HAC- EBM Flashcards
Pneumonia
inflammation of lung due to microorganisms (bacteria, viruses, fungi, parasite)
pneumonitis
inflammation of lung due to factors other than microbial. (chemicals, bird feces, gastric contents, asbestos, silica)
Bronchitis
inflammation of bronchi or bronchial tubes
cough
green, clear, yellow sputum
community acquired pneumonia
CAP
- presumed to be infectious from contact within the community
healthcare associated pneumonia
HCAP
healthcare acquired pneumonia
pneumonia occurs 48 or more hours after admission which was not incubating at time of admission
ventilator associated pneumonia
arises more than 48-72 hrs after
Most common pathogen detected with pneumonia
- Thinovirus
- Influenza A/B
- S. pneumoniae
Symptoms of pneumonia
cough, fever, SOB, fatigue, malaise
signs of pneumonia
- consolidation on CXR
- air bronchogram
- elevated WBC
- hypoxemia
- dullness to percussion
- tactile
- tachypnea
fever
rales
egophony and dullness to perfussion
hemoptysis
CXR- pleural effusion, abscess, broniial pbreath sounds
CURB-65
tool to decide of pt needs to be admitted
Confusion
BUN > 20
RR > 3- BP (SBP 65
0-1 = low risk (Outpt)
2==hospital admission
>2 assess for admission to ICU
in outpt BUN could be dropped and a score of 1 could suggest hospitalization
Which CURB criteria is lowest reason to admit
age
Decision making tools for pneumonia
CURB-65
SMART COP
PSI - stratifies adults into 5 categories for risk of death in 30 days from all causes
First lines of treatment for CAP in healthy
azithromycin doxycycline (first line if macrolide resistance > 20%)
Treat CAP with pt with other comorbidities (heart dz, lung dz, liver, etc) WHAAAT
azithro PLUS beta
fluoroquinolone
beta lactam PLUS macrolide
Treatment for INPT ICU treatment
beta lactam plus either arithromycin or fluoroquinolone
If worried about pseudomonas
antipneumococcal, antipseudomonal beta lactam
pip-tazo plus cipro or levo
Lights criteria
- tells whether effusion fluid is transudate or exudate; if at least one of following three criteria filled, fluid = exudate
Protein Fluid/Protein Body > 0.5
LDH Fluid/ LDH Body > 0.6
LDA Fluid > 2/3 upper limit of normal
Parapneumonic effusion
effusion assd with pneumonia
- occur in 40% cases
- usually resolves w/antibiotics alone
- can do VATS or chest tube
most common cause of post-influenza pneumonia
complication of influenza
Strep pneumo most common but we worry about staph as well
Vaccines for pneumonia
Over 65, now everyone gets Prevnar then get pneumovax a year later
MONA criteria
Morphine oxygen nitroglycerin aspirin beta blocker
