Peripheral Vascular Disease
Gozie Offiah, Arnold Hill in RCSI Handbook of Clinical Surgery for Finals, 2019
Management➢ Best done at a specialist multidisciplinary clinic.➢ Regularly inspect feet.➢ Appropriately fitted footwear & avoid walking barefoot.➢ Chiropodist for debriding calluses and for nail care.➢ If infected ulcer: Broad spectrum antibiotics.+/- Debridement of dead tissue.+/- Amputation of non-viable digits if adequate arterial supply for healing of amputationX-ray/MRI to rule out underlying osteomyelitis.➢ Consider revascularization if significant arterial disease.➢ Consider amputation if no response to medical or other surgical treatments.
Complications of Cardiac Surgery and Trauma
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Superficial sternal wound infections usually present with serosanguineous drainage, with or without associated cellulitis. In general, initial management of sternal wound infections includes sterilizing the wound topically (with betadine or chloraprep) and obtaining cultures of any drainage. Unlike wound infections of incisions elsewhere on the body, the sternotomy incision is not managed by opening the wound at the bedside. Broad-spectrum antibiotics against gram-positive and gram-negative organisms are given until culture results determine a more specific antibiotic selection. If there is any sternal instability or suspicion for deep sternal wound infection, the wound must be reexplored in the operating room. If infection is limited to subcutaneous tissues above the level of the sternum and pectoralis major fascia, the wound may be treated initially with negative pressure (i.e., wound vacuum) and then delayed closure.
Practice Paper 9: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
Chemotherapy generally works by inducing apoptosis and inhibiting mitosis, thus preventing the division and proliferation of malignant cells. The chemotherapeutic agents currently used do not specifically target malignant cells, and therefore also exert their cytotoxic actions on healthy cells. The most commonly affected cells are those with a high turnover, i.e. those of the gastrointestinal mucosa, hair follicles, bone marrow and reproductive system. The damage that chemotherapy exerts on these cell lines can result in mucositis, alopecia, pancytopenia and infertility. In this case, the patient is suffering from mucositis – inflammation and ulceration of the gastrointestinal mucosa secondary to chemotherapy. In addition to causing mouth pain, vomiting and diarrhoea, mucositis places the patient at an increased risk of infection and sepsis secondary to the breakdown of the protective gastrointestinal epithelium. Treatment of mucositis is supportive (mouth care and analgesia). Broad-spectrum antibiotics should be prescribed if infection is suspected.
Efficacy and safety of antimicrobial de-escalation as a clinical strategy
Published in Expert Review of Anti-infective Therapy, 2019
Calypso Mathieu, Bruno Pastene, Nadim Cassir, Ignacio Martin-Loeches, Marc Leone
Before discussing de-escalation, we aim to define the key terms related to antimicrobial stewardship management. The term broad-spectrum antibiotics describes antibiotics with activity against P. aeruginosa, including carbapenems, piperacillin/tazobactam, ceftazidime, or ciprofloxacin, while broad-spectrum antimicrobial therapy designates a combination of antibiotics with activities against P. aeruginosa and methicillin-resistant Staphylococcus aureus [12]. As stated in the guidelines [7], the use of an antibiotic to which the etiological organism(s) are sensitive is described as appropriate therapy, whereas the use of appropriate therapy in the correct dose along with good penetration to the site of infection and in combination (if necessary) is referred to as adequate therapy. To our knowledge, most studies on de-escalation have assessed the rate of appropriate therapy.
Systematic review on activity of liposomal encapsulated antioxidant, antibiotics, and antiviral agents
Published in Journal of Liposome Research, 2022
Reshna K. R, Preetha Balakrishnan, Sreerag Gopi
Antibiotics are chemotherapeutic agents which are powerful weapon against bacterial diseases. The synthetic antimicrobial and biological products of non-microbial origin having antagonistic effects on bacteria. Some antibiotics are able to completely kill other bacteria, they are called bactericidal. While others inhibiting bacterial growth are termed as bacteriostatic. There are several ways of classification of antibiotics, based on their mode of action and spectrum of activity. Broad spectrum and narrow spectrum antibiotics are two classifications according to their spectrum activity. In broad spectrum antibiotics, it will kill or inhibit a broad group of bacteria. For example, antibiotics targeting Gram-negative bacteria. In narrow spectrum antibiotics, it will kill or inhibit the limited species of bacteria (Salem et al.2005).
Non-occlusive mesenteric ischemia: two case reports and a short review of the literature
Published in Acta Chirurgica Belgica, 2018
Georges Versyck, Charles de Gheldere, Patrick Vanclooster
The treatment of NOMI can be divided into three steps: supportive therapy, vasodilation and possibly surgery. The first step in treating NOMI is stopping the etiological factor. This means correcting the hypovolemia, cardiac failure, arrhythmia or shock [8]. Aggressive fluid resuscitation is required in the first hours, using either crystalloid and colloid solutions [22]. Vasoconstrictors are -paradoxically added when the patient remains unstable after adequate fluid resuscitation. Norepinephrine is the preferred vasoconstrictor as it provides positive inotropic effects and improves splanchnic perfusion when used at low doses (<0.5 µg/kg/min) [23,24]. Bomberg et al. [24] demonstrated an increased survival trend while using norepinephrine and vasopressin (1-4 units/hour) to stabilize patients [24]. Hemocultures must be collected as soon as bacterial translocation is suspected. Broad-spectrum antibiotic therapy are given to cover anaerobic, Gram-positive and Gram-negative bacteria. A switch to narrow-spectrum antibiotics is warranted when cultures come back positive [25].
Related Knowledge Centers
- Ampicillin
- Antibiotic
- Antimicrobial Resistance
- Bacteria
- Coccus
- Antimicrobial Spectrum
- Gram-Positive Bacteria
- Gram-Negative Bacteria
- Empiric Therapy
- Narrow-Spectrum Antibiotic