Pneumonia, Influenza, Covid-19, ARDS Flashcards
(38 cards)
What are the risk factors for developing MDR gram negative bacterial PNA and MRSA?
hospitalization >2 days in last 90 days
use of abx in last 90 days
immunosuppression
nonambulatory status
tube feedings
gastric acid supression
severe COPD
What are the risk factors for developing MRSA?
hospitalization >2 days in last 90 days
use of abx in last 90 days
chronic hemodialysis in last 30 days
documented hx of MRSA
CHF
gastric acid suppresion
What are the risk factors for Community acquired MRSA?
cavitary infiltrate or necrosis
gross hemoptysis
neutropenia
erythematous rash
concurrent influenza
young, previous healthy
summer month onset
What is the most common cause of community acquired pneumonia?
S. Pneumoniae
What are the risk factors for CAP?
alcoholism, asthma, institutionalization, over age 70
decreased cough/gag reflex in elderly
dementia, sz disorder, HF, Cerebrovascular disease, smoking, COPD, HIV
What is a likely cause of CAP if recent travel to ohio river valley?
travel to southwest USA?
Travel to SE asia?
hotel or cruise?
histoplasma
hantavirus, coccidioides
Burkholderia, avian flu
Legionella
What is the most important thing in making a diagnosis of pneumonia?
History and physical
What is the treatment for pneumonia based upon?
History
consider co-morbidities
What are risk factors for peudomonas and MRSA?
prior isolation of either organism on culture
recent hospitalization AND receipt of parental abx within last 90 days
What are the risk factors of Pseudomonas with CAP?
- compromized immune system
- recent prior abx use
- structural lung abnormalities such as cystic fibrosis or bronchiectasis
- repeated exacerbations of COPD reqiurring glucocorticoids or abx use
What are the risk factors for pseudomonas with HAP?
increased age, ventilation, abx at admission, transfer from unit or icu, admission in ward with high incedence of P. aurgeinosa infections
What is the definition of HAP?
infection acquired after at least 48hrs of hospitalization
When treating HAP and VAP, consider the following risks
- increased mortaloity
- MDR pathogens and MRSA
- MDR pathogens without MRSA
- MRSA alone
What is the definition of VAP?
HAP that develops more than 48hrs after endoracheal intubation
-difficult to wean of ventilator
lack improvement
new infiltrates on xray, new fever
What is aspiration PNA?
Macroaspiration of fluid/food into lungs
usually due to neurologic dysfunction
What is a trasudate pleural effusion and likely cause?
usually from systemic influences on pleural fluid formation and resorption
Left HF, cirrhosis, neprhotic syndrome, myxedema, peritoneal dialysis
What are the causes of exudative pleural effusions?
caused by local influences on pleural fluid formation and reabsorption
bacterial PNA, malignancy, virus, PE, TB, fungus, parasites
How to diagnose a plueral effusion?
When is a thoracentesis indicated?
Thoracentesis
for all effusions with >1cm layer in decubitus view
if effusion suspected r/t HF, then can try diuresis and 75% do so in 48 hrs
if effision suspected to be r/t infection, thorecentesis is done ASAP
What does Light’s Criteria determine?
What are the criteria?
Determines an exudative effusion
- protein pleural fluid/serum protein ratio >.5
- pleural fluid LDH greater than 2/3 of the labs normal upper limit for serum LDH
- pleural/serum LDH ratio >.6
Transudative effusions will not meet any of these criteria
For exudative effusions, pleural fluid should be tested for what?
Ph
glucose
WBC with diff
micro stidues
cytology
What is the definition of ARDS?
severe dyspnea
diffuse pulmonary infiltrates
hypoexemia
What is the key diagnostic feature for ARDS?
PaO2/FIO2 <300mmHg
diffuse bilateral pulm. infiltrates
absence of elevated left atrial pressure
acute onset
What PaO2/FIO2 ratio indicates severe hypoxemia?
What indicates abnormal gas exchange?
<200
<300
What are the risk factors for ARDS?
sepsis
ONA
trauma
blood transfusions
gastric acid suppression
drug overdose
