lower resp tract infection in adults Flashcards
what are examples of lower respiratory tract infections in adults
acute brinchitis exacerbation of COPD pneumonia - empyema - lung abscesss - bronchiectasis
what is acute bronchitis
inflammation of bronchi temporary <3 months cough and coutum usuallt viral supportive management
what is COPD exacerbation
change in colour of sputum fevers increased breathlessness wheeze cough - strep pneum - haem flu - moraxella cat viral
what is pneumonia and what are the risk factors
inflammation of lung parenchyma
- smoking and alcohol
- extremes of age
- preceding viral illness
- pre existing lung disease
- chronic illness
- immunocompromised
- howpitalisation
- IVDU
what are the clinical features of pneumonia
symptoms - fever, rugir, myalgia, cough and sputum, chest pain, dyspnoea and haemoptysis
signs - tachypnoea, tachycardia, rescued expansion. full percussion, bronchial breathing crépitations and vocal reasonable
what are the investigations for pneumonia
community - maybe none, CXR if in doubt
hospital / bloods - serum biochemistry, FBC, CRP and blood cultures
CXR
sputum culture, viral throat swab legionella urinary antigen
what are the classifications of pneumonia
community: typical (step pneum) and atypical chlamydia pneum)
nosocomial (entérobactéria)
what is the severity scoring for pneumonia
CURB 65
C - confusion
U - blood urea >7mmol/L
R - respiratory rate more than or equal to 30/min
B - systolic BO < 90mmhg, diastolic blood pressure < 60mmhg
65 - age more than or equal to 65
scores mean
0-1 - low risk - community treatment
2 - modersate - usuallt need hospital treatment
3-5 - high risk of death
what antibiotic would normally be used for pneumonia
amoxicillin or co-amoxiclav with clarithromysin
what are special circumstances in patients w pneumonia
influenza
aspiration pneumonia
immunocompromised
MRSA - vancomycin
what are the complications of pneumonia
sepsis acute kidney injury adult respiratory distress syndrome parapneumonic effusion empyema lung abscess disseminated infection
parapneumonic effusion/ empyema characteristics
thoracic ultrasound +/- aspirate fluid parameters - simple ph>7.2 complicated pH<7.2 empyema pus/culture postive may need drain + prolonged abx surgery/intrappeural tpA + DNAse
lung abscess characteristic
more likely with staph aureus, pseudomonas and anaerobes purulent sputum, haemoptysis screen for tb CT scan +/- bronchoscope prolonged antibiotics
describe the reconvert of pneumonia
takes weeks
repeat CXR 6 weeks of >50yrs, smokers
smoking cessation
when does recurrent pneumonia occur
in the immunocompromised
underlying structural lung disease
aspiration
