Chest tubes, or thoracostomy tubes, have been used since the fifth century BC when Hippocrates described the use of a hollow tin tube to drain fluid that was likely an empyema from his description.[i] Chest tubes started to be used…
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More Tags – antibiotic stewardship, antibiotics, Arterial Line, central line, featured, sepsis, sepsis management, septic shock
Timely administration of broad-spectrum antibiotics in septic patients saves lives. Though this has been demonstrated in hundreds of clinical investigations over the last few decades, antibiotics remain the most controversial topic in the management of severe sepsis and septic shock. …
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Aggressive fluid administration is a hallmark of septic shock management and has been espoused by the Surviving Sepsis Campaign and is a part of the CMS SEP-1 sepsis bundle. The sepsis bundle includes administration of 30 ml/kg crystalloid bolus (LR…
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Malpositioned central venous catheters occurs in about 7% of central line placements. A malpositioned central line is any central venous catheter where the tip is located anywhere other than the superior vena cava (SVC) for internal jugular lines or subclavian…
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More Articles – Cardiovascular diseases, Featured, Infections, medical procedures, Respiratory diseases
More Tags – chest tube, empyema, featured, HPC updates, parapneumonic effusion, pleural effusion, thoracentesis, tube thoracostomy
Complicated parapneumonic effusions frequently represent pleural space infections. Approximately 1 in 7 cases of pneumonia have an associated parapneumonic effusion (PPE) on chest x-ray. Most of these effusions are small and usually resolve spontaneously with prompt antibiotic administration. However, moderate-to-large…
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Where to place a central venous catheter is a decision driven mainly by individual preference. The limited evidence available has not established any site as superior; the subclavian position has been reported as being less infection-prone, but more likely to cause…
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More Articles – Cardiovascular diseases, Featured Procedure, Infections, Medical General, medical procedures
According to AASLD Practice Guidelines, all patients with cirrhotic ascites admitted to the hospital should have a diagnostic paracentesis to rule out spontaneous bacterial peritonitis (SBP). Treatment of SBP requires cefotaxime plus albumin 1.5 gm/kg on the first day and…
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This blog summarizes the recent European Association for the Study of the Liver (EASL) guidelines on the management of ascites, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS) in patients with cirrhosis. Cirrhotic ascites occurs as a consequence of portal…
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Staph aureus bacteremia (SAB) includes both MRSA and MSSA bacteremia and carries an attributable mortality rate of up to 25%. As such, it is important to determine ways in which this mortality rate can be reduced. The evidence base for…
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In many hospitals, blood cultures have become a reflexive habit for patients presenting to the ER with any suspected infection. This was, in part, due to the inappropriate addition of routine blood cultures as a core measure in 2001 by…
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There is now very convincing evidence to support a restrictive transfusion threshold — hemoglobin, <7 g/dL — for most critically ill patients that is supported by guidelines from the American Association of Blood Banks and the TRICC and FOCUS trials. …
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Where to place a central venous catheter is a decision driven mainly by individual preference. The limited evidence available has not established any site as superior; the subclavian position has been reported as being less infection-prone, but more likely to cause…
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Fever is universally treated in the setting of infection in virtually all hospitals, but does treatment of fever improve outcomes in patients with sepsis? This meta-analysis of eight randomized trials (1507 patients) and six observational studies (2058 patients) that compared…
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The Infectious Diseases Society of America (IDSA) guidelines remain the gold standard guidelines for infectious disease problems. The IDSA recommends treating patients with community-acquired pneumonia (CAP) for 5 days and it recommends treating those with healthcare-associated pneumonia (HCAP) for 7-8…
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The bactericidal activity of antibiotics depends on the class of antibiotic used. Some antibiotics like vancomycin, aminoglycosides and fluoroquinolones are dose-dependent for their bactericidal activity. Other antibiotics like beta-lactam antibiotics are time-dependent antibiotics. Time-dependent antibiotics have increased bactericidal activity the…
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