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NHIỄM KHUẨN HUYẾT - Coggle Diagram

- - - - nhiễm khuẩn
        
        suy đa tạng
    - - nhiễm khuẩn huyết
        
        hạ HA cần thuốc vận mạch => HA về mức TB
        
        lactate huyết thanh > 2mmol/L
- - - - Penicilin phổ rộng+chất ức chế beta-lactamase / CP 3/ CP 4
        
        :heavy_plus_sign: Quinolon/Aminosid
      - nghi ngờ nhiễm S.aureus
        
        MSSA: oxacilin, cloxacilin, cefazolin
        
        MRSA: vancomycin, teicoplaniin, linezolid
        kị khí:
        :heavy_plus_sign: metronidazol
    - - carbapenem/ Penicilin phổ rộng+ức chế beta-lactamase
        :heavy_plus_sign: quinolon/ aminosid
    - - carbapemem/ Penicilin phổ rộng+ức chế beta-lactamase
        :heavy_plus_sign: quinolon/ aminosid/ fosfomycin
      - nghi ngờ MRSA: vancomycin, teicplanin, linezolid, daptomycin
      - kháng carbapenem
        carbapenem chống P.aerruginosa (đo MIC) và /hoặc peni phổ rộng+ức chế beta-lactamase
        :heavy_plus_sign:colistin
    - - gan mật
        
        CP 3/ CP 4/ carbapenem (nguy cơ nhiễm vk có ESBL)
        :heavy_plus_sign: aminosid/ metronidazol nếu nghi ngờ kị khí
      - tiêu hóa
        
        CP3/ CP4/ carbapenem quinolon
        :heavy_plus_sign: metronidazol (nếu nghi ngờ vk kị khí)
      - hô hấp
        
        ~ viêm phổi
      - tim mạch
        
        S.aureus
        
        MSSA
        
        MRSA
      - sinh dục
        
        cetriaxon + azithromycin + metronidazol
        
        nkbv: carbapenem/ pip+tazo
        :heavy_plus_sign: azithromycin/ metronidazol
        
        nghi đa kháng :heavy_plus_sign:colistin
      - da
        
        S.aureus
        
        tổn thương da => nguy cơ NK BV => sdks có phổ trên P.aeruginosa
    - - đầu tay Vancomycin
        thay thế: Daptomycin, linezolid
    - - vancomycin +
      - CP3/ CP4
        
        carbapenem
        
        betalactam+ức chế beta-lactamase
    - - vancomycin + 2 trong
      - CP3/ CP3
        
        carbapenem
        
        pip/tazo
        
        quinolon (cipro, levo)
        
        aminosid
        
        monobactam
- - - - hô hấp
        
        đông máu
        
        gan
        
        tim mạch (MAP)
        
        TKTW (điểm hôn mê Glasgow)
        
        thận
    - - thay đổi tri giác
        
        MAP ≤100
        
        nhịp thở ≥ 22 lần/phút
  - - - <2
        
        nghi ngờ => theo dõi thêm
      - ≥2
        
        bằng chứng suy đa tạng
        
        SOPA
        
        <2
        
        .
        
        ≥2
        
        NTH
        
        hồi sức, bù dịch nhưng:
        
        phải sd thuốc vận mạch => MAP ≥ 65
        
        lactate huyết thanh > 2 mmo;/L
        
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