tailieunhanh - Support to critical care fundamental (Fifth edition): Part 2

(BQ) Continued part 1, part 2 of the document Support to critical care fundamental (Fifth edition) has contents: Special considerations, critical care in pregnancy, ethics in critical care medicine, management of life threatening electrolyte and metabolic disturbances,. and other contents. Invite you to refer. | Chapter 11 LIFE-THREATENING INFECTIONS DIAGNOSIS AND ANTIMICROBIAL THERAPY SELECTION Objectives Understand and apply the terminology specific to life-threatening 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 used to guide the selection of antimicrobial therapy. Outline antimicrobial treatment for empiric therapy and for specific infections. Case Study A 75-year-old man presents to the emergency department with altered mental status. His family reports that he has had a productive cough for the last 2 days. His vital signs are blood pressure 110 70 mm Hg heart rate 110 min temperature F 39 C respiratory rate 20 min and pulse oximetry 92 while receiving 2 L min 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. INTRODUCTION Life-threatening infections are both a cause and a consequence of critical illness. The incidence of life-threatening infections or sepsis is increasing as a reflection of the growing population of patients at risk for example the elderly immunocompromised patients those with malignancy chronic illness or multiple trauma. Septic shock the most severe form of systemic response to infection is a common cause of death in critically ill adults and children. 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 hypoperfusion and organ dysfunction may include but are not limited