3- complications of pneumonia Flashcards
what is pneumonia?
form of acute respiratory infection that affect the lungs where alveoli filled with pus
what do bronchial breath sounds suggest?
implies airways full of pus and pus transmitting sound from large bronchial airways to your stethoscope
what is empyema?
pus in pleural space = complication of pneumonia
- needs intercostal drain
are primary empyema iatrogenic or idiopathic?
can be both = often iatrogenic (doctors fault), many idiopathic (spontaneous)
what signs mean just a simple parapneumonic effusion?
- Clear fluid
- pH > 7.2 (pretty benign)
- LDH < 1000
- Glucose > 2.2 (low glucose benign as no cells eating up sugar)
what signs mean a complicated parapneumonic effusion?
- pH < 7.2
- LDH > 1000
- Glucose < 2.2
- Requires Chest Tube Drainage
what signs mean empyema?
- Frank pus
- No other tests required
- Requires Chest Tube Drainage
what is the most common organisms causing empyema?
aerobic organisms: both gram positive + gram negative
gram positive: strep pneumoniae, staph aureus, strep milleri (found in healthy people’s mouth, flu like illness encourage bacteria to travel down and cause infection for some reason)
gram negative: e.coli, pseudomonas, klebsiellae
are empeyemas ever caused by anaerobes?
in 13% cases = not common = usually in severe pneumonia or poor dental hygiene
what are you looking for in chest x-ray?
persisting or new effusion
what is the preferred investigation for checking complications of pneumonia?
ultrasound as simple bedside test with targeted sampling
= the appearances will give clue to complexity of fluid
what is purpose of CT scan in pneumonia complication?
- Differentiation between Empyema and Abscess
- Allows extent of effusion/empyema to be appreciated
what are you looking for on chest x-ray?
- look for meniscus (characteristic appearance of the fluid level within the pleural space, resembling a meniscus shape indicating pleural effusion)
- D -sign or split pleural sign (concave shape that looks like a D indicating empyema)
= some are obvious, some are not - not always large
what is antibiotics for empyema treatment?
IV antibiotics = amoxicillin + metronidazole or co-amoxiclav = a broad spectrum as often polymicrobial and need anaerobic cover
Oral antibiotic = usually co-amoxiclav for 5 weeks, directed towards cultured bacteria
what other treatment can be given for empyema?
intrapleural fibrinolytics = attempt to break down inflammation to try and help patient get better more quickly
- if complicated effusion and dont get better with drain & antibiotic = give 2 drugs (tPA and DNA) in co,bimatoon up the drain and suddenly all the fluid comes out
