Surviving Sepsis (01:52)
Lab interpretation is critical for accurate diagnosis and treatment plans. This video addresses labs related to sepsis and the serving sepsis campaign.
Spectrum of Sepsis (07:31)
The sepsis spectrum includes SIRS, sepsis plus infection, sever sepsis, septic shock, and multi-organ dysfunction syndrome. In 2001, the four criteria for diagnosing sepsis were elevated temperature, heart rate, respiratory rate, and abnormal WBC. The serving sepsis campaign added additional criteria for sepsis diagnosis.
Rates of Sepsis (02:19)
The increase in cases of sepsis is partially due to prolonged lifespan and comorbid disease processes. Multi-organ dysfunction syndrome is the progressive dysfunction of two or more organ systems driven by an inflammatory process.
Inflammatory Mediators (03:49)
Cytokines are proteins and peptides that act systemically and locally in pro and anti- inflammatory mechanisms. A common lab to diagnose inflammation is the CRP. Zarbano reviews the pathophysiology of sepsis.
Oxyhemoglobin Dissociation Curve (03:49)
The oxyhemoglobin dissociation curve describes how tightly hemoglobin holds onto oxygen molecules. The curve shifts depending on the pH of blood, carbon dioxide levels, and temperature.
Labs Related to Sepsis (08:19)
Common labs used to assess sepsis include lactic acid levels, procalcitonin levels, anion gap, cultures, and the "shift to the left." Lactate levels of four or greater indicates septic shock.
Lab Interpretation Example (01:47)
Zarbano reviews a hypothetical metabolic panel. The anion gap and septic shock can be closed using fluid volume resuscitation, insulin drip, electrolyte replacement, and bicarb replacement.
Lab Cultures (02:12)
Cultures include blood, urine, sputum, stool, cerebral spinal fluid, and peritoneal fluid. The golden hour is the time between ordering a culture and antibiotics for a suspected infection, and administering the antibiotics. The shift to the left is an increase in immature neutrophils.
Surviving Sepsis Campaign Bundles (07:04)
The three hour bundles improve long-term outcomes for patients with sepsis.
The six hour bundle uses vasopressors to treat hypertension and monitoring lactate levels. Norepinephrine and epinephrine are the vasopressors used to treat sepsis.
Viral meningitis is more common than bacterial meningitis. Untreated, mortality rates for bacterial meningitis are high; even with treatment, long-term impairments can be sustained. Early stages of bacterial meningitis appear benig, making diagnosis difficult.
Diagnosis Suspected Meningitis (02:58)
Lumbar punctures, CBC's with differentials, blood cultures, basic metabolic panels, and co-ag panels are used to diagnose meningitis and establish opening pressures. Untreated, meningitis can result in serious complications and even death.
Patient Positioning for Lumbar Punctures (03:29)
Patients should be positioned on their left lateral side to round their lower back and expose L4 and L5. Elderly patients and infants are positioned for comfort. Headaches are a complication associated with lumbar punctures.
Lab Interpretation of Lumbar Punctures (05:33)
Zarbano reviews normal and abnormal results of cerebral final fluid analysis. With viral meningitis, the meninges of the brain are irritated whereas with viral encephalitis, brain tissues are inflamed.
Treating Meningitis (00:55)
Bacterial meningitis is treated with time in isolation, antibiotics, and supportive measures. Viral meningitis is treated with supportive measures. Viral encephalitis is treated with antiviral agents and supportive measures.
Cultures And Sensitivities (05:43)
Zarbano differentiates gram positive and gram negative bacteria. Gram negative bacteria is difficult to treat. Determining if a bacteria is gram negative or gram positive determines which antibiotic is used to treat the patient.
Bactericidal antibiotics attack and destroy bacteria whereas bacteriostatic antibiotics slow down the invading organism, allowing the immune system to fight. Zarbano reviews antibiotic classes. Antibiotic resistance is a result of the overuse of intense antibiotics for minor infections.
Urine Analysis (09:29)
Zarbano reviews normal and abnormal characteristic of urine. The three areas of UA testing include physical characteristics, biochemical testing, and microscope evaluation.
Urinary Tract Infections (01:55)
Women are more likely to contract urinary tract infections because of cross-contamination and urethra length. Symptoms manifest differently between younger and older women.
Case Study (08:06)
Zarbano presents a case study of an elderly woman exhibiting symptoms of a urinary tract infection.
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