Can you solve this? A 40-year-old female presents to the emergency department critically ill. She is 1 day postoperative from a rhinoplasty. In the emergency department, her blood pressure is 90/60 mm Hg, heart rate is 120 beats per minute, respiration is 20 breaths/min, and the temperature is 38.3 C (101 F). On examination, the patient is in significant distress and has a nasal packing in place. Her laboratory evaluation reveals a leukocytosis, thrombocytopenia, and acute renal failure. What is the most appropriate next step in the management of this patient?
A. Remove nasal packing and IV vancomycin B. Remove nasal packing and IV ciprofloxacin C. IV vancomycin only D. IV ciprofloxacin only
Remove nasal packing and iv vancomycin -staphylococcal tss was first reported in 1978; by 1990, more than 3,300 cases had been reported in the united states, 90% of which occurred during menstruation in women who were using tampons. the incidence of staphylococcal tss declined precipitously after superabsorbent tampons were withdrawn from the market. most cases are now nosocomially acquired, often as a result of postoperative staphylococcal wound infections, particularly those associated with nasal packing after rhinoplasty. staphylococcal tss caused by toxin-producing strains of methicillin-resistant staphylococcus aureus has been reported in the united states and japan.tss is a multisystem disease with diverse clinical manifestations. leukocytosis and thrombocytopenia (< 100,000 platelets/l) are common findings. urinalysis may show mild pyuria and, occasionally, microscopic hematuria. blood urea nitrogen and creatinine levels are elevated in more than 50% of patients. serum bilirubin and hepatic enzyme levels are elevated in about half of patients. serum creatine kinase levels are high in more than one third of patients, and myoglobinuria has developed in some patients. blood cultures show no growth in almost all cases. group a streptococci can produce a severe form of tss that resembles staphylococcal tss; in streptococcal tss, however, bacteremia is common, necrotizing fasciitis may be present, and mortality is much higher (30 to 70%). the management of staphylococcal tss calls for immediate correction of hypotension and shock with vigorous fluid replacement, attention to the site of s. aureus colonization or infection (e.g., removal of the tampon and drainage of any abscess), and systemic antimicrobial therapy with an antistaphylococcal agent.
Remove nasal packing and iv vancomycin -staphylococcal tss was first reported in 1978; by 1990, more than 3,300 cases had been reported in the united states, 90% of which occurred during...Read More