Ch24

Infectious disease + Sepsis

How diseases spread…

• Infectious diseases

• Bacteria

• Viruses

• Other microbes: Fungi, fungal meningitis

• Communicable diseases: Direct contact, Contact with secretions

Incubation period

When an infection does cause illness, the time from exposure to development of the first symptoms (if contagious, you’re spreading unknowingly

Communicable period

Internal when pt is shedding or releasing infectious material; when microbe can be potentially transmitted

Factors causing infection and illness after exposure

• Virulence: Hep B can live outside on dry blood for 30-40 days (super virulent), vs. HIV (not very virulent) dies in seconds

• Dose: some rxns are dose-dependent, some aren’t

• Route

• Body resistance: peds patients, immunocomprised, immunosuppressed, chronic illnesses people

Sepsis

Sepsis is a life-threatening condition resulting from an abnormal and counterproductive response by the body that causes damage to tissues and organs. The body overreacts and secretes substances that, instead of helping, hurt cells, tissues, and organs.

Leads to denatured brain proteins. Cannot come back if they denature.

Septic Shock

Occurs when these changes (from sepsis) result in shock and hypotension that do not respond to intravenous fluids. (Leaky/permeable vessels)

Stages of Sepsis

Infection (Local)

Sepsis (Systemic)

Septic Shock (Systemic w/ hypotension)

Infection (Local) stage of sepsis

Microbes multiply; body mounts normal immune response and increases WBCs

Sepsis (systemic) stage of sepsis

Body produces lactic acid + other chemicals. ability to produce WBCs may be limited/exhausted

Septic shock (systemic w/ hypotension) stage of sepsis

Lactic acid + other chemicals accumulate in blood, causes vasodilation + increased capillary permeability (leaky); leads to hypotension

Most people die in this phase

Preventions of septic shock

Tell diabetes to check feet (sometimes feet cant have feeling bc of diabetes; unknowingly have cuts)

Pneumonia is a common start to septic shock. Treat ASAP

Locations of body that are likely to be associated w/ sepsis

• Lungs: Pneumonia

• Gastrointestinal tract: Abdominal surgery, Pancreatitis

• Genitourinary tract: Kidney or prostate infections, Urinary catheter

• Skin: Long-term intravenous catheter, Tracheostomy, Gastrostomy tube, Pressures sores

Patient assessment of sepsis

Systemic Inflammatory Response Syndrome (SIRS) criteria; determines if septic or at risk for septic shock.

• Temperature – NOT JUST FEVER! Lower than 96.8° F (36° C) Higher than 101° F (38.3° C)

• Heart rate over 90

• Respiratory rate over 20

• Systolic BP lower than 90 mmHg

• New-onset altered mental status or worsened mental status

What’s qSOFA? What are the factors of it?

Quick Sepsis-related organ failure assessment

• Resembles SIRS criteria

• Does not predict whether someone is septic

• Predicts whether septic patient will have longer to stay in ICU or be more likely to die

Factors:

• Altered Mental Status

• Respiratory rate > 22

• Systolic blood pressure < 100mmHg

Patient care: Sepsis

• Look for signs of sepsis in an infected patient.

• Provide supportive care.

• If a patient meets SIRS or similar criteria, inform the ED (sepsis alert).

Common Communicable Disease Assessment and Care

• Prevention: Appropriate vaccinations, Standard Precautions

• Assessment: Has the patient travelled? Has the patient received recommended vaccinations?

• Care: Understand how the patient feels. Wear personal protective equipment. Get further testing and/or receive preventative prophylactic antibiotics

Chickenpox

• Caused by varicella-zoster virus (VZV)

Very contagious:

• Direct person-to-person contact

• Airborne from rash on skin or mucous membranes

• Dried scabs do not spread disease.

Usually develop natural immunity; unlikely to have it twice.

Chickenpox treatment/prevention

• Isolation of patients until lesions dry.

