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Dexamethasone in Adults with Bacterial Meningitis nejm

Van den Berghe G, Wilmer A, Hermans. Dexamethasone in Adults with Bacterial Meningitis. The clinicians history should be focused around the chief complaint with a pertinent review of systems. Medication

Van den Berghe G, Wilmer A, Hermans. Dexamethasone in Adults with Bacterial Meningitis. The clinicians history should be focused around the chief complaint with a pertinent review of systems. Medication side effects or pharmacologic properties may either induce or mask sirs (i.e. While empiric antibiotics may be reasonable in many situations, the key is to discontinue antibiotics when infection is ruled out or to narrow the antibiotic spectrum once a pathogen is isolated. Monitoring of organ dysfunction in sepsis/systemic inflammatory response syndrome: novel strategies. Jan de Gans,. Intensive insulin therapy in the medical ICU. Drotrecogin alfa, a recombinant form of activated protein-C (APC) has no role in sirs. Empiric antifungal therapy ( fluconazole or an echinocandin) may be considered in hemodynamically unstable patients who have already been treated with antibiotics, are neutropenic, receiving TPN or who have long term central venous access in place. Evaluation for evidence of hypoperfusion (skin mottling, mental status changes, delayed capillary refill and decreased urinary output) should be performed in all patients. D., and Diederik van de Beek,.D., for the European Dexamethasone in Adulthood. The key to preventing the multiple hits is adequate identification of the cause of sirs and appropriate resuscitation and therapy. Acute-phase proteins and other systemic inflammatory responses to inflammation. Bacterial meningitis is a medical, neurologic, and sometimes neurosurgical emergency that requires a multidisciplinary approach. This may be a second hit and lead to worsening sirs. A thorough history is critical in determining the steroids proper evaluation of the patient with sirs as the differential diagnosis is extremely broad (. Sirs is defined as 2 or more of the following:.

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