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11 Cards in this Set
- Front
- Back
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Adverse effects of etomidate (4) |
N/v Myoclonic movements Seizures (lowers sz threshold) Adrenal suppression |
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Side effects of succinylcholine (5) |
Hyperkalemia arrhythmia Exacerbation of neuropathy / myopathy Malignant hyperthermia Elevation of ICP in patients with mass lesions |
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CVP goals in bacterial meningitis? |
Unknown CVP recommendations by Surviving Sepsis Campaign Guidelines CVP 8-10, goal MAP 65 or more |
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Reconstruct Table 7-3 p.144 Kiwon Lee Hemodynamics effects of vasopressin on cerebral circulation (P.N.E.D.V. effects of CBF ICP CMRO2 PbtO2) |
All agents increase CBF Phenylephrine increases ICP Epinephrine increases CMRO2 NE and V increases PbtO2 |
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Indications for CT scan by Practice Guideline Committee for Treatment of Bacterial Meningitis |
Depressed LOC Focal / lateralizing neuro exam New onset seizures Immunosuppressive h/o CNS pathology
*neuro exam: papilledema, ophthalmoplegia, hemiparesis, abnormal motor response |
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Steroids - evidence in meta-analysis in infants and children |
Reduced hearing impairment (H. Influenza) and protects against severe hearing loss (Strep pneumonia) if steroids started prior to or with first dose of ABx |
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Evidence for steroids in adults with bacterial meningitis |
1 RCT demonstrating significant mortality reduction in adults (notably the only subgroup with statistically significant reductions in unfavorable outcomes = strep pneumo) |
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Steroid dosing in bacterial meningitis |
Dexamethasone 10mg IV q6h x 4 days First dose 15-20mins prior to antibiotics
*current guidelines recommend dexamethasone 0.15mg/Kg q6h x2-4d 10-20m before antibiotics (in all infants, children, adults with suspected bacterial meningitis). Discontinue when CSF GS or blood CS show no evidence of pneumococcal meningitis. |
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Adverse effects of hypertonic solution (4) |
Hypokalemia Hyperchloremic acidosis Fluid overload Bleeding (decreased platelet aggregation, prolonged coagulation times) |
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Other promising therapies for bacterial meningitis |
Nimodipine Statins |
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Proposed mechanism of statins benefitting bacterial meningitis |
Downregulates acute phase cyto-/chemokines (TNF, IL1, IL6)
Increase activity of endothelial NO synthase (eNOs) |