• Antiviral medications to shorten course of disease and prevent complications

• Vaccination

Receive vaccine within 3 days of exposure.

Measles

• Also called rubeola, a highly infectious viral disease

• Easily spread + HIGH mortality: Inhaled droplets in air. Contact with nose and throat secretions

Measles S/S

• Starts with fever, cough, eye irritation

• Small white or bluish-white spots on inside of cheek (Koplik spots)

• Red-blotchy rash

Chickenpox S/S

• Starts with vague symptoms resembling cold

• Followed by fever and rash that itches and looks like blisters

Measles Treatment/Prevention

• No specific treatment

• Prevention: Vaccination, Quarantine, Hand hygiene

Mumps

Caused by paramyxovirus

Transmission: droplets; direct contact w/ saliva

Not quite as deadly; called mumps bc you get inflamed lymph nodes. Biggest concern is lymph nodes in airway

S/S Mumps

• Starts with vague symptoms such as muscle aches, loss of appetite, Headache

• Progresses to swelling and inflammation of one or both parotids (salivary glands)

• Parotitis lasts 7 to 10 days

Mumps Prevention

• Vaccination

• Quarantine of patients for 5 days after swelling appears

Hep A

Spread by fecal-oral route

Hepatitis

Inflammation of liver

Hep A S/S

• Fever

• Nausea

• Loss of appetite

• Malaise

• Abdominal pain

• Jaundice a few days later

• Generally worse in older patients

Hep A Treatment/Prevention

• No specific treatment

• Prevention: Hand hygiene, Proper food preparation, Vaccination

Hep B

Very common in many parts of world

Transmission: blood + any fluid that contains blood, semen, cerebrospinal fluid, aminotic fluid, vaginal secretions, a few other fluids

Hep B S/S

• Nausea

• Vomiting

• Loss of appetite

• Vague abdominal pain

• Progresses to jaundice

• Younger patients have fewer or no symptoms but much more likely to develop chronic infection.

Hep B treatment/prevention

No specific treatment

Prevention:

• Vaccination

• Proper decontamination of equipment after a call

Postexposure activities of Hep B

• Wash exposure site with soap and water.

• See health care provider right away.

• Vaccination

• Possible immune globulin injection

Hep C

very similiar to hep b

Transmission: bloodborne thru shared needles, less commonly via sex or childbirth

Hep C S/S

• Nausea

• Vomiting

• Loss of appetite

• Vague abdominal pain

Hep C prevention/treatment

Several safe medication regimens but no vaccine

Prevention: standard precautions, proper use/disposal of sharps

HIV/AIDS

Generally die via pnuemonia due to hijacked immune system

Routes of transmission: shared needles, unprotected sex between men, any penetrative activity w/ blood and semen, during delivery/breastfreeding from mom to newborn

HIV/AIDS S/S

• For some patients, flu-like symptoms within a few week of HIV infection

• Fever

• Sore throat

• Fatigue

AIDS is characterized by…

Opportunistic infections such as:

• Pneumocystis carinii

• Kaposi’s sarcoma

• Tuberculosis

Treatment/Prevention HIV/AIDS

• Antiviral medications reduce and suppress HIV viral load.

Prevention:

• Standard Precautions

• Public measures to reduce shared needle use and promote condom use

HIV/AIDS: what to do after significant exposure to blood/body fluids

• Wash the area.

• Consult a health care provider.

Influenza

Common viral illness

Spread by droplets / direct contact.

Influenza S/S

• Fever

• Nonproductive cough

• Severe muscle aches

• Sore throat

• Headache

• Severe weakness

Influenza treatment/prevention

• Antiviral medications lessen the severity and shorten but must be taken within 48 hours of symptom onset.

