Ebook Fundamental critical care support - FCCS (5/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Fundamental critical care support - FCCS (5/E): Part 2
Ebook Fundamental critical care support - FCCS (5/E): Part 2
Chapter 11LIFE-THREATENING INFECTIONS: DIAGNOSIS AND ANTIMICROBIAL THERAPY SELECTIONObjectives■Understand and apply the terminology specific to life-t Ebook Fundamental critical care support - FCCS (5/E): Part 2threatening infections.■List the risk factors for the development of infection.■Identify systemic and site-specific clinical manifestations of life-threatening infections, and understand the diagnostic use of clinical laboratory testing.■Describe the different clinical and epidemiologic variables us Ebook Fundamental critical care support - FCCS (5/E): Part 2ed to guide the selection of antimicrobial therapy.■Outline antimicrobial treatment for empiric therapy and for specific infections.Case StudyA 75-yeaEbook Fundamental critical care support - FCCS (5/E): Part 2
r-old man presents to die emergency department with altered mental status. His family reports that he has had a productive cough for the last 2 days. Chapter 11LIFE-THREATENING INFECTIONS: DIAGNOSIS AND ANTIMICROBIAL THERAPY SELECTIONObjectives■Understand and apply the terminology specific to life-t Ebook Fundamental critical care support - FCCS (5/E): Part 2e receiving 2 Linin oxygen by nasal cannula. You are the primary physician and are called to admit him to the hospital.-Does this patient have sepsis or severe sepsis?-What level of care is needed for this patient?What initial interventions should be instituted immediately?I. INTRODUCTIONLife-threat Ebook Fundamental critical care support - FCCS (5/E): Part 2ening infections are both a cause and a consequence of critical illness. The incidence of life-threatening infections or sepsis is increasing as a refEbook Fundamental critical care support - FCCS (5/E): Part 2
lection of the growing population of patients at risk, for example, the elderly; immunocompromised patients; those with malignancy, chronic illness, oChapter 11LIFE-THREATENING INFECTIONS: DIAGNOSIS AND ANTIMICROBIAL THERAPY SELECTIONObjectives■Understand and apply the terminology specific to life-t Ebook Fundamental critical care support - FCCS (5/E): Part 2ren. Early recognition and appropriate management of infections and their sequelae can decrease the mortality rate.Sepsis is defined as systemic manifestations of infection. Severe sepsis is sepsis associated with organ dysfunction, hypoperfusion, or hypotension. Abnormalities that suggest hypoperfu Ebook Fundamental critical care support - FCCS (5/E): Part 2sion and organ dysfunction may include, but are not limited to, lactic acidosis, oliguria, coagulation disorders, and an acute alteration in mental stEbook Fundamental critical care support - FCCS (5/E): Part 2
atus. These abnormalities are not specific for sepsis and may be present in other conditions. Septic shock is sepsis with arterial hypotension, defineChapter 11LIFE-THREATENING INFECTIONS: DIAGNOSIS AND ANTIMICROBIAL THERAPY SELECTIONObjectives■Understand and apply the terminology specific to life-t Ebook Fundamental critical care support - FCCS (5/E): Part 2tation with concomitant organ dysfunction. Patients receiving inotropic or vasopressor agents may not be hypotensive when perfusion abnormalities are measured.Definitions of sepsis may?e difficult to apply to an individualpatient.Initial considerations in resuscitation and infection management are d Ebook Fundamental critical care support - FCCS (5/E): Part 2escribed in Table 11-1.Additional details are found in tins chapter and in Chapter 6 and 7.II. DIAGNOSIS OF INFECTIONThe diagnosis of serious or life-Ebook Fundamental critical care support - FCCS (5/E): Part 2
threatening infection is based on a careful and complete assessment of the patient’s history, including risk factors, and the presence of characteristChapter 11LIFE-THREATENING INFECTIONS: DIAGNOSIS AND ANTIMICROBIAL THERAPY SELECTIONObjectives■Understand and apply the terminology specific to life-t Ebook Fundamental critical care support - FCCS (5/E): Part 2idered. Laboratory, microbiologic, and imaging results also support the diagnosis of documented or suspected infection.A. Evaluation of New Fever in Critically III Adult PatientsIn some ICUs, the measurement of a newly elevated temperature triggers an automatic order set that includes many tests tha Ebook Fundamental critical care support - FCCS (5/E): Part 2t are time consuming, costly, and disruptive to the patient and staff. Moreover,the patient may experience discomfort, be exposed to unneeded radiatioEbook Fundamental critical care support - FCCS (5/E): Part 2
r the controlled environment of the ICƯ, or lose considerable blood to tills testing. WHICH IS OHC11 repeated several times within 24 hours and dailyChapter 11LIFE-THREATENING INFECTIONS: DIAGNOSIS AND ANTIMICROBIAL THERAPY SELECTIONObjectives■Understand and apply the terminology specific to life-t Ebook Fundamental critical care support - FCCS (5/E): Part 2d cost-eifective milliner. A new lever in a patient in the ICU should trigger a careful clinical assessment rather than automatic orders for laboratory and radiologic tests. The goal of such an approach is to determine, in a directed manner, whether infection is present so that additional testing ca Ebook Fundamental critical care support - FCCS (5/E): Part 2n be avoided and therapeutic decisions can be made. Recommendations tor the evaluation of new fever arc listed in Table 11-2.Table 11-1: Initial ResusEbook Fundamental critical care support - FCCS (5/E): Part 2
citation and Infection lssuesa bInitial Resuscitation (first 6 hours)•Begin resuscitation immediately in patients with hypotension or elevated serum lChapter 11LIFE-THREATENING INFECTIONS: DIAGNOSIS AND ANTIMICROBIAL THERAPY SELECTIONObjectives■Understand and apply the terminology specific to life-t Ebook Fundamental critical care support - FCCS (5/E): Part 2-1/h-1Central venous (superior vena cava) oxygen saturation >70%Diagnosis•Obtain appropriate cultures before starting antibiotics provided this does not significantly delay antimicrobial administration•Obtain two or more blood cultures (Table 11-2)•Cultures other sites as clinically indicated Ebook Fundamental critical care support - FCCS (5/E): Part 2Chapter 11LIFE-THREATENING INFECTIONS: DIAGNOSIS AND ANTIMICROBIAL THERAPY SELECTIONObjectives■Understand and apply the terminology specific to life-tGọi ngay
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