L 47 & 48 Flashcards
Pneumonia definition?
Lung inflammation caused by infection in which the air sacs fill with pus and may become solid.
Will inflammation affect both or just one lung in pneumonia?
It can affect both or just one (double, or single pneumonia)
Pneumonia symptoms: x7
High fever, chills, painful/productive cough, shortness of breath, dyspnoea, tachypnoea, fatigue.
Danger symptoms for urgent referral of pneumonia (7 total, 2 main)
Temperature >38 Shortness of breath accompanied by a cough. Respiratory rate >30 (at rest) Oxygen saturation <92% Chest pain (when not coughing) Haemoptysis (coughing up blood) Cough persisting longer than 21 days.
4 types of pneumonia
CAP
HAP
VAP (ventilation acquired)
Aspiration pneumonia
Diagnosis of pneumonia by….
Chest x-ray
Pulse oximetry (oxygen level in blood via finger test)
Full blood count, white cell count, CRP, U+E (urea + electrolytes)
Culture of LRT sample (if pss)
Consider
High pH causes blood …
What does this mean?
High pH = blood alkalosis
High metabolic PaCO2 and low respiratory PaCO2
Low pH causes blood …
What does this mean?
Low pH = blood acidosis
High respiratory PaCO2 and low metabolic PaCO2
Define CAP
Community acquired pneumonia (CAP)
Pneumonia acquired outside of hospital or health care facilities
Common causes of CAP (typical and atypical bacteria)
Typical bacteria: S. pneumoniae, Haemophilus influenzae, Staphylococcus aureus
Atypical bacteria: Legionella spp (soil), mycoplasma pneumoniae, chlamydophilia pneumoniae
What could suggest that a patient has mycoplasma pneumoniae?
The patient will often have a rash
Are the following gram -ve or +ve?
S. pneumoniae Haemophilus influenzae Staphylococcus aureus S. pneumoniae: G+ve Haemophilus influenzae: G-ve Staphylococcus aureus: G+ve
CAP common viral (x4) and fungal causes (x1)
Viral: RSV, Influenza A or B, COVID-19
Fungal: pneumocystitis pneumonia caused by the pneumocystis jirovecii
What antibiotics would be first line for Streptococcus pneumoniae?
Drugs that work against gram +ve bacteria
Macrolides (azithromycin, clarithromycin)
Penicillins: Penicillin, amoxicillin
Augmentin, tazocin, doxycycline, cephalosporins
What antibiotics would cover haemophilus influenzae?
Drugs that work against gram -ve bacteria Amoxicillin Augmentin Broad spectrum cephalosporins Tazocin
What antibiotics would cover staph aureus?
Drugs that work against gram +ve bacteria
Cephazolin, cephalexin
Augmentin
Doxycycline
Would you use flucloxacillin to treat pneumonia?
No, it isn’t really used in respiratory infections as it is not broad enough for what we are trying to treat.
What antibiotics would cover legionella?
Any drugs that work against gram negative bacteria
Azithromycin
Clarithromycin
Doxycycline
Is legionella gram positive or gram negative?
Gram -ve
What covers mycoplasma pneumoniae?
Any drugs that work against gram -ve bacteria
Macrolides (clarithromycin, azithromycin)
Doxycycline
What covers chlamydiphilia pneumoniae?
Anything that targets gram -ve
Doxycycline, azithromycin, clarithromycin
How do we decide how severe someones CAP is?
Work out their CURB-65 score
What does CURB65 stand for? How do you get points?
C: Confusion U: Urea = 7+ mmol/L R: Respiratory rate = 30+ B: Low BP (<90 SBP or <60 DBP) 65: Aged 65+ You get points by meeting this criteria. Higher score = worse potential outcome
What does a CURB score of 3-5 mean?
22% chance of 30 day mortality. Admission to hospital and manage as severe.
What is the issue with CURB65 score in clinical settings?
What would the adjustment be?
Communities don’t have access to quick urea results like hospitals do.
0 = low severity
1-2 = moderate severity
3-4 = high severity
What is the CRB-65 score of Mr B?
32 y/o man and we don’t have his past medical history
He smokes 20 cigarettes a day
He returned from Spain with a dry cough which has lasted for several days
He is febrile, with a respiratory rate of 32/min which appears laboured.
C = not mentioned = 0 R = 1 point (is over 30) B = unknown = 0 65 = 0, he is only 32 y/o Therefore his CRB65 score is 1.
Define HAP
Hospital acquired pneumonia
Acute pneumonia that is acquired at least 48 hours after admission to hospital and was not incubating at time of admission (didn’t have it before)
Common pathogens that cause HAP x4 + class
Normally gram -v bacilli e.g Pseudomonas aeruginosa Escheria coli Klebsiella pneumonia Acinetobacter species
Define VAP
What is it caused by?
Ventilator associated pneumonia.
A subset of HAP
Pneumonia occurring more than 48 hours after endotracheal intubation.
Caused by a biofilm on the endotracheal tube
Common pathogens that cause VAP
Normally G+ve bacilli e.g s.aureus
Normally G-ve bacilli e.g Pseudomonas aeruginosa, E.coli, Klebsiella pneumonia
Define aspiration pneumonia
Pneumonia that occurs when food, saliva, liquid, or vomit is breathed (aspirated) into the lungs instead of the stomach.
How do we assess the patient’s treatment efficacy?
How long/what do we look at
An improvement trend is expected to be seen 48-72 hours within initiating antimicrobial treatment.
Look at:
Symptoms, FBC, urea, CRP, chest x-ray, temperature, respiratory rate, mental status.
What non-antibiotic treatments do we give for pneumonia patients?
Fluids, oxygen, supportive care (e.g paracetamol), try to keep patients moving = helps cough up sputum.
