infection 3

Cellulitis: etiology and about

bacterial infection of skin

• subcutaneous tissue, fat, soft tissue layer

can be serious

pathogen

• bacteria

  • streptococcus

  • staphylococcus

Cellulitis: s&s and TX

s&s

• skin warm to touch

• tight and glossy appearance

• red (so systematic s&s can be present)

• swollen

• tender

• painful

• severe - eschar (necrosis)

tx

• oral abx

• pain killers

• surgery

• IV abx

upper vs lower respiratory

upper

• nasal cavity

• pharynx (nasopharynx and oropharynx)

• larynx (laryngopharynx)

lower

• trachea

• primary bronchi

• lungs

how does active inspiration work

diaphragm + external intercostals contract

• intrapulmonary pressure decreases

• atmospheric pressure is greater than lungs so

• air rushes in

• intra-pleural pressure remains low

  • lungs can expand

O2 Hbg Dissociation Curve: Facts

graph that shows how easily Hgb binds to and releases O2 (depends O2 lvls)

cooperative binding

• hard to start accepting O2 for Hbg, but gets easier as more binds

• Hbg affinity for O2 increases for the next O2 molecule

Plateau portion

• high o2 saturation

• at the lung

Steep portion

• low o2 saturation

• at peripheral tissues

• allows for rapid unloading of large amount of o2

P50

• Po2 value when Hgb sat = 50%

• used to measure affinity

L shift

• happens in the lungs

  • caused by low CO2, low temp, high pH (more alkaline)

• highhh Hgb-O2 affinity (holds onto o2 more)

• L = lungs love o2, holds onto harder

R shift

• happens in active tissues (exercise/infection)

  • caused by high CO2, high temp, low pH (more acidic)

  • so more O2 delivered

• lower Hgb-O2 affinity (easier to let go)

• R = release O2

Common cold: about and pathogens

viral infection

• upper resp. tract (URT)

• most common URT illness

common pathogens

• rhinoviruses

• respiratory syncytial virus (RSV)

• coronaviruses

Common cold: s&s and transmissions

• nasopharynx congestion (coryza)

• post nasal drip (PND)

• phayngitis

• headache

• malaise

• fever (virus dependent)

• maybe otitis media

contagious

• transmission depends on virus

  • airborne = droplets

  • contact w/ contaminated surface

Eustachian Tube: Adult vs. Peds

• connects nasopharynx to inner ear

Peds

• shorter, more horizontal

• makes it easier for bacteria from pharynx to travel into this space

  • cause infection

  • higher risk of otitis media

Common cold: TX

supportive

• infection is self-limiting (goes away on its own)

Symptom Relief drug classes

• adrenergic agonists

  • decongestants

    • decrease nasal secretions (vasoconstrict)

  • Pseudoephedrine, Ephedrine

• antihistamines

  • decrease inflam. symptoms

  • Diphenhydramine, Chlorpheniramine, Loratadine (Claritin)

• antitussives

  • CNS depression of cough reflex

  • Codeine, Dextromethorphan

• analgesics

  • less pharyngitis pain

  • Tylenol, Menthol

• combo drugs

  • Benylin, Triaminic, Sudafed

Common cold: supplemental TX

used to reduce severity, improve immune fx OR as preventative tx

• menthol

• vit c

  • immunogenic (producing immune response)

• echinacea

  • immune modulator

  • enhances phagocytosis

• ginseng

  • immune modulator

  • anti-inflammatory

    • Cold-FX (medicinal extract)

Coronaviruses: about

family of viruses

• not an influenza virus

causes disease

• common cold

• COVID-19

• SARS

immunocomp.

• can cause severe + multi-organ disease

transmission

• droplets

• contam. surfaces

Coronaviruses: General s&s and TX

TX: bugsanddrugs

s&s

• headache

• rash

  • vesicular

  • hives r possible

COVID-19: s&s

* = uncommon

systemic

• fever

• fatigue

kidney

• decrease fx*

intestines

• diarrhea*

respiratory

• dry cough

• SOB

• sore throat*

• runny nose*

• sneezing*

circulatory

• decrease WBCs*

COVID-19: Tx

SARS-CoV-2

TX

• Paxlovid

  • nirmatrelvir + ritonavir

  • protease inhibitor + CYP3A inhibitor (PO)

• Remdesivir

  • Veklury

  • Viral RNA polymerase inhibitor (IV)

• Tocilizumab

  • Actemra

  • IL-6 Antibody (IV)

Epiglottitis: about, pathogen

sudden + severe inflammation of epiglottis

• flap of cartilage that covers the airway during swallowing

• life threatening

  • resp. obstruction → resp. failure → mortality

pathogen

• bacteria

  • group A Strep

  • Strep. pneumoniae

  • Haemophilus influenzae type B (Hib)

    • significant cause in unvaccinated children + adults

    • known for being reponsible for >90% of peds cases

Epiglottitis: s&s and TX

s&s

• mouth breathing

• drooling

• fever

• pale/cyanosis

• anxiety

• compensatory tachycardia

• sitting upright w/ neck and head extended forward

TX

• empiric abx stat

• intubation PRN

Rhinosinusitis/sinusitis: A+P Sinuses and about

bones

• frontal, sphenoid, ethmoid, maxillary bone

have openings (ostia) into nasal cavity

lined w/ respiratory epithelium

(rhinosinusitis = nasal passages inflam)

(sinusitis = sinus inflammation)

how?

• nasal passages inflammation obstructs normal sinus outflow + traps pathogen

Rhinosinusitis/sinusitis: pathogen and TX

pathogen

• upper airway pathogens

  • Hib

  • Strep. pneumoniae

TX

• bugsanddrugs :)