Pe

VS: BP 132/80 mm Hg, P 82 bpm, RR 20 per minute, T 37.8°C (100°F)

Labs: WBC 11 x 103/mm3 (11 x 109/L), serum creatinine 88 ^mol/L (1 mg/dL), glucose 5.55 mmol/L (100 mg/dL)

Based on the available data, does AD have an SSI?

What interventions may increase AD's comfort?

How should AD be screened for SSI?

How long should AD be followed in order to identify a possible SSI? Patient Encounter 2

GL is a 56-year-old male who presents to the emergency department with crushing chest pain described as a "10/10" and shortness of breath. He weighs 82 kg (180 lb) and is 5' 9" (175 cm) tall. An ECG reveals an elevated ST segment and lab data are significant for elevated troponins. GL is diagnosed with acute myocardial infarction.

After GL is stabilized, the decision is made to place multiple stents. The surgeon consults with you on recommendations for antibiotic prophylaxis. Significant history for GL: allergy to amoxicillin (anaphylaxis), smokes two packs of cigarettes per day, and lives with his wife and two children.

VS: BP 162/95 mm Hg, P 120 bpm, RR 28 per minute, T 35.8°C (96.4°F)

Labs: Serum creati nine 0.9 mg/dL (80 p,mol/L), troponins 0.8 ng/mL (0.8 mcg/L)

The surgeon wants to use vancomycin for this case; what is your opinion on this?

The surgeon decides to use vancomycin at a dose of 1 g over 30 minutes. During the infusion, GL experiences a rash and a call is made for an epinephrine pen. What is happening to GL and how would you alter the therapy?

What is the risk of overuse of vancomycin in hospitals and what pathogens are becoming problematic?

Colorectal Surgery

Antimicrobial prophylaxis for colorectal operations must cover a broad range of grampositive, gram-negative, and anaerobic organisms. Strategies include oral antimicrobial bowel preparations, parenteral antimicrobials, or both. Oral prophylaxis combinations of neomycin and erythromycin or neomycin and metronidazole are common. Oral antimicrobials should be administered at 19, 18, and 9 hours prior to surgery. A delay in surgery may require a redose, depending on the length of postponement. For parenteral prophylaxis, cefoxitin or cefotetan is appropriate. Cefazolin combined with metronidazole or ampicillin/sulbactam is an effective alternative if antianaerobic cephalosporins are not available. For patients with ^-lactam allergies, use clindamy-cin combined with gentamicin, aztreonam, or ciprofloxacin; metronidazole combined with gentamicin or ciprofloxacin is also appropriate.

Appendectomy is one of the most common intra-abdominal operations. Antimicrobial prophylaxis used for appendectomy is similar to that used for colorectal regimens. In the case of ruptured appendix, antimicrobials are used for treatment, not prophylaxis.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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