04-16 Pneumonia Flashcards
• Describe the pathogens that cause different types of pneumonia and the drugs that treat them • Identify the geographic, behavioral and social factors that predispose to pneumonia • Recognize the clinical manifestations, diagnosis and treatment of pneumonia • Recognize the critical role of chest radiography in the diagnosis of pneumonia • Review the role of vaccination in the prevention of pneumonia • Review behavioral risk factors for pneumonia such as alcohol abuse • Identify the role o
Describe the pathogens that cause different types of pneumonia and the drugs that treat them
COMMUNITY-ACQUIRED PNEUMONIA (CAP)
—Mycoplasma
— Strep pneumo
—Chlamydophiia
—Influenza
—Legionella (severe cases)
ASPIRATION PNEUMONIA (Think EtOH)
—Poly microbial w/ oral anaerobes
HEALTHCARE-ASSOC’D PNEUMONIA (HCAP)
—Staph
—GNRs
VENTILATOR-ACQUIRE PNEUMONIA
—Pseudomonas
Identify the geographic, behavioral and social factors that predispose to pneumonia
Review behavioral risk factors for pneumonia such as alcohol abuse
Worldwide problem; #8 cause of death aux É.U.
Recognize the clinical manifestations, diagnosis (and treatment, see other card) of pneumonia
MANIFESTATIONS
—cough, fever, dyspnea, tachypnea, even hypotension + tachy
—OnDoc P.E. findings: asymm crackles (“râles”), whispered pectoriloquy, egophony, incr. vocal fremitus, and asymm dullness to percussion
—INFILTRATE ON CHEST X-RAY is cardinal finding (super important; required for dx; critical, etc.)
—Neutrophilia
—Positive cultures
Review the role of vaccination and other preventive measures in the prevention of pneumonia
Vaccinate against:
—Pneumococcal
—Influenza
Prevent and Treat:
—TB
—HIV/AIDS
Identify the role of thoracentesis in the management of empyema
If pt is not getting better consider the possibility of an empyema which must be drained.
Discuss the role of the physician in the prevention of antibiotic misuse and consequent antibiotic resistance
Describe the importance of avoiding antibiotic misuse in the prevention of antibiotic resistance
Don’t Rx for viral bronchitis!
—Use “smalllest gun” possible when tx’ing pneumonia.
Identify the major causes of URI and recognize which require treatment
See URI Card set
Identify viral illnesses which cause URI and which can be diagnosed using clinically-available molecular diagnostic tests
Influenza can be tested for
Community Acquired Pneumonia
—Bugs
—Drugs
—Back-Up Drugs
CAP
—Bugs: Strep pneumo and atypicals (mycoplasma, chlamydophiia, legionella); ALSO influenza
—Drugs: azithro
—2nd line: doxy
Community Acquired Pneumonia (Sicker)
—Bugs
—Drugs
—Back-Up Drugs
CAP (Sicker)
—Bugs: Strep pneumo (resistant) + atypicals
—Drugs: ceftriaxone + azithro
—2nd line: moxifloxacin or levofloxacin (more ADRs and otherwise too broad, but useful if pt allergic)
Comm-Acquired Pneumonia (wicked sick: home→ICU)
—Bugs
—Drugs
—Back-Up Drugs
CAP (wicked sick)
—Bugs: Strep pneumo (resistant) + GNRs
—Drugs: vanc + ceftriaxone
—2nd line: vanc + moxifloxacin
Healthcare-Acquired Pneumonia
—Bugs
—Drugs
—Back-Up Drugs
HCAP
—Bugs: Staph aureus, GNRs, atypicals
—Drugs: vanc + ceftriaxone
—2nd line: vanc + amp/sb (Unasyn)
*Add pip/tazo if high risk (Pseudomonas cvg)
Ventilatory-Acquire Pneumonia
—Bugs
—Drugs
—Back-Up Drugs
VAP
—Bugs: resistant GNRs, Staph
—Drugs: vanc + pip/tazo +/- quinolone
—2nd line: vanc + ceftriaxone +/- quinolone
Aspiration Pneumonia
—Bugs
—Drugs
—Bugs: anaerobes
—Drugs: CAP drugs (e.g. azithro) + metronidazole or clindamycin +/- β-lactamase inhibitor
