IBCC Episode 17 - Community Acquired Urosepsis

The Internet Book of Critical Care Podcast

Adam Thomas

Foam, Medicine, Health & Fitness, Science, Criticalcare, Medicaleducation

5 • 714 Ratings

🗓️ 26 December 2018

⏱️ 12 minutes

🔗️ Recording | iTunes | RSS

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Summary

Merry Christmas / Happy Holidays everyone!

Here is a little present for you during these cold times. For those of you who have seen this population, they can get sick, fast! However, when you've got your approach and management down, they can get better, just as fast! Come take a listen for the identification, microbiology and treatment or urosepsis.

Transcript

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0:00.0	Welcome back to the Internet Book of Critical Care podcast. I'm here with Adam Thomas
0:08.2	and we're going to go through Community Acquired Euroceptus.
0:10.6	And in the same light as pneumonia, remember this is community acquired Eurocepsis,
0:15.4	new classification coming from Josh here. So these are patients coming from community who are
0:19.8	very sick. So Josh,
0:21.3	tell me about Euroceptus. So I guess one just beginning point here is that the path of physiology
0:26.0	of your sepsis typically involves bacteria ascending from the bladder. And it's really when
0:29.6	they get into the kidneys, cause pylenfritis and kind of spill into the bloodstream that the patients
0:33.5	get septic. Simply the presence of bacteria and infection in the bladder itself,
0:43.3	cystitis itself, really shouldn't cause a lot of septus. We think the GU system is the site of infection for this really, really sick patient in front of us. Our screening test is going to be
0:47.0	the urinalysis. Break it down for me, Josh. Is the UA sensitive? Is it specific? What are the nuances
0:52.1	here? Assuming that the patient does not have neutropenia and their immune system is fairly normal,
0:56.9	the urinalysis should be positive for a patient with ureceptus. So you should always see over 10
1:01.3	DLBCs for high power field. And the absence of white cells basically excludes zero sepsis.
1:05.7	The problem with the UA is that it is not specific. So there's lots of folks walking around to the community with abnormal urinal urenalcies, bacteria in their urine, and that may mean nothing. So when these folks roll into the
1:14.8	emergency department, if you see an abnormal urinalysis, and you'll often see it because it's kind of
1:19.0	like low-hanging fruit. Everyone gets one. It kind of pops up in the computer. There's this risk
1:23.4	of just focusing on the abnormal UA and being like, oh, well, this patient's sick because they
1:27.5	have your sepsis when, in fact, they have bolystitis or pneumonia or some other horrible thing.
1:31.8	And the neutropenic nuance is really important.
1:34.0	I've had a few BMT patients who are coming in really sick with that febivirotinia and a normal
1:39.3	UA.
	...

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