cefotaxime and Shock

The work-up and initial management of a critically ill neonate is challenging and anxiety provoking for the Emergency Physician. While sepsis and critical congenital heart disease represent a large proportion of neonates presenting to the Emergency Department (ED) in shock, there are several additional etiologies to consider. Underlying metabolic, endocrinologic, gastrointestinal, neurologic, and traumatic disorders must be considered in a critically ill infant. Several potential etiologies will present with nonspecific and overlapping signs and symptoms, and the diagnosis often is not evident at the time of ED assessment.. We present the case of a neonate in shock, with a variety of nonspecific signs and symptoms who was ultimately diagnosed with tachycardia-induced cardiomyopathy secondary to a resolved dysrhythmia. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the diagnostic and therapeutic approach to the critically ill neonate in the ED, and expands the differential diagnosis beyond sepsis and critical congenital heart disease. Knowledge of the potential life-threatening etiologies of shock in this population allows the Emergency Physician to appropriately test for, and empirically treat, several potential etiologies simultaneously. Additionally, we discuss the diagnosis and management of supraventricular tachycardia and Wolff-Parkinson-White syndrome in the neonatal and pediatric population, which is essential knowledge for an Emergency Physician.

Topics: Acidosis; Acyclovir; Adenosine; Ampicillin; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Antiviral Agents; Cardiomyopathies; Cefotaxime; Electrocardiography; Emergency Service, Hospital; Feeding Behavior; Fluid Therapy; Glucose; Humans; Hypoglycemia; Hypotension; Hypoxia; Infant, Newborn; Lethargy; Male; Propanolamines; Propranolol; Shock; Tachycardia; Tachycardia, Supraventricular; Vomiting; Wolff-Parkinson-White Syndrome

Spontaneous bacterial peritonitis (SBP) is an ascitic fluid infection as a complication of end stage liver disease. The outcome is related to the severity of hepatorenal function, gastrointestinal bleeding, and many others; however it is not well known whether the infection acquisition sites have an effect on the prognosis of SBP. In order to identify the prognostic significance of the acquisition sites, we studied 106 patients who were diagnosed as culture positive SBP between October 1998 and August 2003. Thirty-two episodes were nosocomial and 74 were community acquired. Gram-negative bacilli such as Escherichia coli were dominant in both of the nosocomial and community-acquired SBPs. Despite significantly higher resistance to cefotaxime in nosocomial isolates compared to community-acquired isolates (77.8% vs. 13.6%, p=0.001), no difference was found regarding short or long term prognosis. Infection acquisition sites were not related to short or long term prognosis either. Shock, gastrointestinal bleeding and renal dysfunction were related to short term prognosis. Only Child-Pugh class C was identified as an independent prognostic factor of long-term survival.

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ciprofloxacin; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Escherichia coli; Female; Gastrointestinal Hemorrhage; Humans; Kidney Diseases; Klebsiella pneumoniae; Male; Middle Aged; Multivariate Analysis; Peritonitis; Prognosis; Shock; Survival Rate; Time Factors

Topics: Adolescent; Adult; Anti-Bacterial Agents; Brain Edema; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Chloramphenicol; Humans; Infant; Kinetics; Meningitis; Penicillins; Shock

Topics: Adult; Cefotaxime; Colon; Colonoscopy; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Female; Gentamicins; Humans; Hysterectomy; Methylmethacrylates; Metronidazole; Obstetric Labor Complications; Pregnancy; Puerperal Disorders; Shock; Uterine Hemorrhage; Vancomycin