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Flashcards in FN: Pneumonia Deck (25):
1

Epi

1/1000

2

Mortality

10% in hospital, 30% in ITU

3

Anatomic classification

Bronchopneumonia - patchy consolidation of different lobes
Lobar pneumonia - fibrosupportive consolidation of a single lob. Congestion red grey resolution

4

Classification

Community acquired Pneumonia
Hospital Acquired Pneumonia
Aspiration
Immunocomprimised

5

Community acquired

1. Pneumococcus, mycoplasma, haemophilus
2. S. aureus, Moraxella, Chlamydia, Legionella
3. viruses (155)

6

Hospital acquired pneumonia

>48hrs after hospital admission
Gram ive enterobacteria, S. aureus

7

Aspiration

increased risk with: stroke, bulbar palsy, reduced GCS, GORD, achalasia
Anaerobes

8

Immunocomprimised

The usual suspects, plus
PCP, TB, fungi, CMV/HSV

9

Symptoms

Fever, rigors
Malaise, anorexia
dyspnoea
Cough, purulent sputum, haemoptysis
Pleuritic pain

10

Signs

Raised RR, Raised HR
Cyanosis
Confusion

11

consolidation signs

Reduced expansion
Dull percussion
Bronchial breathing
Reduced air entry
Crackles
Pleural rub
Raised VR

12

Investigations

Bloods: FBC, U+E, LFT, CRP, culture, ABG (if sats low)
Urine: Ag tests (Pneumococcal, legionella)
Sputum: MC&S
Imaging CXR

13

Special tests

Paired sera Abs for atypicals - mycoplasma, Chlamydia, legionella
Immunofloerence (PCP)
BAL
Pleural tap

14

Severity

CURB-65 (only if xray changes)
Confusion (AMT 7mm)
Reso rate >30/min
BP 65

15

CURB 65 score related to treatment

0-1 - home treatment
2 - hospital Rx
>3 consider ITU

16

Management

BX
Oxygen
Fluids
Analgesia
Chest physio
Consider ITU if shock hypercapnia, hypoxia
f/up @ 6wks with CXR - check for underlying Cancer

17

CAP management mild

Amoxicillin 500mg TDS PO for 5d or clarithro 500mg BD PO for 7d

18

CAP management moderate

Amoxicillin 500mg TDS and clarithro 500mg BP PO/IV (clarithro alone if penicillin allergy) for 7d

19

Cap management severe

Co-amoxiclav 1.2g TDS IV/cefuroxime 1.5mg TDS IV and clarithro 500mg BD IV for 7-10d

20

Cap management Atyp

Chlamydia: tetracycline
PCP: Co-trimazole
Legionella: Clarithro + rifampicin

21

HAP management mild/

Co-amoxiclav 625mg PO TDS for 7d

22

HAP maagement severe/>5d

Tazocin ± vanc ± gent for 7d

23

Aspiration pneumoni amangement

Co-amoxiclav 625mg PO TDS for 7d

24

Pneumovax (23 valent)

>65 years
Chronic HLKP failure or condition
DM
Immunosuppresion: hyposplenism, chemo, HIV
CI: P, B, Fever

25

Vaccination

Revaccinate every 6years

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