21. Acute Resp Flashcards
What is pneumonia?
Alveoli infection!
Split into CAP and HAP (after 48 hours in hospital)
What are the causative organisms of pneumonia?
CAP - Streptococcus pneumoniae
Mycoplasma pneumoniae
Haemophilus pneumoniae
Atypical - Mycoplasma pneumoniae
Legionella pneumophilia
Chlamydia psittaci
Chlamydia pneumoniae
HAP - Staphylococcus aureus
Pseudomonas aeruginosa
Klebsiella
Risk factors for pneumonia
Smoking Recent travel Faulty air conditioning - legionella Pet birds - chlamydia psittaci Immunocompromised
Pneumonia symptoms?
Typical
Fever, SOB, productive cough, pleuritic chest pain
Atypical
Dry cough, headache, diarrhoea, myalgia, hepatitis, confusion (legionella)
Pneumonia O/E?
Reduced chest expansion Dull percussion Basal coarse crepitations Bronchial breathing Increased vocal resonance
Atypical - mycoplasma - transverse myelitis, erythema multiforme, AI haemolytic anaemia
legionella - hyponatraemia abnormal LFTs
Pneumonia investigations?
Sputum MCS Bloods ABG - type I resp failure Pleural fluid MCS CXR on imaging
Mycoplasma will have red cell agglutination on blood film
Legionella has urinary antigens and strange LFTs
Management of pneumonia?
CURB-65 Confusion < or = 8 Urea >7 Resp rate >30 SBP <90 Age >65
Score of 1 is GP and oral abx
Score of 2 is A&E with IV abx
3 or more is hospital admission, IV abx and consider ITU
Typical - amoxicillin and then co-amoxiclav
further
Doxycycline if pen allergic
Atypical - clarithromycin
PJP needs co-trimoxazole for HIV patients
What is acute bronchitis?
Infection of bronchi, upper resp tract
Usually viral e.g. rhinovirus, flu, RSV, COVID
Risk factors for bronchitis?
Smoking
CF and COPD
Signs and symptoms of acute bronchitis?
Minimally/nonproductive cough for weeks
Dyspnoea, chest pain and tightness with wheezing from this
Mild fever (high or long would suggest pneumonia)
How might we investigate acute bronchitis?
Generally clinically based
If CXR it’s to exclude pneumonia
Managing acute bronchitis?
Paracetamol and ibuprofen as required
Hydration
If cough persists for more than 2 weeks, inhaled corticosteroids
If underlying lung pathology used oral antibiotics
What is a PE?
One or more emboli that blocks an artery in the lung. This usually comes from a thrombus in the veins that has moved.
Symptoms of PE?
Pleuritic chest pain
Dyspnoea
Collapse if acute massive
Haemoptysis
S1Q3T3 pattern on ECG for acute massive
CXR shows westermark’s sign (check this)
How are we assessing a PE?
Well’s score
>4 is high risk, needs CTPA
<4 do d-dimer, low risk