmol/L, administering 30 mL/kg of crystalloids. Antibiotics should be given within 1 hour as broad-spectrum therapy. Vasopressors like norepinephrine should target a MAP above 65 mmHg. Steroids are recommended for septic shock
Neutropenia is defined as an absolute neutrophil count (ANC) below specific thresholds, with severe neutropenia being an ANC below 500/microL. The risks of infection are related to the duration and degree of neutropenia as well as other factors that compromise immunity. Febrile neutropenia is diagnosed based on temperature thresholds and requires prompt evaluation and treatment with broad-spectrum intravenous antibiotics to cover common bacterial and fungal pathogens. Fluid resuscitation is the initial treatment for shock in febrile neutropenic patients, while vasopressors may be needed if the patient does not respond to fluids alone.
This document discusses sepsis without a known focus of infection. It outlines common pathogens that can cause sepsis and clinical signs of sepsis. It defines sepsis, severe sepsis, and septic shock. It discusses treatment approaches including empiric antibiotic therapy and source control. It also covers catheter-related bloodstream infections, risk factors, prevention, and management strategies. Special populations that may have different common pathogens are highlighted.
Sepsis & septic shock an updated managementahad80a
1) Sepsis and septic shock are systemic inflammatory responses to infection that can lead to organ dysfunction and death. The management involves recognizing the condition, administering antibiotics and fluids, controlling the infection source, and providing supportive organ care.
2) Diagnostic criteria include signs of infection along with dysregulated inflammatory response and organ dysfunction. Management goals within 3-6 hours include antibiotics, fluid resuscitation, lactate measurement, vasopressors for hypotension, and in some cases steroids and glucose control.
3) Common infection sites include the lungs, urinary tract, abdomen, and intravenous lines. Antibiotics should have appropriate spectrum and be given quickly based on likely pathogens. Other supportive therapies
Septic shock is a life-threatening condition that arises when sepsis leads to dangerously low blood pressure and problems in organ function. It results from an infection that causes changes throughout the body. Early recognition and treatment are important, including administering antibiotics within an hour, aggressive fluid resuscitation, and monitoring for organ dysfunction. Goals of management are restoring blood pressure, reversing signs of low perfusion, and treating the underlying infection while avoiding additional organ injury.
This document discusses antibiotic strategy in community-acquired pneumonia (CAP). It begins by classifying different types of pneumonia, such as CAP, HCAP, HAP, ICUAP, and VAP. It then discusses definitions, clinical diagnosis, bacteriological diagnosis, pathogenesis, severity scoring using PSI and CURB-65, treatment recommendations based on location and severity, special considerations, treatment duration, and prevention strategies for CAP. The overall document provides guidance on evaluating and managing antibiotic treatment for CAP.
Community-acquired pneumonia is usually caused by Streptococcus pneumoniae and presents with fever, cough, and dyspnea. Diagnosis involves chest x-ray and culture. Treatment depends on severity and includes macrolides or fluoroquinolones for outpatients and fluoroquinolones plus azithromycin for inpatients. Hospital-acquired pneumonia has a higher risk of Gram-negative bacteria. Ventilator-associated pneumonia requires combination therapy including antipseudomonal drugs. Pneumocystis pneumonia affects those with AIDS and presents as hypoxia; treatment is TMP/SMX with steroids for severe cases.
Diagnosis & Mangement of Community-Acquired Pneumonia, Hospital Acquired Pneu...Riaz Rahman
Clinical overview of Community Acquired Pneumonia, Hospital Acquired Pneumonia, Aspiration Pneumonia. Covers pathophysiology, clinical management, prevention, risk stratification (pneumonia severity index), prognostic factors, complications. Includes case studies, comprehension questions. Given at Jackson Park Medical Center on 12/1/2013. Includes references.
This document discusses pneumonia, including its classification, pathophysiology, risk factors, diagnosis, treatment, and complications. Pneumonia is an infection of the lungs that can be community-acquired, hospital-acquired, or ventilator-associated. It results from microbial pathogens in the lungs and the body's immune response. Common symptoms include fever, cough, and difficulty breathing. Diagnosis involves chest x-ray and culture of sputum samples. Treatment is usually initial empirical antibiotics but may require adjustment based on severity and failure to improve. Complications can include respiratory failure, shock, and lung abscesses.
1. Pneumonia is an inflammation of the lung parenchyma that presents with recent radiological shadowing. It can be misdiagnosed, mistreated, and under estimated.
