LRTI Flashcards
(37 cards)
what is acute bronchitis
- viral infection
- inflammation of the - trachea or bronchi
presents with a fever, acute cough 1-4 weeks
pneumonia: hospitalisation and mortality
pneumonia often results in hospitalisation and the chance of mortality in hospital is quite significant.
- Mortality depends on pre-morbid state or the severity of pneumonia
pneumonia: symptoms? early vs late?
early stages of pneumonia are quite non-specific
malaise myalgia- muscle pain fever chest pain cough- initially dry purulent sputum dyspnoea - if condition is bad enough
pneumonia: investigations
serum biochemistry and full blood count CXR - may give diagnosis blood cultures throat swab urinary legionella antigen HIV test sputum microscopy and culture- often not useful
what are blood cultures used for in pneumonia investigations
try to isolate organisms but it’s only positive in 25 % of patients
why is legionella a significant bacterium
it causes pneumonia or similar disease called Legionnaires’ disease
why is sputum microscopy and culture often not useful
because it’s often negative but if it does come back positive the results take a while to come back and in the meantime the patient has been treated with antibiotics
define the term ‘consolidation’ in the lung
lung tissue that has filled with liquid instead of air.
it is a radiologic term
what investigation is not carried out often for pneumonia
CT scan however you may come across it in a CT scan whilst looking for something else
common organisms that cause pneumonia infection
strep pneumoniae 39%
H.influenzae 5.2%
Legionella 3.4 %
staph aureus 0.8%
what is the most common scoring system to determine the severity of pneumonia
CURB 65
explain CURB 65
C confusion
U blood urea >7
R respiratory rate >30
B diastolic blood
pressure <60
65 age> 65
score of 1 for each
score out of 5 overall
3-5 high risk of death and need for (ITU intensive treatment unit)
what treatment is used for those with a CURB score 0-1
amoxycillin or clarithromycin/ doxycycline
what treatment is used for those with a CURB score 2
amoxycillin and clarithromycin or levofloxacin
what treatment is used for those with a CURB score 3-5
co-amoxiclav and clarithromycin or levofloxacin (if allergic to penicillin)
if pneumonia is more severe, what treatment options are available (4)
oxygen - if hypoxic
IV fluids - dehydration due to liver damage
CPAP
intubation and ventilation - very severe cases - tracheal tube inserted
what complications can come with pneumonia ie other conditions (9)
Resp failure - type 1 quite common
septicaemia - sepsis and shock
acute kidney injury
empyema- infection in the pleural space
lung abscess- collection of pus within cavity of lung
metastatic infection- organisms in the blood spread through body
Acute Respiratory Distress Syndrome (ARDS) - inflammatory complication
Atrial fibrillation -common in elderly usually resolves with treatment. Beta blocker or digoxin may be required to slow heart rate in short term
hypotension - due to dehydration/vasodilation due to sepsis
how is empyema investigated, diagnosed and treated
investigate using CT thorax and pleural ultrasound
diagnosed by sampling fluid in the pleural space
pH should be less than 7.2
treatment includes chest drain, IV antibiotics or surgery for patients not improving with this management
Empyema and pneumonia
may or may not follow documented episode of pneumonia
mostly caused by streptococcus and anaerobes
chest pain without cough
high swinging fever due to pus
lung abscess and pneumonia
may or may not follow pneumonia
symptoms are non specific - lethargy, weight loss, swinging fever
investigations and treatment for lung abscess
CT thorax and sputum culture including TB microscopy and culture
prolonged antibiotics
drainage is via bronchial tree but occasionally drainage through chest wall
What is bronchiectasis and what happens to the airways due to this condition?
Abnormal permanently dilated airways due to bronchial wall inflammation, thickening and irreversible damage
this causes a build-up of excess mucus that can make the lungs more vulnerable to infection as it can trap more bacteria
If an infection does develop, the bronchi may be damaged again, so even more mucus gathers in them and the risk of infection increases further.
airway walls thicken and the airways dilate even out at the periphery of the lung
causes of bronchiectasis
Idiopathic
Immotile Cilia Syndrome – cilia stop working - not common cause
Cystic fibrosis – commonest autosomal recessive condition
Childhood infections such as measles or whooping cough
Hypogammaglobulinaemia – don’t produce sufficient amount of antibodies to fight infection. Can be acquired or inherited
asthma
aspiration pneumonia
inhale own vomit
- leads to lung injury and resultant bacterial infection.
