Pneumonia Flashcards
What is pneumonia
Inflammation of the lung parenchyma (mainly alveolar sacs) caused by an infection
How does Pneumonia present
Cough - excess sputum production, usually green or yellow. May contain blood
Confusion - new onset
Pyrexia
Chest pain - pleuritic pain - worse on inspiration
Shortness of breath
Cyanosis - reduced ventilation
Bronchial breathing
Examination: Dull on percussion Crackles on inspiration - coarse Pleural friction rub - pleural effusion Effusion: decreased resonance Consolidation: increased vocal resonance
What are the differentials
TB - ruled out by blood culture
PE - rule out on X ray or CTPA/V/Q scan if kidney disease
COPD - could be acute exacerbation
Bronchiectasis - usually hx of CF, childhood infections etc
Pulmonary oedema - may also have peripheral oedema, looks different on X ray, other signs of heart failure
How is pneumonia investigated
Bedside Sats - lowered RR - high HR - could be high BP - hypotension temp - pyrexia
Bloods - FBC - WCC high - CRP - high - U+Es - LFTs monitor liver and kidney damage to prevent organ damage from SIRS Blood cultures!
Imaging
- CXR
Microbiology
- Sputum culture
Which organisms commonly cause Community acquired Pneumonia
Strep pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
Which organisms commonly cause HAP
Strep pneumoniae Moxarella Catarrhalis Haemophilus Influenzae Klebsiella E coli Staph Aureus L Pneumophilia
How is mild CAP treated
Amoxicillin 5 day course
Pen allergic: doxycycline or Clarithromycin
How is moderate CAP treated
Amoxicillin + macrolide (clarithromycin)
7-10 day course
Pen allergy: Clarithromycin and Doxycycline
How is severe CAP treated
Co-amoxiclav 1.2g/8HR IV + clarithromycin IV 500mg/12HRs
Pen allergy: Cefuroxime/Ceftrixone + clairhtormycin IV
How is HAP treated
Treat with gentamicin and Ceftriaxone IV
What is the definition of HAP
Pneumonia acquired 48hr after hospital admission
Which score is used in pneumonia and what does it stand for?
CURB65 Confusion - new onset Urea >7mmol/L Respiratory rate >30 per min BP <90 systolic and <60 diastolic >65 years of age
0-1 = treat at home amoxicillin or doxycycline
2 = must be treated in hospital amoxicillin + clarithromycin or doxy and clarith
>3 = High mortality consider ITU
IV abx - Co-amox + clarith
IC Cefuroxime + clarith
What is the other management (other than abx) for pneumonia
Analgesia - paracetamol + NSAIDs
Oxygen - keep pO2 above 8.0kPa
keep sats above 94%
If not getting better repeat CXR for complication
What are the complications of pneumonia?
Pleural effusion - build up of fluid - usually exudative
Empyema - build up of pus in pleura - treated with chest drain
Lung abscess - causes spike in symptoms, round lesion on CXR
Sepsis - IV abx
Type 1 resp failure - high flow non rebreathe mask
What are the causes of nonresolving pneumonia
CHAOS
Complication - abscess, empyema, resp failure
Host - immunocompromised - check for HI in patients with longer than normal, atypical organism or recurrent infections
Antibiotic - inadequate dose, poor absorption orally, incorrect organism cover
Organism - resistance to abx
Second diagnosis - may have another patholgoy, Potentially wrong - TB
