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What pathogens occur in Staphylococci, gram-negative bacilli, and neutropenic patientsfi Proteins or glycoproteins secreted by cells that act as signals between cells of the immune system and mediators of response to infection What factors/substances are Cytokines include the interleukins, the included in the cytokinesfi Hyperthermia does not involve changes in the set point; rather, it involves heat production that exceeds heat loss, as occurs with malignant hyperthermia or heat stroke. Includes the preceding criteria in the setting of suspected or proven infection What is sepsis syndrome or Sepsis with an evidence of altered organ severe sepsisfi Microbiologic studies including blood cultures and culture of any potential source of a systemic infection (draw blood cultures before initiating antibiotics) 3. For nosocomial and neutropenic sepsis, coverage should include activity against Pseudomonas. If an indwelling vascular catheter infection is suspected, vancomycin should be considered. What supportive therapies Fluid and electrolyte management and should be consideredfi List the organisms Encapsulated organisms including associated with postsplenecS. Fever is a common early sign, and 80% of patients have clinical signs of soft-tissue infection. Aggressive monitoring and management of circulatory shock and its complications 4. What are the initial Fever, headache, malaise, myalgia, symptoms of Rocky nausea, vomiting, and rash Mountain spotted feverfi Describe the rash of Rocky Mountain spotted fever in terms of the following: Timing Seen in 15% of patients on day 1 and in 50% by day 3. Petechiae may develop (secondary to progressive vascular injury with hemorrhage) in up to 75% of cases on or after day 6. Distribution Ankles and wrists are affected first, then the trunk, palms, and soles.

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This includes the requirement that it must be fitted with a (continuous) temperature registration system and an acoustic alarm, so that measures can be taken to secure the required temperature. The requirements for minimum and maximum temperatures must also be guaranteed during transport to the hospital and during storage in the hospital. The storage conditions to guarantee the shelf-life of the various blood components must be indicated exactly under all conditions (both storage and transport) and must be recorded in working instructions. Materials or components other than blood components may not be stored in the blood storage systems. The storage conditions for blood components must be indicated exactly for all conditions and must be recorded in a working instruction. The temperature of the blood component is recorded from the moment of donation (whole blood and plasma). So-called household refrigerators are not suitable for the storage of blood components for transfusion. If a validated storage system is not in use, erythrocytes should be administered to the patient within 6 hours of receipt. The aim should be to keep the component outside the refrigerator (temperature > 10 fiC) for no longer than half an hour before administration to the patient. This can mean that departments where blood is stored (both operating rooms and recovery rooms) for a longer time (maximum of 24 hours) before transfusion must be fitted with validated blood storage refrigerators. After opening or inserting a needle/spike into the system, the maximum storage time is limited to a maximum of 6 hours due to the risks of bacterial growth. Erythrocyte components that have reached a temperature exceeding 10 fiC after storage may not be returned to storage and must be administered within 6 hours or otherwise they 40 Blood Transfusion Guideline, 2011 must be destroyed. Erythrocyte components must be destroyed if the storage temperature has exceeded 25 fiC (Sanquin Guideline Blood Components 2008). May not be kept outside the refrigerator for longer than approximately half an hour before administration to the patient. Has a maximum shelf-life of 6 hours after opening or insertion of a needle in the system, due to the risks of bacterial growth. Storage duration of erythrocytes in relation to clinical course the initial observation that the storage duration of erythrocyte concentrates is associated with the clinical course was published in 1994 (Martin 1994).

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They occur characteristically in the lung and gastrointestinal tract as the result of arterial occlusion. These sites are loose, well-vascularized tissues with redundant arterial blood supplies (in the lung, from the pulmonary and bronchial systems; in the gastrointestinal tract, from multiple anastomoses between branches of the mesenteric artery), and a hemorrhage into the infarct occurs from the nonobstructed portion of the vasculature. This is an important contribution to infarcts associated with volvulus, incarcerated hernias, and postoperative adhesions. Thrombosis is intravascular coagulation of blood, often causing significant interruption of blood flow. This process results from the interaction of platelets, damaged endothelial cells, and the coagulation cascade. Conformational change in the platelet membrane makes the platelet phospholipid complex available, thus contributing to the activation of the coagulation cascade, leading to the formation of thrombin. Arachidonic acid, provided by activation of the platelet membrane phospholipase, proceeds through the cyclooxygenase pathway to the production of thromboxane a2 (txa2). The inhibition of cyclooxygenase by low-dose aspirin is the basis of aspirin therapy for prevention of thrombotic disease. These cells are resistant to the thrombogenic influence of platelets and coagulation proteins. Intact endothelial cells act to modulate several aspects of hemostasis and oppose coagulation after injury by thromboresistance. This has been classically described as following two distinct, but interconnected, pathways (Figure 3-1). This simplified conceptualization is useful for laboratory testing, but the division into extrinsic and intrinsic pathways is somewhat artificial. Contact activation is important in in vitro clotting in glass containers and in laboratory testing, but its physiologic role has been questioned because a deficiency of the contact factors is not associated with abnormal bleeding. It can also be activated by the platelet phospholipid complex, which becomes available through conformational changes in the platelet membrane. It restores blood flow in vessels occluded by a thrombus and facilitates healing after inflammation and injury. The proenzyme plasminogen is converted by proteolysis to plasmin, the most important fibrinolytic protease. Thrombotic disorders can be antithrombotic (hemorrhagic), leading to pathologic bleeding states such as hemophilia and von Willebrand disease. They can also be prothrombotic, leading to hypercoagulability with pathologic thrombosis. Hereditary thrombophilia is a prothrombotic familial syndrome occurring most often in adolescents or young women.

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