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CPR II Exam 2 > Pneumonia, Influenza, Covid-19, ARDS > Flashcards

Pneumonia, Influenza, Covid-19, ARDS Flashcards

1
Q

What are the risk factors for developing MDR gram negative bacterial PNA and MRSA?

A

hospitalization >2 days in last 90 days

use of abx in last 90 days

immunosuppression

nonambulatory status

tube feedings

gastric acid supression

severe COPD

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2
Q

What are the risk factors for developing MRSA?

A

hospitalization >2 days in last 90 days

use of abx in last 90 days

chronic hemodialysis in last 30 days

documented hx of MRSA

CHF

gastric acid suppresion

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3
Q

What are the risk factors for Community acquired MRSA?

A

cavitary infiltrate or necrosis

gross hemoptysis

neutropenia

erythematous rash

concurrent influenza

young, previous healthy

summer month onset

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4
Q

What is the most common cause of community acquired pneumonia?

A

S. Pneumoniae

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5
Q

What are the risk factors for CAP?

A

alcoholism, asthma, institutionalization, over age 70

decreased cough/gag reflex in elderly

dementia, sz disorder, HF, Cerebrovascular disease, smoking, COPD, HIV

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6
Q

What is a likely cause of CAP if recent travel to ohio river valley?

travel to southwest USA?

Travel to SE asia?

hotel or cruise?

A

histoplasma

hantavirus, coccidioides

Burkholderia, avian flu

Legionella

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7
Q

What is the most important thing in making a diagnosis of pneumonia?

A

History and physical

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8
Q

What is the treatment for pneumonia based upon?

A

History

consider co-morbidities

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9
Q

What are risk factors for peudomonas and MRSA?

A

prior isolation of either organism on culture

recent hospitalization AND receipt of parental abx within last 90 days

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10
Q

What are the risk factors of Pseudomonas with CAP?

A
  1. compromized immune system
  2. recent prior abx use
  3. structural lung abnormalities such as cystic fibrosis or bronchiectasis
  4. repeated exacerbations of COPD reqiurring glucocorticoids or abx use
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11
Q

What are the risk factors for pseudomonas with HAP?

A

increased age, ventilation, abx at admission, transfer from unit or icu, admission in ward with high incedence of P. aurgeinosa infections

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12
Q

What is the definition of HAP?

A

infection acquired after at least 48hrs of hospitalization

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13
Q

When treating HAP and VAP, consider the following risks

A
  1. increased mortaloity
  2. MDR pathogens and MRSA
  3. MDR pathogens without MRSA
  4. MRSA alone
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14
Q

What is the definition of VAP?

A

HAP that develops more than 48hrs after endoracheal intubation

-difficult to wean of ventilator

lack improvement

new infiltrates on xray, new fever

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15
Q

What is aspiration PNA?

A

Macroaspiration of fluid/food into lungs

usually due to neurologic dysfunction

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16
Q

What is a trasudate pleural effusion and likely cause?

A

usually from systemic influences on pleural fluid formation and resorption

Left HF, cirrhosis, neprhotic syndrome, myxedema, peritoneal dialysis

17
Q

What are the causes of exudative pleural effusions?

A

caused by local influences on pleural fluid formation and reabsorption

bacterial PNA, malignancy, virus, PE, TB, fungus, parasites

18
Q

How to diagnose a plueral effusion?

When is a thoracentesis indicated?

A

Thoracentesis

for all effusions with >1cm layer in decubitus view

if effusion suspected r/t HF, then can try diuresis and 75% do so in 48 hrs

if effision suspected to be r/t infection, thorecentesis is done ASAP

19
Q

What does Light’s Criteria determine?

What are the criteria?

A

Determines an exudative effusion

  1. protein pleural fluid/serum protein ratio >.5
  2. pleural fluid LDH greater than 2/3 of the labs normal upper limit for serum LDH
  3. pleural/serum LDH ratio >.6

Transudative effusions will not meet any of these criteria

20
Q

For exudative effusions, pleural fluid should be tested for what?

A

Ph

glucose

WBC with diff

micro stidues

cytology

21
Q

What is the definition of ARDS?

A

severe dyspnea

diffuse pulmonary infiltrates

hypoexemia

22
Q

What is the key diagnostic feature for ARDS?

A

PaO2/FIO2 <300mmHg

diffuse bilateral pulm. infiltrates

absence of elevated left atrial pressure

acute onset

23
Q

What PaO2/FIO2 ratio indicates severe hypoxemia?

What indicates abnormal gas exchange?

A

<200

<300

24
Q

What are the risk factors for ARDS?

A

sepsis

ONA

trauma

blood transfusions

gastric acid suppression

drug overdose

25
Q

What is the exudative phase of ARDS?

A

alveolar edema and neutrophil inflammation

diffuse alveolar damage

atelectasis and reduced lung compliance

hypoxemia, tachypnea, progressive dyspnea, hypercarbia due to loss of alveolar exchange

CXR with bilateral opacities consistent with pulmonary edema

26
Q

What is the proliferative phase of ARDS?

A

progressive lung injury and pulmonary fibrosis

27
Q

What is the fibrotic phase of ARDS?

A

prolonged progressive fibrosis and need for more ventilator support or supplemental O2

increased risk for PTX, increased dead space

28
Q

In ARDS, alveolar collapse can occur due to alveolar/interstitial fluid accumulation and loss of worsening hypoxemia, therefore low tidal volumes are combined with the use of what to minimize what?

A

low TV are combined with the use of positive end-expiratory pressure (PEEP) at levels that strive to minimize alveolar collapse and achieve adequate oxygenation with the lowest required FIO2

can also try to improve oxygenation by putting pt in prone position

29
Q

What are some ancillary therapies for patients with ARDS?

A

due to interstitial and alveolar edema, limit IV fluids to only as needed

most patients require sedation and even paralytic agent s

Avoid glucocorticoids or NO in ARDS

30
Q

What are some respiratory complications of influenza?

A

PNA due to influenza or a secondary bacteria

31
Q

What is the most common extrapulmonary manifestation of influenza?

A

Myositis (often in influenza b)

32
Q

What are the treatments for influenza?

A

neuramindase inhibitors (inhibit egress of virus from cell)

start within 48hrs of infection and may see resolution of sx 1-2 days sooner

33
Q

What are risk factos of COVID 19

A

CVD

DM

HTN

Chronic lung disease

cancer

CKD

obesity

smoking

34
Q

what are the complications of ARDS associated with COVID19?

A

patients deteriorate rapidly

important to look at history to identify increased risk of illness severity

35
Q

what are the three drugs that are used to treat a patient with probable HAP or VAP?

A

Cefepime

Ciprofloxacin

Vancomycin

treat for 5 days and then decrease regimen

36
Q

Which drug is great for aerobic and anerobic gram - but not pseudomonas?

A

Ertapenem

37
Q

Which drug covers G+ only and can treat MSSA and MRSA?

Which drug covers G+ and G-, anarobes and pseudomonas?

A

Vancomycin

Fluoroquinolones

38
Q

What is the empiric treatment for CAP?

A

Ceftriaxone with Azithromycin

CPR II Exam 2 (23 decks)

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