Pneumonia Flashcards
(42 cards)
How can pneumonias be sub-classified?
Community acquired
Hospital acquired
What is the definition of pneumonia in community practice?
Symptoms of a lower respiratory tract infection (cough and one other), new focal signs on examination, and signs of systemic illness, pyrexia, sweating, rigors
+ No other more likely cause
(Signs and symptoms suggestive of pneumonia with no other more likely cause)
Note- Unlike in a hospital setting radiological evidence is not required to diagnose pneumonia in the community
What is the definition of pneumonia in hospital practice?
Signs and symptoms suggestive of pneumonia
Radiological evidence of pneumonia on a CXR- radiographic shadowing for which there is no other explanation
What is the definition of a hospital acquired pneumonia?
Acquired more than 48 hours after hospital admission. Includes ventilator and healthcare acquired pneumonia
What is the most common causative organism of CAP and HAP?
Streptococcus pneumoniae
What are the two most common causes of pneumonia in ITU?
Streptococcus pneumoniae
Legionella
What are the symptoms of pneumonia?
Cough Sputum production Fever, Fatigue, Malaise Pleuritic chest pain Dyspnoea Rigors
What are the clinical signs of pneumonia? (includes signs seen on examination)
Tachycardia Tachypnoea Reduced chest wall expansion Dullness to percussion Crepitations on auscultation Reduced oxygen saturations Sputum pot Bronchial breathing Pyrexia Confusion, Drowsiness, Coma
What respiratory failure might be seen in pneumonia?
Type 1 due to V/Q mismatch
Results in hypoxia without carbon dioxide retention but this may be seen later on or in patients with pre-existing COPD
What immediate investigations should be done if presenting at hospital?
Oxygen saturations
CXR
What blood tests should be done for someone presenting with pneumonia to hospital?
FBC U+Es LFTs CRP ESR Culture HIV screen?
ABG if SPO2 less than 92%
When should an ABG be carried out for someone presenting with pneumonia?
If suspecting respiratory failure and SPO2 less than 92%
Should a sputum culture be done for all patients with pnuemonia?
Community- Not routinely, if not responding to ABx therapy consider
Hospital- Do for all hospital admissions for pneumonia or HAP. MC&S and AFB/ZN staining if considering TB
Should a sputum culture be done for patients in the community presenting with pneumonia?
Sputum culture should not be done routinely for all patients presenting with pneumonia in the community.
Should be considered if not responding to ABx treatment
If moderate or severe (CRB-65 of 2 or more) will require admission to hospital and a sputum culture should be done there
What might test might be done on the urine of a patient with severe CAP?
Legionella antigen
Common causative organism of ITU pneumonias
For a patient presenting at hospital with a CAP what investigations should be done?
CXR
Oxygen saturations
ABG if O2 Sats less than 92%
Bloods- FBC, U&E, ESR, CRP, LFT, Culture
Sputum culture- MC&S, Consider AFB/ZN Staining
Urine testing for legionella antigen (if severe)
How can CRP be used to guide ABX prescribing in the community?
CRP can be used to guide ABx prescribing for LRTI
0-20= No ABx
20-100= Delayed ABX
>100= Immediate ABx
What are the criteria for CURB-65?
Confusion= 1 point Urea> 7 = 1 Point Respiratory Rate> 30 = 1 Point Blood Pressure- DBP <60 or SBP<90 = 1 Point Aged 65 or more= 1 point
In the community what CRB-65 score indicates admission to hospital?
2 or more
But use clinical judgement
In the hospital what does the CURB-65 scores indicate?
0-1 = Low Risk 2= Moderate Risk 3-5= High Risk
(Of death)
If 4 or 5 refer to critical care team
Describe the supportive, definitive and preventative management for patients presenting with pneumonia at hospital
Supportive- IV Fluids, Oxygen Therapy, Monitoring
Definitive- ABx
Preventative- LMWH for VTE prophylaxis if appropriate
How soon should investigations and treatment be carried out for a CAP at hospital?
All within 4 hours
Offer ABx as soon as possible after diagnosis
How should a low severity CAP be treated? CRB- less than 2
What should you advise patients?
Oral ABx mono-therapy
Amoxicillin 500mg TDS 5 day course
Or doxycycline or clarithromycin if penicillin allergic
If no improvement or worsened symptoms after 3 days seek further medical help.
How should a moderate severity CAP be treated? CURB- 65 of 2-3
Oral ABx- Dual Therapy
Amoxicillin with a macrolide (clarithromycin or erythromycin)
7-10 days worth
Use IV prep if CI
