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  <head>
    <title>038-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Sepsis, stewardship, and infection prevention">
      <outline text="Sepsis concept and pathophysiology">
        <outline text="Organ dysfunction from dysregulated response to infection">
          <outline text="A syndrome, not a culture result"/>
          <outline text="May occur without fever or hypotension"/>
        </outline>
        <outline text="Innate receptors, complement, coagulation, endothelium"/>
        <outline text="Pro- and anti-inflammatory signals together">
          <outline text="Tissue damage and immune exhaustion"/>
        </outline>
        <outline text="Vasodilation and leak reduce circulating volume"/>
        <outline text="Microcirculatory shunting despite adequate pressure"/>
        <outline text="Lactate is a risk marker and trend">
          <outline text="Normal value does not exclude serious sepsis"/>
          <outline text="Persistent rise needs reassessment, not automatic fluid"/>
        </outline>
      </outline>
      <outline text="Recognition and differential diagnosis">
        <outline text="Infection with acute organ deterioration"/>
        <outline text="Atypical in older, pregnant, neonatal, immunosuppressed">
          <outline text="Neutropenia blunts local inflammation"/>
          <outline text="Beta blockade blunts tachycardia"/>
        </outline>
        <outline text="Scores identify risk but do not replace judgement"/>
        <outline text="Examine likely sources, including devices"/>
        <outline text="Search for non-infectious mimics"/>
        <outline text="Septic shock: vasopressor need with raised lactate">
          <outline text="Do not wait for criteria when perfusion fails"/>
        </outline>
      </outline>
      <outline text="Immediate assessment and cultures">
        <outline text="Airway, breathing, circulation, glucose, urine output"/>
        <outline text="Reassess after each intervention"/>
        <outline text="Blood cultures before antibiotics without meaningful delay"/>
        <outline text="Molecular tests accelerate diagnosis">
          <outline text="May detect colonisation"/>
          <outline text="Negative panel misses untargeted organisms"/>
        </outline>
      </outline>
      <outline text="Antimicrobial timing and selection">
        <outline text="Proportional urgency, not one identical clock">
          <outline text="Shock: urgent active therapy after rapid cultures"/>
          <outline text="Stable and uncertain: focused investigation"/>
        </outline>
        <outline text="Empirical choice: source, exposure, resistance, host"/>
        <outline text="Sepsis alters distribution, binding, clearance">
          <outline text="Loading dose despite kidney dysfunction"/>
        </outline>
        <outline text="Reassess daily: narrow, optimise, define duration"/>
        <outline text="Improvement does not prove the diagnosis"/>
      </outline>
      <outline text="Fluids, vasoactive therapy, organ support">
        <outline text="Crystalloid boluses with response assessment">
          <outline text="Fixed large volumes harm limited reserve"/>
        </outline>
        <outline text="Leg raise, refill, urine, mentation, echo guide fluid"/>
        <outline text="Norepinephrine first for distributive shock"/>
        <outline text="Inotropes for selected myocardial dysfunction"/>
        <outline text="Corticosteroids only in vasopressor-dependent shock"/>
        <outline text="Lung-protective ventilation, glucose, delirium care"/>
        <outline text="Transfusion follows oxygen delivery and bleeding"/>
      </outline>
      <outline text="Source control">
        <outline text="Antibiotics cannot drain pus or remove necrosis"/>
        <outline text="Drainage, debridement, surgery, relief, device removal"/>
        <outline text="Act as soon as safely feasible">
          <outline text="Imaging must not delay necrotising or perforation surgery"/>
        </outline>
        <outline text="Obtain deep cultures"/>
        <outline text="No improvement: search for another source"/>
      </outline>
      <outline text="Antimicrobial stewardship">
        <outline text="Best outcome, least toxicity, resistance, cost"/>
        <outline text="Audit, feedback, allergy clarification, oral switch"/>
        <outline text="Asymptomatic bacteriuria treated only in defined cases"/>
        <outline text="Do not treat colonisation or viral syndromes"/>
        <outline text="Biomarkers support but cannot decide alone"/>
        <outline text="Duration follows syndrome, source, host, response">
          <outline text="Many infections need shorter courses"/>
          <outline text="Automatic extension can be harmful"/>
        </outline>
      </outline>
      <outline text="Precautions and device infection">
        <outline text="Standard precautions apply to every patient">
          <outline text="Gloves do not replace hand hygiene"/>
          <outline text="Soap and water for soil, spores, outbreaks"/>
        </outline>
        <outline text="Contact, droplet, airborne routes differ"/>
        <outline text="Isolation risks loneliness and missed care"/>
        <outline text="Every device breaches defence">
          <outline text="Continuing indication and daily review"/>
        </outline>
        <outline text="Urinary catheters: valid indication, early removal"/>
        <outline text="Ventilator prevention: less sedation, oral care"/>
        <outline text="Surgical prevention: prophylaxis timing, clipping">
          <outline text="Drains do not justify continued prophylaxis"/>
        </outline>
      </outline>
      <outline text="Environment and outbreaks">
        <outline text="Cleaning, disinfection, sterilisation differ"/>
        <outline text="Processing depends on tissue contact"/>
        <outline text="Organic material impairs disinfection"/>
        <outline text="Verify, define cases, map person, place, time"/>
        <outline text="Genomic links need epidemiological context"/>
        <outline text="Report, preserve specimens, audit control"/>
      </outline>
      <outline text="Vaccination and recovery">
        <outline text="Vaccines reduce susceptibility and severe disease">
          <outline text="Live vaccines unsafe in immunosuppression, pregnancy"/>
        </outline>
        <outline text="Staff: vaccination, fit testing, sharps safety"/>
        <outline text="Needlestick: first aid, consent testing, prophylaxis"/>
        <outline text="Survivors: weakness, cognition, organ impairment"/>
        <outline text="Reconcile medicines, record resistance, rehabilitate"/>
      </outline>
    </outline>
  </body>
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