2. Pneumonia is classified by aetiology (community acquired, hospital acquired, aspiration) and anatomy (lobar, bronchopneumonia).
3. Risk factors include age, comorbidities, respiratory conditions, lifestyle factors, and immunosuppressant therapy.
This document provides information on sepsis for EMS providers, including causes and risk factors, signs and symptoms, treatment guidelines, and case studies. Sepsis is a serious condition that can lead to septic shock and organ failure if not treated quickly. The guidelines describe identifying septic patients in the field using specific criteria and initiating fluid resuscitation and transport to the hospital for early goal directed therapy to improve outcomes. Case studies demonstrate application of the guidelines and emphasize importance of early recognition and treatment.
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...DrDevTaneja1
Digital India will need a big trained army of Health Informatics educated & trained manpower in India.
Presently, generalist IT manpower does most of the work in the healthcare industry in India. Academic Health Informatics education is not readily available at school & health university level or IT education institutions in India.
We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
Health informatics has huge employment potential and provides a big business opportunity for the healthcare industry. A big pool of trained health informatics manpower can lead to product & service innovations on a global scale in India.
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TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...Pristyn Care Reviews
Precision becomes a byword, most especially in such procedures as hip and knee arthroplasty. The success of these surgeries is not just dependent on the skill and experience of the surgeons but is extremely dependent on preoperative planning. Recognizing this important need, Pristyn Care commits itself to the integration of advanced imaging technologies like CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) into the surgical planning process.
CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
The Importance of Black Women Understanding the Chemicals in Their Personal C...bkling
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Presentation made by Mat Southwell to the Harm Reduction Working Group of the English Drug and Alcohol Commissioners. Discuss stimulants, OAMT, NSP coverage and community-led approach to DCRs. Focussing on active drug user perspectives and interests
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
nursing management of patient with Empyema pptblessyjannu21
prepared by Prof. BLESSY THOMAS, SPN
Empyema is a disease of respiratory system It is defines as the accumulation of thick, purulent fluid within the pleural space, often with fibrin development.
Empyema is also called pyothorax or purulent pleuritis.
It’s a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. This area is known as the pleural space.
Pus is a fluid that’s filled with immune cells, dead cells, and bacteria.
Pus in the pleural space can’t be coughed out. Instead, it needs to be drained by a needle or surgery.
Empyema usually develops after pneumonia, which is an infection of the lung tissue. it is mainly caused due in infectious micro-organisms. It can be treated with medications and other measures.
1. Sepsis
Basics
Description
Presence of an infection with an associated systemic inflammatory response
The systemic inflammatory response syndrome (SIRS) is composed of 4 criteria:
Temperature >38°C or <36°C
Heart rate >90 bpm
Respiratory rate >20/min or PaCO2 <32 mm Hg
WBC >12,000/mm3
, <4,000/mm3
, or >10% bands
Sepsis = suspected infection with ≥2 SIRS criteria:
Release of chemical messengers by the inflammatory response
Macrocirculatory failure through decreased cardiac output or decreased perfusion pressure
Microcirculatory failure through impaired vascular autoregulatory mechanisms and functional shunting of oxygen
Cytopathic hypoxia and mitochondrial dysfunction
Hemodynamic changes result from the inflammatory response:
Elevated cardiac output in response to vasodilatation
Later myocardial depression
Multiple organ dysfunction syndrome (MODS):
Acute respiratory distress syndrome (ARDS)
Acute tubular necrosis and kidney failure
Hepatic injury and failure
Disseminated intravascular coagulation
Sepsis should be viewed as a continuum of severity from a proinflammatory response to organ dysfunction and tissue
hypoperfusion:
Severe sepsis: Sepsis with at least 1 of the following organ dysfunctions:
Acidosis
Renal dysfunction
Acute change in mental status
Pulmonary dysfunction
Hypotension
Thrombocytopenia or coagulopathy
Liver dysfunction
Septic shock: Sepsis-induced hypotension despite fluid resuscitation:
Systolic BP <90 mm Hg or reduction of >40 mm Hg from baseline
Sepsis is the tenth leading cause of death in the U.S.:
In-hospital mortality for septic shock is ∼20%
Etiology
Gram-negative bacteria most common:
Escherichia coli
Pseudomonas aeruginosa
Rickettsiae
Legionella spp.
