Respiratory Infections Flashcards
(49 cards)
Acute bronchitis - clinical presentation
Usually preceded by URI
*Productive cough
Rhonchi and moist rales
Cxr normal (pneumo has consolidation)
Bronchitis - organisms
Usually Viral - flu, RSV, rhinovirus, coronavirus
Bacterial - mycoplasma pneumo, chlamydia pneumo, pertussis
Chronic bronchitis - clinical presentation
“smoker’s cough”
incessant coughing (worse in am) and purulent sputum
Acute bronchitis - treatment
Treat symptoms: Rest, fluids, decrease viscosity of secretions, APAP/NSAIDS, Cough - dextromethorphan
If bacterial or viral x 4-6 days, consider abx (macrolides and FQ)
If high suspicion flu - Tamiflu or relenza if flu
Pneumonia - atypical pathogens
Chlamydia pneumo, mycoplasma pneumo (12-20%) “walking pneumo”, legionella pneumo (GI symptoms)
Chronic bronchitis - treatment
Non pharmacological - smoking cessation, postural drainage, humidification of air to liquefy secretions
Bacterial - amp, doxy, TMP/SMX, fluoro and macrolides (esp. Azithromycin)
Pneumonia - typical pathogens
*Strep pneumo (70%) Staph aureus (more common post viral) H. Influenza Moraxella catarrhalis Klebsiella pneumo (currant jelly sputum)
Pneumonia - when to consider anaerobes
Consider if pt has impaired consciousness or periodontal disease
Pneumonia - common pathogens (COPD/smoking)
Strep pneumo
H. Influenza
Moraxella
Legionella
Pneumonia - common pathogens (aspiration)
Anaerobes
Pneumonia - common pathogens (poor dental hygiene)
Anaerobes
Pneumonia - common pathogens (nosocomial)
Staph aureus
Gr - (klebsiella & pseudomonas)
Pneumonia - clinical presentation
Abrupt onset Fever, chills, dyspnea, productive cough Sputum - rust colored or hemoptysis *CXR - dense lobar or segmental infiltrates CBC - leukocytosis
Pneumonia - approach to treatment
- Determine most likely organism
- Admit or outpatient (PORT prediction scale or CURB-65/CRB-65)
- Comorbidities? HIV, neutropenia
- Consider organisms that might be missed
Preventative measures for CAP
Immunizations - flu and pneumonia
RSV antibody for high risk infants
Chronic bronchitis - organisms
*viral H.influenza Strep pneumo Moraxella Klebsiella pneumo
What factors increase risk for aspiration?
Altered LOC
Neuromuscular disease
Risk stratification for pneumonia
PORT prediction rule
CURB 65
CRB65
Why are patients on PPIs or H2RAs at higher risk for pneumonia?
Lower gastric acid means some bugs in the gut are not killed. If aspirates, can get in lungs.
What are the co-morbidities to consider in pneumonia treatment?
Chronic heart/lung/renal disease DM Alcoholism Asplenia Malignancies Immunosuppressed DRSP infection
How long to treat pneumonia?
Minimum 5 days (afebrile x 48-72 hrs)
Clinically stable - vitals, sats, mental status
Do not discharge within 24 hours if any sign of clinical instability. Must be able to tolerate PO meds.
Pneumonia (healthy, no abx past 3 months) - DOC
Macrolides (clarithro or azithro) or
Doxycycline (ONLY if walking pneumonia)
Pneumonia - w/ co-morbidity or hospitalized (non-ICU)
DOC - Resp FQ (moxi, gemi, high dose levo) or Resp BL (piperacillin or ticarcillan) + macrolide (to add coverage for atypicals)
What level should you monitor when giving vancomycin?
Troughs (want 15-20)
Why? Time dependent killer
