Week Two - Case Two Flashcards
what is pneumonia and what is it characterised by
a common lower respiratory tract infection and is characterised by inflammation of the lung tissue.
it is almost always an acute infection, and almost always is caused by bacteria.
what is diagnosis of pneumonia usually confirmed by
chest x-ray
what is the most fatal hospital acquired infection
pneumonia
what percentage of pneumonia cases at pneumococcal in cause and what are the rest
75% of cases are pneumococcal in cause, and 20% atypical. The remaining 5% may be caused by aspiration of vomit, radiotherapy and allergic mechanisms.
what is hospital acquired pneumonia defined as
pneumonia that develops 48hrs after admission
what is the prognosis for hospital acquired pneumonia
generally poor, due to co-morbidities, older age range of patients, and resistance of organisms
what are the common organisms in hospital acquired pneumonia
gram negative bacilli, staphylococcus aureus
drug resistant organisms are more common and are more dangerous
what is the prognosis for community acquired pneumonia
generally good, especially for younger patients
S. pneumoniae and viral pneumonias are still fatal in older patients
what are the common organisms in community acquired pneumonia
streptococcus pneumoniae, haemophilius influenzae
anaerobes are rare
what does step pneumoniae infection often follow
often follows viral infection with influenza or parainfluenza
what is hospital acquired infection often with
gram negative organisms
what are the symptoms of pneumonia
Typically the same for hospital acquired / non-hopsital acquired cases
Shortness of breath
Cough
May be productive in adolescents and adults – Purulent sputum possible
Often dry in infants and the elderly
Fever
Rigors
Vomiting
Headache
Loss of appetite
Very occasionally – haemoptysis
Pleuritic chest pain – which may on occasion radiate to the shoulder (if diaphragm is involved) or the anterior abdominal wall
Pleuritic chest pain – a sharp shooting or stabbing pain, usually in the side, that is most painful on inspiration, but can also be felt on expiration, or even whilst talking.
Upper abdominal tenderness in some patients with lower lobe pneumonia
Signs of consolidation – both on examination and CXR
Dyspnoea
Tachypnoea
Tachycardia
Increased secretions – noticeable in ventilated patient in hospital acquired cases
what are the signs seen in strep pneumoniae
rapid shallow breathing and pleural rub
what may be the only sign in elderly patients
confusion
what oxygen saturation is usually worrying
<92%
what would a CXR look like
- evidence of infiltrate in the form of consolidation
- changes may not appear for up to 48hrs after symptoms, however, after effective treatment, consolidation may still be seen on CXR for up to 6 weeks
what is not routine in community acquired infection of pneumonia
blood cultures to assess the identity of the causatory organism
what would a FBC show
- elevated WCC
- elevated ESR (>100mm/h) and increased CRP
- possible anaemia (sign of abscess)
- blood cultures - check for septicaemia
why would one take a urine sample in suspected pneumonia
in severe cases of pneumonia, where legionella is suspected, urine testing for legionella antigen may be indicated
what is pleural fluid aspiration test used for
to assess for organisms.
what is the CURB-65 score and what is it used for
used to assess the severity of community acquired pneumonia. it predicts the risk of mortality. (CURB score 0 = <1% risk, CURB score 5= 60% risk). Each factor of the score is worth 1 point
C – Confusion – use the abbreviated mental test (score ≤8)
U – Urea – >7mmol/L
Respiratory rate – ≥30/min
Blood Pressure <90 systolic, or <60 diastolic
65 – age >65 years
A score ≥3 is severe pneumonia. ≥2 requires hospitalisation
what are the differentials for pneumonia
PE - patient is not usually scenically unwell. shortness of breath is more likely to be of a sudden onset
pulmonary/pleural TB
pulmonary oedema
what is the treatment for pneumonia if not vomiting and CURB65 score is < or equal to 2
use oral antibiotics, if severe and/or vomiting IV antibiotics are required
what should oxygen saturation be kept at
> 92%
what is used to prevent dehydration and shock
fluids
what is the most common complication of pneumonia
respiratory failure
what is respiratory failure defined as
PaO2 <8kPa.
what is respiratory failure treated with
60% oxygen (high flow)