TY - CHAP M1 - Book, Section TI - Antimicrobial Therapies in the ICU A1 - Oettinger, Glenn A1 - Zhang, Luyi Kathy A2 - Lee, Kiwon Y1 - 2017 N1 - T2 - The NeuroICU Book, 2e AB - A 53-year-old man suffered a severe traumatic brain injury after being struck in an automobile-pedestrian accident. He was intubated in the field and stabilized in the emergency department (ED). He has a previous history of a hernia repair (15 years) and no pertinent social history. His admission height and weight are 71 inches and 80 kg, respectively. He remains stable until hospital day 7 when a leukocytosis develops (WBCs 10.6 to 15.7 cells/mm3), and he was febrile overnight (Tmax, rectal 101.2°F) and develops macroscopically cloudy urine. The serum creatinine level rose from baseline 0.8 mg/dL to 2.1 mg/dL. A Foley catheter is in place. Serum lactate concentration is at 4.4 mmol/L His morning chest radiograph is unremarkable, showing an endotracheal tube in good position. Urinalysis is reported as cloudy with WBC clumps, 30 WBCs, and positive leukocyte esterase. Arterial blood gas levels on an inspiratory oxygen concentration of 40% are as follows: pH 7.31, Paco2, 36 mm Hg; Pao2, 76 mm Hg; and HCO3–, 20 mEq/L; blood pressure (BP), 91/50 mm Hg (mean arterial pressure [MAP], 64 mm Hg); heart rate (HR), 109 bpm; respiratory rate (RR), 29 bpm. The team diagnoses this patient with severe sepsis and activates the institution’s severe sepsis pathway. They draw blood and urine cultures, initiate fluid resuscitation with a normal saline bolus of 30 mL/kg, and empiric antibiotics are started. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - neurology.mhmedical.com/content.aspx?aid=1163957510 ER -