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  • Juri 4:39 am on June 18, 2019 Permalink | Reply  

    TSS by Josh Farkas 

    Toxic Shock Syndrome Management: A tale of two patients

     

    Conclusions

    TSS is unusual in its ability to cause severe septic shock in previously normal young people. Given that patients often have high physiologic reserve, they may initially look deceptively OK, masking the severity of their illness. This often causes delays in instituting sufficiently aggressive management.  In addition to aggressive supportive care, specific therapies including IVIG and toxin-suppressive antibiotics may be very important.  The following checklist includes some interventions which should be considered when treating a patient with TSS.

    • Hemodynamic support
      • Early norepinephrine to establish a MAP>65mm
      • Fluid resuscitation
      • Low threshold to add vasopressin and stress-dose hydrocortisone if not responding well to norepinephrine
      • Serial echocardiography to identify occurance of septic cardiomyopathy
    • Respiratory support
      • Consider pre-emptive intubation (e.g., for severe shock or respiratory distress).  Meticulous attention required to peri-intubation hemodynamics.
    • Dual toxin-supressive antibiotic therapy
      • Clindamycin 900 mg IV q8 hours first dose STAT
      • Linezolid 600 mg IV q12 hours first dose STAT
    • Intravenous immunoglobulin (IVIG)
      • Standard course: 1 g/kg IVIG on day #1, then 0.5 g/kg IVIG on days #2 and #3
      • Consider higher dose IVIG (2 g/kg) for refractory shock or necrotizing fasciitis
    • Source control
      • Early surgical consultation for debridement/drainage of any focus of infection
      • Definitive imaging if needed to search for a focus of infection (e.g. CT scan, pelvic ultrasound, etc.)
      • Exclude retained tampon, nasal packing, or foreign body

     

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  • Juri 8:16 pm on June 17, 2019 Permalink | Reply  

    TSS: fever-sore throat-hypotension/ presyncope 

    do not miss TSS.jpg

     
  • Juri 8:20 pm on May 29, 2019 Permalink | Reply  

    via VA Report: Peripheral Stigmata of Infective Endocarditis
     
  • Juri 7:32 am on May 17, 2019 Permalink | Reply  

    ReCap Zeit nerdfallmedizin.blog 

    Um die periphere Durchblutung zu bestimmen, kann man auch schnell die ReCap Zeit bestimmen, ein Grenzwert wäre hier 2sek – viel länger sollte die Recap Zeit bei gesunden Menschen nicht dauern.

    Die Recap Zeit wird am am besten auf der Kniescheibe getestet. In der Praxis bietet sich zur schnellen orientierenden Messung aber auch das Nagelbett der Finger an (Achtung, kalte Finger können auch bei gesunden Patienten eine verlängerte Recap Zeit aufweisen.

    Rekapzeit mit Philiip.jpg

     

     

    Eyeballing – Atemfrequenz und Marmorierung unbedingt ernst nehmen!

     
  • Juri 7:14 am on February 11, 2019 Permalink | Reply  

    infections in cirrhosis 

     
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