Pneumonia

Question 1

How is pneumonia diagnosed?

Answer 1

-Mostly clinical - crackles + abnormally coloured sputum indicate viral cause, asymmetry on auscultation of lungs suggest bacterial
-A-E should still be done

Question 2

How is a CURB-65 score used?

Answer 2

-Determines whether patient should be treated at home or in hospital
-Ie to assess risk of mortality

Question 3

What is measured in the CURB-65 tool?

Answer 3

1 point is given to each of the following:
-Confusion
-Urea >7
-Increased RR (>30)
-Low BP
-Aged >65

Question 4

When should a patient with pneumonia be admitted to hospital?

Answer 4

-CURB-65 score >3
-If 1 /2 - admission should be considered

Question 5

What investigations are carried out once a patient is admitted?

Answer 5

-FBC, U+Es, LFTs, CRP
-Sputum culture
-CXR
-Blood gas
-BUFALO if septic

Question 6

How should patients with pneumonia be managed?

Answer 6

CURB = 0
-500mg amoxicillin TDS for 5 days
-500mg clarithromycin BD for 5 days if allergic to penicillin
CURB = 1-2
-Amoxicillin + Clarithromycin (doxy if penicillin allergic)
CURB = 3-4
-Co-amoxiclav + Clarithromycin (possibly IV)
SEPSIS
-Ceftriaxone IV or Tazocin + clarithromycin
-Give metronidazole if ?aspiration to cover anaerobes