Gram-positive bacteria:
Enterococcus spp.
Staphylococcus aureus
Streptococcus pneumoniae
Fungi (Candida species)
Viruses
2. Pediatric Considerations
Children with a minor infection may have many of the findings of SIRS
Major causes of pediatric bacterial sepsis:
Neisseria meningitidis
Streptococcal pneumonia
Haemophilus influenzae
Diagnosis
Signs and Symptoms
History
Question for signs of infection and a systemic inflammatory response:
Fever
Dyspnea
Altered mental status:
Change in mental status
Confusion
Delirium
Nausea and vomiting
Look for a source of the infection:
Cough, shortness of breath
Abdominal pain
Diarrhea
Dysuria/frequency
Past history should highlight risk factors and immunosuppressive states:
Underlying terminal illness
Recent chemotherapy
Malignancy
History of a splenectomy
HIV
Diabetes
Nursing home resident
Physical Exam
An elevated respiratory rate is an early warning sign of sepsis and occurs without underlying pulmonary pathology or
acidosis
BP is often normal early in sepsis
Hypotension when septic shock occurs
Extremities are often warmed and flushed despite hypotension
Look for a source of the infection:
Abdominal exam
Rectal exam to assess for an abscess
Chest exam for signs of pneumonia
Any rash is important:
Localized erythema with lymphangitis (streptococcal or staphylococcal cellulitis)
Rash involving palms of hands and soles of feet (rickettsial infection)
Petechiae scattered on the torso and extremities (meningococcemia)
Ecthyma gangrenosum (pseudomonas septicemia)
Round, indurated, painless lesion with surrounding erythema and central necrotic black eschar
Decubitus ulcers
Indwelling catheter
CNS infections:
Coma
Neck stiffness (meningitis)
3. Essential Workup
Serum lactate should be done early in the course to assess severity and need for vasopressors and fluids
Blood cultures prior to antibiotics:
Broad spectrum of lab tests and imaging studies to locate the source of the infection and assess for MOF
Placement of a central line with an ScvO2 catheter may be used to adjust therapy
Diagnostic Tests and Interpretation
Lab
Serum lactate:
>4 mmol/L defines severe sepsis
Normal lactate does not rule out septic shock
CBC with differential:
Leukocytosis is insensitive and nonspecific
Neutrophil count <500 cells/mm3 should prompt isolation and empiric IV antibiotics in chemotherapy patients
>5% bands on a peripheral smear is an imperfect indicator of infection
Hematocrit:
Patients should be maintained with a hematocrit >30% and hemoglobin >10 g/dL
Platelets:
May be elevated in the presence of infection or sepsis-induced volume depletion
Low platelet count is a significant predictor of bacteremia and death
Electrolytes, BUN, creatinine, glucose
Ca, Mg, pH
C-reactive protein
Cortisol level
INR/prothrombin time/partial thromboplastin time
Liver function tests
ABG or VBG:
Mixed acid–base abnormalities: Respiratory alkalosis with metabolic acidosis
VBG correlates very closely with ABG, except for SaO2
Blood cultures:
From 2 different sites
1 may be drawn through an indwelling central line (i.e., Broviac)
Urine analysis and culture
Imaging
CXR:
Determine whether pneumonia is the infectious source
Fluffy, bilateral infiltrates may indicate that ARDS is already present
Free air under the diaphragm indicates the source of the infection in intraperitoneal and a surgical intervention is
mandatory
Soft tissue plain films:
Indicated if extremity erythema or severe pain
Air in the soft tissues associated with necrotizing or gas-forming infection
Imaging studies to locate the source of the infection based on the presentation:
CT scan of the abdomen and pelvis
Abdominal US for gallbladder disease
Transthoracic or transesophageal echocardiogram
Diagnostic Procedures/Other
Lumbar puncture:
For meningeal signs or altered mental status
Central venous access:
Central venous pressure (CVP) and ongoing measurement of central venous oximetry
Differential Diagnosis
4. Pancreatitis
Trauma
Hemorrhage
Cardiogenic shock
Toxic shock syndrome
