3- LRI Flashcards
What is the MCC of acute bronchitis
Lower respiratory viruses (self limited)
Adenovirus, influenza virus
(Kids: also Parainfluenza)
IF bacterial, what are MCC of acute bronchitis
Mycoplasma Pneumoniae
Normal flora contamination with: S. Pneumoniae, Staph, Haemophilus
When would suspect a bacterial etiology in acute bronchitis
previously healthy pt. with persistent fever
respiratory Sx for 4-6 days
Immunocompromised/predisposed
How do you treat acute viral bronchitis
Symptomatic for fever, malaise, lethargy; IBO, Acetaminophen, fluids
-Avoid abx, rarely use cough suppressants
How do you treat Acute bacterial bronchitis
Abx therapy aimed towards likely pathogen (S. pneuma and M. pneumoniae)- AZITHROMYCIN (macrolide)
-Fluoroquinolone as alternate
What is the single most common reason patients seek medical attention
respiratory tract infections (major cause of morbidity from acute illness)
What are the most common LRI
Bronchitis
Bronchiolitis
Pneumonia
What is bronchitis
inflammation of the walls of bronchi/bronchioles causing narrowing
affects large elements
What is bronchiectasis
widening of the bronchi with excess mucus causing narrowing
affects small elements
How is bronchitis classified
Acute: all ages
Chronic: usually adults
What are symptoms of bronchiolitis (infancy)
cough, coryza, vomiting, diarrhea, noisy breathing, labored breathing (grunting, flaring, retractions)
What are Acute bronchiolitis findings
Tachy, RR 40-80 (retractions), wheezing, INSP rales, mild conjunctivitis
Normal WBC
ABN ABG’s (hypoxemia- rarely hypercarbia)
What is the MCC of acute bronchiolitis
RSV (self limiting)
How do you treat healthy acute bronchiolitis babies
treat fever, oral fluids, observe for labored breathing
How do you treat severe babies
oxygen therapy, IV fluids
+/- bronchodilators and Ribavarin
Who would you give Ribacvarin to
acute bronchiolitis patients with bronchopulmonary dysplasia
congenital HD
premature
immunodeficient
What is prophylaxis for RSV
Pavilizumab (preferred) or RSV immunoglobulin
-Should be given to those with underlying heart/pulm disease monthly during peak season (late fall-early spring)
What are S/E of palivizumab
fever rash antibody formation anaphylaxis thrombocytopenia
What causes chronic bronchitis
inhalation of noxious agents + env. factors + bac/viral info
What is the definition of chronic bronchitis
chronic cough, excess sputum, and organisms in expectoration for >3 months for 2 years
How do you treat an acute chronic bronchitis exacerbation
Chest physiotherapy/ humidified air (mobilize and increase expectoration)
Bronchodilators (albuterol)
+/- Oxygen therapy and Abx
What are common pathogens in chronic bronchitis
H. Influenza
M. Catarrhalis
S. Pneumoniae
If needed, what abx are preferred in chronic bronchitis
Doxycycline Ampicillin Amoxicillin Augmentin Levo/Moxifloxacin
What will you find on chronic bronchitis PE
inspiratory rales/rhonchi, exp. wheezing
Hyper resonance, decreased BS
obesity, clubbing, barrel chest
What will chronic bronchitis labs show
Erythrocytosis
decreased vital capacity, prolonged exp. flow
What are PNA PE findings
Dullness to percussion, increased tactile remits, decreased BS, crackles, retractions
tachycardia, tachypnea
What will PNA lab findings show
Leukocytosis
PNA symptoms are
Abrupt onset fever, chills, dyspnea, pleuritic CP, productive cough (rust sputum)
RF for CAP
65+ y/o DM cardio/pulm/renal/liver disease smoking, alcohol (asplenia)
RF for HAP
60+ y/o aspiration, COPD, ARDS, coma antacids, ppi, H2 antagonist head trauma, ICP NG tube/enteral ntr reintubation/tracheostomy IV abx w/in 90 days (MDR risk)
RF for VAP
all HAP RF +
MDR risk w/ septic shock, acute renal replacement therapy, 5+ days of hospitalization
What is the MCC of PNA in adults
Strep Pneumo
What is the MCC of PNA in kids
RSV, parainfluenza, adenovirus
(if bacterial, S. Pneumo)
(older children, M. pneumoniae)
What is “adjunct therapy” for PNA in adults
humidified O2 for hypoxemia
bronchodilators if w/ bronchospasm
rehydration fluids
chest physiotherapy
What is Grade 1A PNA prevention
Pneumo vaccine and flu vaccine
Flu meds as prophylaxis or w/in 48 hours of Sx onset
What is Grade 1B PNA prevention
Macrolide (azithromycin) if in close contact with pertussis
Use SINGLE dose aerosol meds
