Lower Respiratory Tract Infections Flashcards
List the defence mechanisms of LRT.
Mucus Cilia Swallowing, coughing, sneezing Alveolar macrophages and lymphoid tissue Immunoglobulin A Normal flora bacteria - G+ - streptococci, staphylococci
Describe acute bronchitis
Acute inflammation of the bronchial tree leading to a cough.
Cough can last 3 weeks.
Absence of pneumonia.
Usually self-limiting.
Symptoms of acute bronchitis is caused by the acute inflammation of the bronchial tree. What are these symptoms?
Increased mucus production
Oedema of the bronchus
Cough
Wheeze
May have temperature
Infection may be cleared but repair of bronchial wall takes weeks hence patient may still have cough
Pulmonary function tests show bronchial obstruction seen in asthma but will return to normal
What are some self-care treatment options for acute bronchitis?
Honey and lemon Pelargonium Paracetamol/ibuprofen OTC expectorant - guaifenesin OTC antitussive/cough suppressant - pholcodine
Describe community acquired pneumonia.
Acute infection of the lung parenchyma caused by bacteria or virus. Causes localised collapse and consolidation of alveolar sacs causing impaired gas exchange.
What are the complications of community acquired pneumonia?
Pleural effusion - build up of excess fluid between pleural membrane and lungs.
Lung abscesses - pus-filled cavity in your lung surrounded by inflamed tissue.
Acute respiratory disease syndrome (ARDS) - life-threatening lung injury that allows fluid to leak into the lungs.
Septic shock - dangerous drop in blood pressure.
What are the 8 risk factors for developing community acquired pneumonia?
Age = >65 Residence in healthcare setting COPD Smoker/exposure to cigarette smoke Alcohol abuse Poor oral hygiene Contact with children Use of acid regulating drugs
What are the symptoms (7) of community acquired pneumonia?
Dyspnea - shortness of breath Sputum production - maybe mucopurulent Pleural pain - sharp chest pain Sweating Fevers Rigors - shivering Aches and pains
What should be monitored in hospital acquired pneumonia?
Monitor pulse, BP, Respiratory Rate, temperature, oxygen saturation, mental status, CRP (if no improvement in 48-72hours).
Describe bronchiolitis.
Viral infection predominately caused by respiratory syncytial virus.
Causes inflammation of the epithelial lining of the bronchial tree.
Infected epithelial cells slough off into the small airways leading to partial or complete collapse or obstruction of the airways.
Results in impaired gas exchange.
What are the emergency/urgent signs of severe bronchiolitis in children?
Apnea Child looks very unwell Severe respiratory distress Respiratory rate >70 breaths/min Central cyanosis Sats <90% on room air or <92% if <6weeks old or underlying co-morbidities. (Sats = O2 saturation)
How to tell if bronchiolitis is getting severe in children?
Agitation and reduced consciousness Exhaustion Cyanosis Use of accessory muscles of breathing at rest Dehydration
In what cases is an immediate or backup antibiotic prescription given?
- patient systemically very unwell
- pre-existing co-morbidity
- young children born prematurely
- > 65 with 2 of the following or >80 with 1 of the following:
hospital admission in previous year, Type 1/2 diabetes history of congestive heart failure, use of oral corticosteroids, if CRP levels high.
What are the 6 signs of community acquired pneumonia?
- Patient will be moderately to severely ill.
- Focal chest signs such as decreased/asymmetric breath sounds.
- High temperature.
- May be hypoxic.
- Confusion (esp in older patients)
- Abnormal chest x-ray
What is CRB-65?
A tool used in community/primary care to assess severity of CAP in adults.
CONFUSION - new disorientation in person.
raised RESPIRATORY rate - >30 breaths/min (normal = 12-18)
low BLOOD pressure - diastolic <60mmHg or systolic <90mmHg
age = >65
What do the scores mean when using CRB-65?
0 = low risk of death
1-2 = intermediate risk of death
3-4 = high risk of death
(above 2 = hospital)
What does NICE recommend for all patients transferred to hospital?
Recommends that diagnosis confirmed with chest x-ray and treatment done within 4 hours of presentation at AandE.
Calculate CURB-65 score.
Check patients CRP, LFT and FBC.
What is CURB-65/
A tool used in hospital to assess the severity of CAP.
CONFUSION - new disorientation in person
blood UREA nitrogen level > 7mmol/mol
raised RESPIRATORY rate - >30 breaths/min (normal = 12-18)
low BLOOD pressure - diastolic <60mmHg or systolic <90mmHg
age = >65
What do the scores mean when using CURB-65?
0-1 = low risk of death
2 = intermediate risk of death
3-4 = high risk of death
(above 3 = ICU needed)
What is hospital acquired pneumonia?
Acute LRT infection acquired after at least 48 hours of admission to hospital with no history of intubation.
Symptoms at day 1 or 2 of admission = CAP.
Affects those in ICU, major surgery or prolonged stay.
What are the causative organisms for HAP?
Early onset (<5 days post adm) = streptococcus pneumoniae Late onset (>5 days post adm) = acquired in hospital - MRSA, pseudomonas aeruginosa, non-pseudomonal G- bacteria.
What are the risk factors for HAP?
- poor infection control/hand hygiene
- aspiration (drawing fluid out of body)
- multi drug resistant bacteria
- intubation and mechanical ventilation
What are the signs and symptoms of HAP?
Fever >38 degrees Leukocytosis or leukopenia Purulent sputum Decline in oxygen saturation Cough, dyspnea, chest pain, malaise anorexia Tachycardia Decreased lung resonance Asymmetrical chest expansion Abnormal chest sounds
What tests are required to be carried out for HAP?
Measure oxygen saturation Chest x-ray FBC Blood gases CRP Renal function and LFTs Sputum cultures
How is covid pneumonia diagnosed?
- Temperature >38
- Respiratory rate >20 breaths/min
- Heart rate above 100 bpm
- New confusion
- CRB65 not valid in covid
- Antibiotics prescribed if secondary bacterial infection is suspected
Outline the primary and secondary prevention for pneumonia.
Primary
- Vaccinations - influenza annually and one off pneumococcal vaccine unless splenic dysf or chronic renal disease - should be done every 5 years.
- Covid-19 vaccinations.
- Smoking cessation.
Secondary
- Reinforce vaccinations.
- Smoking cessation.
What is the prognosis of bronchiolitis?
Self-limiting condition
Usually last 3-7 days with cough resolving in 3 weeks in most patients.
In what groups of children can bronchiolitis cause severe infection?
Chronic lung disease Congenital heart disease Neuromuscular disorders Immunodeficiency <3 months old Premature
How is bronchiolitis in children diagnosed?
Suspect in children under 2 presenting with:
- coryzal prodromal phase lasting 1-3 days and cough with:
tachypnea (shallow and fast breathing)
chest recession (air not flowing freely through lungs)
wheeze or crackles on chest auscultation
What are some general bronchiolitis symptoms in children?
Fever
Poor feeding
Apnea
Increased respiratory rates
What symptoms of bronchiolitis indicates that child should be referred to hospital?
Respiratory rate >60 breaths per min Taking only 50-75% of usual fluid Clinically dehydrated Oxygen saturation persistently <92% Underlying co-morbidities
What injection is given to prevent serious lung infection in children caused by RSV virus?
(RSV = respiratory syncytial virus)
Palivizumab
- monoclonal antibody
- Synagis is the brand
