Infection Flashcards
What does crackles in the lung indicate?
Fluid build up and infection
Can be water/blood/pus
Why does fluid build up in the lungs cause SOB?
Can block air flow
What information do you need with a query chest infection patient?
> CRP, blood urea nitrogen, WBC
> Sputum and blood culture to identify microorganism
> If they have an existing respiratory condition, their lung function test
> 02 sats- do they need oxygen?
> Severity and type (especially in pneumonia)
> Acute or chronic onset?
> LFT and renal function
> Are they septic?
> Is it the flu?
> Can they swallow tablets/are they vomiting?
How would you determine if pneumonia is community acquired?
No hospital admissions in the last 6 months
What score can be used to determine pneumonia mortality risk and what does each factor mean?
CURB65
Confusion (mental test score 8 or less)
Urea nitrogen (>7 mmol/l)
Respiratory rate (30 breaths per min or more)
BP (Diastolic 60 or less, or systolic is less than 90)
65 years or more
What do the CURB65 scores mean (point ranges and risk)?
0 or 1 - low risk (<3%)
2- intermediate risk (3-15%)
3-5 - High risk (> 15%)
What does the CURB65 score determine?
Mortality risk %
What is 1st line for non severe CAP and what is the CURB65 score?
What if the patient can only have IV therapy?
< 2
Amoxicillin 500mg TDS PO/IV + doxycline 200mg OD PO for 5-7 days
If IV needed- change doxycycline to clarithromycin 250 mg BD IV
What is the treatment for a penicillin allergic non severe CAP?
What if IV is needed?
CURB65 < 2
Doxycycline 200 mg OD 5-7 days
If IV needed- change doxycycline to clarithromycin 250 mg BD IV
What is the 1st line treatment for severe CAP and what is the CURB65 score?
What if the patient can only have IV therapy?
CURB65 >2
Co-amoxiclav 1.2 g TDS IV and doxycyline 200mg OD PO for 5-7 days
If IV needed- change doxycycline to clarithromycin 500 mg BD IV
What is the treatment for a penicillin allergic severe CAP?
CURB65>2
Vancomycin (refer to dosing guidance) and ciprofloxacin 400mg BD for 5-7 days
How do you distinguish between early and late onset HAP?
Early onset is within 3 days of admission
Late onset if more than 3 days after admission
What is the 1st line treatment for early onset HAP?
Co-amoxiclav 625 mg TDS PO or 1.2G TDS IV for 5 days
What do NICE guidelines say about pneumonia treatment duration compared to local London hospital guidelines?
NICE guidelines recommend 7-10 day course of ABX (local hospital guidelines suggest 5-7)
What is the penicillin allergic treatment for early onset HAP?
What is the alternative if the patient can only have IV?
Doxycycline 200 mg OD 5-7 days
If IV needed- change doxycycline to clarithromycin 250-500 mg BD IV
What is the 1st line treatment for late onset HAP?
Co-amoxiclav PO or IV and gentamicin IV for 5-7 days
What is the penicillin allergic treatment for late onset HAP?
Vancomycin IV and gentamicin IV for 2 doses then review
What are the symptoms of cellulitis and what makes you more at risk?
- Sometimes near toes if you have athletes foot
- Lower legs affected
- Swollen, painful, tender
- More at risk if you have poor circulation e.g. diabetes or if you have broken skin around that area (easy for bacteria to get in)
- Can be limb threatening
What do you need to consider with query cellulitis?
What about if they are diabetic?
- Where did it come from- e.g. a bite, fresh water expsoure, occupational exposure, pets?
- WBC and CRP for signs of infection
- LFT and renal function
- If diabetic, look out for signs of necrotic tissue
What are the likely organisms of cellulitis?
- Streptococcus pyrogenes
- Staph.aureus
- Staph. Epidermidis
How would you diagnose pneumonia?
Chest a ray
How would you diagnose pneumonia?
Chest X ray
If a patient comes in with pneumonia, how quick does treatment need to be started?
Within 4 hours of admission
What does GCS score measure?
Level of consciousness
