45. Pnie Flashcards
Ne pas oublier le diagnostic de pneumonie chez les pts… (3)
deterioration,
delirium,
abdominal pain
Pnie with normal chest xray could happen when the pt is /has (3)
consider dehydration,
neutropenia,
human immunodeficiency virus [HIV] infection
hx that ring a bell for unusual pathogens (5)
history of tuberculosis,
exposure to birds,
travel,
HIV infection,
aspiration
be arware of drug interactions when treating pnie such as
antibio + warfarin
Pt with pnie not responding to, what other underlying dx there could be ( 3 cat - 7)
cancer
chronic obstructive pulmonary disease
bronchospasm
consider atypical pathogens (e.g., Pneumocystis carinii, TB)
complications (e.g., empyema, pneumothorax).
anticipate this tx options before pt deteriorates
bilevel positive airway pressure BiPAP
continuous positive airway pressure, CPAP
intubation
preventing pneumonie .. think about
flu vaccine, Pneumovax, ribavarine
follow up care
patient education
repeat chest X-ray examination
instructions to return if the condition worsens
typical pathogens
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
atypical pathogens
Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella spp
aspiration pneumonia
Bacteroides (anaerobes)
community acquired vs nosocomiale
No hospitalization within 14d of onset OR <4d prior to onset
diagnosis pneumoinia (3)
Two symptoms (fever, rigors, cough change, pleuritic chest pain, SOB)
AND auscultatory findings (localized crackles, bronchial breath sounds)
AND X-ray opacity
labs tests that can help the diagnosis
CRP
procal
leuco - less specifique
if hospitalized
Ceftriaxone 1-2g IV q12-24h
AND
Levofloxacin or Moxifloxacin or Azithromycin
ceftri = superior to piptazo! strep
15% Strep pneumo resistant
antibio covering atypical bacteria
Clarithromycin
Azithromycin
doxycycline
Consider covering for legionella if risk factors
Elderly, immunosuppression, smoker, lung disease
T>39ºC
Neurological (Confusion/Weakness/Gen det)
GI (diarrhea)
Electrolytes (Hyponatremia. hypophosphatemia, renal/hepatic dysfunction, thrombocytopenia, leukococytosis)
Hematuria
Hotel, cruise ships, residence (water reservoir contamination)
Repeat CXR in 6w (r/o underlying disease) if (6)
> 50yo or immunosuppressed, lung disease, alcohol, smoker, >5% weight loss in past month
Extensive/necrotizing pneumonia
preventing pneumonias 2
Influenza
Pneumococcal >65yo or comorbidity
Prevents invasive pneumococcal disease (bacteremia)
