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Diagnosis, assessment, Investigation, monitoring and data interpretation

2.1 Obtains a history and performs an accurate clinical examination

2.2 Undertakes timely and appropriate investigations

2.3 Performs electrocardiography (ECG / EKG) and interprets the results

2.4 Obtains appropriate microbiological samples and interprets results 

2.5 Obtains and interprets the results from blood gas samples

2.6 Interprets imaging studies

2.7 Monitors and responds to trends in physiological variables

2.8 Integrates clinical findings with laboratory investigations to form a differential diagnosis 

Diagnosis, assessment, investigations, monitoring and data interpretation

How I manage Antibiotics. Mervyn Singer describes his approach to managing Antibiotics at the Critical Care Reviews Conference 2017 Belfast

January 01, 2020

'The How I Manage' section of the critical care reviews conference 2017 had the who's whos of ICM describing how they manage patients. These are shorter than some of the other lectures and useful insights into real practice.

This post was Mervyn Singer describing how he approaches antibiotics on his ITU.

Key points 

  • He challenges the Kumar paper dogma that antibiotics need to be given within the first hour in shock but instead suggests a considered and appropriate response to infection. (quite surprising given his involvement in Sepsis 3)

  • Gram stain and cultures essential

  • Source control the most important step

  • Short courses of antibiotics better than long

  • Uses single agent in the majority of cases unless deep seated infection

  • Atypical cover rarely needed for CAP

  • Close monitoring in ITU can allow a watchful approach

  • Underdosing tissue concentrations may be an issue given changes in fluid state in the critically ill

  • Stop antibiotics if confident its not an infection- don't finish the course

  • Point of care testing will hopefully be the future

 

For a review of the kumar paper see this review at the bottomline. 

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