FN: Pneumonia Flashcards
Epi
1/1000
Mortality
10% in hospital, 30% in ITU
Anatomic classification
Bronchopneumonia - patchy consolidation of different lobes
Lobar pneumonia - fibrosupportive consolidation of a single lob. Congestion red grey resolution
Classification
Community acquired Pneumonia
Hospital Acquired Pneumonia
Aspiration
Immunocomprimised
Community acquired
- Pneumococcus, mycoplasma, haemophilus
- S. aureus, Moraxella, Chlamydia, Legionella
- viruses (155)
Hospital acquired pneumonia
> 48hrs after hospital admission
Gram ive enterobacteria, S. aureus
Aspiration
increased risk with: stroke, bulbar palsy, reduced GCS, GORD, achalasia
Anaerobes
Immunocomprimised
The usual suspects, plus
PCP, TB, fungi, CMV/HSV
Symptoms
Fever, rigors Malaise, anorexia dyspnoea Cough, purulent sputum, haemoptysis Pleuritic pain
Signs
Raised RR, Raised HR
Cyanosis
Confusion
consolidation signs
Reduced expansion Dull percussion Bronchial breathing Reduced air entry Crackles Pleural rub Raised VR
Investigations
Bloods: FBC, U+E, LFT, CRP, culture, ABG (if sats low)
Urine: Ag tests (Pneumococcal, legionella)
Sputum: MC&S
Imaging CXR
Special tests
Paired sera Abs for atypicals - mycoplasma, Chlamydia, legionella
Immunofloerence (PCP)
BAL
Pleural tap
Severity
CURB-65 (only if xray changes)
Confusion (AMT 7mm)
Reso rate >30/min
BP 65
CURB 65 score related to treatment
0-1 - home treatment
2 - hospital Rx
>3 consider ITU
Management
BX
Oxygen
Fluids
Analgesia
Chest physio
Consider ITU if shock hypercapnia, hypoxia
f/up @ 6wks with CXR - check for underlying Cancer
CAP management mild
Amoxicillin 500mg TDS PO for 5d or clarithro 500mg BD PO for 7d
CAP management moderate
Amoxicillin 500mg TDS and clarithro 500mg BP PO/IV (clarithro alone if penicillin allergy) for 7d
Cap management severe
Co-amoxiclav 1.2g TDS IV/cefuroxime 1.5mg TDS IV and clarithro 500mg BD IV for 7-10d
Cap management Atyp
Chlamydia: tetracycline
PCP: Co-trimazole
Legionella: Clarithro + rifampicin
HAP management mild/
Co-amoxiclav 625mg PO TDS for 7d
HAP maagement severe/>5d
Tazocin ± vanc ± gent for 7d
Aspiration pneumoni amangement
Co-amoxiclav 625mg PO TDS for 7d
Pneumovax (23 valent)
>65 years Chronic HLKP failure or condition DM Immunosuppresion: hyposplenism, chemo, HIV CI: P, B, Fever
Vaccination
Revaccinate every 6years
