Respiratory Block Flashcards
Define community acquired pneumonia.
Pneumonia occurring in individuals who have been in hospital for <48 hours and are NOT significantly immunocompromised (e.g. CF, bronchiectasis, high level residential care).
Streptococcus pneumoniae, Haemophilus influenzae.
Describe risk factors for Community Acquired Pneumonia.
> 50 years, ETOH, smoking, IV drug use, asthmatics, CKD, COPD, dementia, heart failure, immunosuppression, Indigenous, seizure disorders, stroke, recent viral respiratory infection.
Describe some of the most common pathogens responsible for pneumonia.
Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus influenzae.
Atypicals include:
Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella species, Staphylococcus aureus.
Which pneumonia causing pathogen is common in the elderly?
Mycobacterium tuberculosis.
Which pneumonia causing pathogen is common in the immunocompromised, particularly HIV?
Pneumocystis jirovecii or carinii.
Which melioidosis causing pathogen is common in the north of Western Australia?
Burkholderia pseudomalleii.
What is a PICO question?
Population/Patient
Intervention
Comparison
Outcome
What immunisation regime prevents pneumonia infection?
Pneumococcal vaccination, starting at 2 mths of age.
Increased freq. for ATSI individuals and immunocompromise e.g. CSF leak, asplenia, HIV.
Non-ATSI > 70 years, ATSI >50 years.
Name the clinical features of pneumonia.
SIGNS: Fever, sweats, rigors. Cough, sputum, haemoptysis. Lethargy, anorexia. Pleuritic chest pain. SYMPTOMS: Febrile Decreased cap refill. Crackles on chest auscultation. Consolidation, dull percussion, increased vocal resonance, bronchial breathing.
Which pneumoniae pathogen commonly occurs after influenzae?
Staphylococcus aureus.
Which pneumonia pathogen commonly occurs in conjunction with aspiration or alcoholism?
Streptococcus pneumoniae, Klebsiella pneumoniae, Acinetobacter and the anaerobes.
Which pneumonia pathogen commonly occurs in close proximity to birds?
Chlamydia psittaci.
Which pneumonia pathogen commonly occurs in conjunction with gingivitis?
Streptococcus viridans.
Which antibiotics are used to cover pneumococcus?
Beta-lactams e.g. penicillins and 3rd generation cephalosporins.
Which antibiotics are used to cover the ‘atypicals’?
Macrolides or doxycycline.
Which antibiotics is used in patients with a macrolide or penicillin allergy?
Mocifloxacin i.e. a QUINOLONE.
What is the moderate-severity drug regimen for pneumonia?
Benzyl-penicillin 1.2g IV, 6 hourly;
PLUS either:
Doxycycline 100mg orally 12 hourly,
OR
Clarithromycin 500mg orally 12 hourly.
Oral amoxicillin can be given instead of BenPen in patients who can tolerate orals.
If oral not available, then IV azithromycin.
Which investigations are appropriate for a ? pneumonia patient?
Sputum sample for a PCR and MC+S, as well as gram stain and cultures.
Bloods for cultures, if poss.
Serology:
- mycoplasma, legionella, chlamydia, influenzae, parainfluenzae, RSV.
(before ABx administration).
Viral PCR for extended respiratory screen.
COVID RAT and PCR.
Urinary pneumococcal (+/- legionella) antigen.
What secondary investigations are necessary for a ?pneumonia patient?
CXR
ABG/VBG
FBC, UandE’s, LFT’s, CRP (also procalcitonin, ESR)
Name 3 methods of grading pneumonia severity and their acronyms.
CURB-65 - Confusion, Urea, Respiratory Rate above 35, Blood pressure below 90, aged over 65 (Community Acquired).
SMART-COP - Systolic below 90mmHg, Multilobar Involvement, Albumin <3.5, RR >30, Tachycardia, Confusion, 02 Sats <90, pH <7.35 (Community-Acquired).
PSI Pneumonia Severity Index - lots.
Describe other considerations when providing supportive therapies for pneumonia patients?
Manage cardiac dysfunction, prevent sepsis, DVT prophylaxis, corticosteroids, correct neutropenia.
Define nosocomial pneumonia.
Pneumonia acquired after >72 hours in hospital care.
Pseudomonas aeruginosa, Staph. aureus, Klebsiella pneumonia, Enterobacter.
What is the most common cause of nosocomial pneumonia?
Most commonly the GRAM NEGATIVES;
Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and Acinetobacter.
What are the most common NOSOCOMIAL pathogens in immunocompromised patients?
Streptococcus pneumoniae, Mycobacterium pneumoniae, Legionella.
LYMPHOCYTIC ORIGIN:
Pneumocystis jirovecii, TB, viral pneumonia.
NEUTROPHILIC ORIGIN:
Pseudomonas aeruginosa, Staph aureus, aspergillus.
How do bronchioles differentiate from bronchi?
Bronchi have cartilage and submucosal glands within their walls.
Bronchi are pseudostratified columnar, bronchioles are CILIATED simple cuboidal. Bronchioles include CLUB CELLS.
Define the elements of the respiratory acinus.
Respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli.
What is the definition of pneumonia?
Infection of the lung parenchyma, distal to the terminal bronchiole.
Bronchopneumonia is infection of the airways including the bronchioles.
Describe some situations in which the host defence mechanisms for pneumonia may be impaired.
Immunosuppression, intubation, coma, general anaesthetic, anything reducing the respiratory drive or cough reflex, intubation, neuromuscular disease.
Injury to the mucociliary escalator e.g. smoking, gas inhalation, CF, obstruction.
Decreased macrophage function e.g. smoking, alcohol.
Describe the 3 main classifications of pneumonia by anatomical location.
Lobar, bronchopneumonia, interstitial pneumonia.
When might you be able to see an air bronchogram?
When the parenchymal tissue is opacified by fluid/exudate etc so that the air-filled spaces of the bronchioles and bronchi are more clearly visible.
What are the pores of Kohn?
Small communicating channels between adjacent alveoli, providing a collateral pathway for aeration.
Describe the process of congestion in pneumonia.
1-2 days in which lungs become heavy, red and boggy;
++intra-alveolar exudate,
not many neutrophils,
++bacteria present,
vascular congestion is evident.
Watery sputum and fine crackles on auscultation.