Prevention:

• Hand hygiene

• Surgical masks

• Vaccination

Croup

Also known as laryngotracheobronchitis, caused by human parainfluenza virus (HPIV) — inflammation + swelling of larynx, trachea, bronchi

Children b/t 6months + 3 yrs are most susceptible

Transmitted via droplets from coughs/sneezes/survives on objects

S/S Croup

• history of upper resp. infection that later produces seal bark cough 

• symptoms often worsen at night (steamy shower or cold air helps)

Croup Treatment/Prevention

• Assess child as for any pt w/ SOB

• Prevention: hand hygeine, refrain from touching nose, eyes, mouth

Pertussis

Whooping Cough: Respiratory infection caused by Bordetella pertussis bacteria

Spread by large droplets in air

Pertussis S/S

• Begins like a typical upper respiratory infection

• Worsens into fits of uninterrupted coughing followed by “whooping” sound on inspiration

Treatment/Prevention Pertussis

• Treatment with antibiotics

• Prevention with vaccine

• Hand hygiene

• Refrain from touching nose, eyes, and mouth.

Pnuemonia S/S

• Fever

• Chills

• Shortness of breath

• Tachypnea

• Pleuritic pain

• Productive cough

• Inflammation consolidated in part of lung on x-ray

• Potential febrile seizures in young children and infants

• Altered mental status common sign in elderly patients

How does pneumonia spread

droplets but requires close contact of several days

Pneumonia treatment/prevention

Treat w/ antibiotics

prevent w/ vaccination, hand hygiene, cough etiquette

Tuberculosis

Hard to treat; hardy virus. Caused by bacterium: myobacterium tuberculosis

Spread by coughing, singing, sneezing

TB S/S

• Cough (initially dry, later productive of purulent sputum): particularly cough that's been going on for a while. At risk populations are high density populations.

• Fever

• Night sweats

• Weight loss

TB treatment/prevention

• Treatment with antibiotics

• Prevention with vaccine,High index of suspicion, Airborne disease precautions including N-95 respirator

Meningitis

Common in high density pops. can be caused by bacteria or fungi. Purple dots/bruising on core

• Inflammation of meninges caused by bacterium Neisseria meningitidis

Spread by direct contact

S/S Meningitis

• Abrupt onset of fever

• Nausea

• Vomiting

• Severe headache

• Nuchal rigidity: stiffness/pain in neck

• Photophobia: sensitive to light

• Possible petechiae: tiny, pinpoint red or purple spots that appear on the skin due to bleeding under the skin

Meningitis Treatment/Prevention

• Treatment with antibiotics for meningococcal meningitis

• Prevention by vaccination

Sexually Transmitted Infections — two major categories + examples

• Viral STIs: HIV, Hepatitis A, B, and C, Genital herpes, Human papilloma virus (HPV)

• Bacterial STIs: Chlamydia, Gonorrhea, Syphilis

STI prevention

Condoms, vaccination, education

Why are STIs not common in EMS setting?

not a common reason for patients to access 911 emergency services except for women who develop pelvic inflammatory disease (PID)

PID (pelvic inflammatory disease)

• Most commonly caused by gonorrhea or chlamydia

• Causes severe lower abdominal pain that may or may not be associated with increased vaginal discharge

Lyme Disease

Tick bites transmit this (no vaccine yet)

Most pts display a rash (erythema migrans) within a week that looks like a bulls eye

Lyme Disease Treatment/Prevention

Treat w/ antibiotics; hard to treat bc diagnosis is often late 

Prevention in backcountry rescue / wooded areas: cover arms/legs, check frequently for ticks, remove ticks w/ tweezers

Why do antibiotics that used to be effective no longer work?

• Result of bacteria developing resistance

• Patients may get infections that are no longer treatable, and patients may die from diseases that were easily cured a few years ago.

• Use Standard Precautions to protect yourself, your co-workers, and other patients.

When the next outbreak occurs…

• Remain calm.

• Understand that news reports may exaggerate the extent of the number of ill or the ease with which the disease is spread.

• Follow the recommendations of the CDC and your local health department.