Anaphylaxis
Adrenal insufficiency
Drug or toxin reactions
Heavy metal poisoning
Hepatic insufficiency
Neurogenic shock
Treatment
Pre Hospital
Aggressive fluid resuscitation for hypotension
Initial Stabilization/Therapy
ABCs
Supplemental oxygen to maintain PaO2 >60 mm Hg
Intubation and mechanical ventilation if shock or hypoxia are present
Administer 0.9% NS IV
Ed Treatment/Procedures
Early goal-directed therapy:
500 cc boluses of 0.9% saline up to 1–2 L empirically
Consider central line or large bore IV access
Continue 500 cc saline boluses until CVP >8 cm H2O
If the mean arterial pressure <65 mm Hg and CVP >8, then initiate pressors:
Norepinephrine or dopamine to raise BP
Norepinephrine is preferred if tachycardia or dysrhythmias are present
Epinephrine for cases where shock is refractory to other pressors
If the ScvO2 <70 and HCT <30, transfuse 2 U PRBCs
If ScvO2 >70 and HCT >30 and MAP >60, then add dobutamine
Administer antibiotics early, based on the most likely organisms or site of infection
If source identified, or highly suspected, treat the most likely organisms:
Cover for MRSA, VRE, and Pseudomonas if there are risk factors
Pulmonary source:
Second- or third-generation cephalosporin and gentamicin
Intra-abdominal source:
Ampicillin and metronidazole and gentamicin
Cefoxitin and gentamicin
Urinary tract source:
Ampicillin or piperacillin and gentamicin or levofloxacin
Consider stress-dose hydrocortisone if recent steroid use or possible adrenal insufficiency
Pediatric Considerations
Antibiotic therapy based on age:
<3 mo (2 drugs): Ampicillin and gentamicin or cefotaxime (50–180 mg/kg/d div q4–6h)
≥3 mo: Cefotaxime or ceftriaxone (50–100 mg/kg/d div q12–24h)
Initiate vasopressors after no response to 60 mL/kg IV fluid
Avoid hyponatremia and hypoglycemia
Dexamethasone for children with bacterial meningitis:
0.15 mg/kg q6h for 4 d
5. Medication
Ampicillin: 1–2 g (peds: 50–200 mg/kg/24 hr) IV q4–6h
Cefoxitin: 1–2 g (peds: 100–160 mg/kg/24 hr) IV q6–8h
Ceftazidime: 1–2 g (peds: 100–150 mg/kg/24 hr) IV q8–12h
Dopamine: 1–5 mcg/kg/min (renal dose); 5–10 mcg/kg/min (pressor dose)
Gentamicin: 1–1.5 mg/kg (peds: 2–2.5 mg/kg q8h) IV q8h
Hydrocortisone: 100 mg IV q6–8h
Metronidazole: Load with 1 g (peds: 15 mg/kg) IV, then 500 mg (peds: 7.5 mg/kg q6h)
Nafcillin: 1–2 g IV q4h (peds: 50 mg/kg/24 hr div q4–6h)
Norepinephrine: 2–8 mcg/min
Piperacillin: 3–4 g IV q4–6h
Vancomycin: 500 mg (peds: 10 mg/kg) IV q6h
First Line Medication:
Normal immune function without an identifiable source:
Second- or third-generation cephalosporin and gentamicin
Nafcillin and gentamicin
Add vancomycin if there is a history of methicillin-resistant S. aureus, or the patient resides in a nursing facility, or
there is a history of recent hospitalizations
Second Line Medication:
Immunocompromised host without an identifiable source:
Piperacillin and gentamicin
Ceftazidime and either nafcillin or vancomycin and gentamicin
Ongoing Care
Disposition
Admission Criteria
Sepsis almost always requires inpatient care
Discharge Criteria
Patients with less severe infections (e.g., streptococcal pharyngitis) meeting the criteria for sepsis with stabilized vital signs
Issues for Referral
Sepsis with toxicity, septicemia, or septic shock requires admission, generally to an ICU
Pearls and Pitfalls
Start antibiotics as soon as sepsis is suspected
Failure to recognize multiorgan failure and initiate aggressive fluid resuscitation in the initial presentation of sepsis
Additional Reading
The ProCESS Investigators, Yealy DM, Kellum JA, et al. A randomized trial of protocol-based care for early septic shock.
N Engl J Med. 2014;370:1683–1693.
Seymour CW, Rosengart MR. Septic shock: Advances in diagnosis and treatment. JAMA. 2015;314:708–717.
Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock
(Sepsis-3). JAMA. 2016;315:801–810.
Venkatesh B, Finfer S, Cohen J, et al. Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med.
2018;378:797–808.
Authors
Annette M. Ilg
Nathan I. Shapiro