LRTI Flashcards
What are some examples of LRTI
acute bronchitis acute exacerbation of chronic bronchitis pneumonia - CAP - HAP Influenza SARS Anthrax
What is acute bronchitis
inflammatory syndrome of the tracheobronchial tree
What is acute bronchitis caused by
Viral pathogens mainly
M. pneum
C. Pneum
Bordatella pertussis
What is the clinical presentation of acute bronchitis
cough
sputum
smokers have prolonged cough
What is txt for acute bronchitis
no antibiotics symptomatic support -rest - clear fluids - NSAIDS - Antitussive - bronchodilators
DON’T USE cold medications
What is AECB
acute infection exacerbation in patients with existing chronic bronchitis
What is AECB caused by
Viral 20-50%
C, M, S pneum
H flu
M Cat
What are AECB symptoms
DOE
sputum purulence
sputum volume
What is txt for mild/moderate AECB
stop smoking antichol bronchodilator oral prednisone usually no abx - Amoxicillin - Coxycycline
What is txt for severe AECB
stop smoking antichol bronchodilator oral prednisone abx - amox/clav - macrolides - cepharlosporins - flouriquinilones
what is CAP
most common infectious cause of death US
mortality increases if hospitalized
What is CAP MOA
inhalation of particles
seeding via bloodstream from extra-pulmonary infection
aspiration
What is CAP caused by
atypical
S pneumon
Viral
infections with co-morbidities
What are some symp for CAP due to strep. pneum
Rust colored Sputum
Rapid onset fever
High WBC
CXR - lobar consolidation
What are some symp for CAP due to Mycoplasma pneumoniae
slow course
non-productive cough
WBC normal or slightly high
What are some symp for CAP due to Legionella pneumoniae
Pleuritic chest pain
hemoptysis
increased LFT
Hyponatremia
How diagnosis CAP
CXR sputum stain sputum culture BP RR signs dehydration mental status pulse oximetry CBC serum electrolytes LFT BUN/Cr glucose
What do you use to determine hospitalization when dealing with CAP
CURB-65
What is CURB-65
Confusion Uremia > 19 RR > 30 BP < 90/60 age > 65
What is the txt choice for CAP in Outpatient that was previously healthy with no abx in last 3 months
Macrolide
What is the txt choice for CAP in Outpatient with presence of co-morbidity or high resistance
Respiratory fluoroquinolone
OR
Macrolide + amino-penicillin option
What is the txt choice for CAP in Inpatient in non-ICU
IV route
Respiratory fluoroquinolone
OR
Macrolide + cephalosporin
What is the txt choice for CAP in Inpatient in ICU
IV route
Cephalosporin + azithromycin
OR
Respiratory fluoroquinolone
when to switch from IV to oral therapy with CAP
Hemodynamically stable
improving clinically
able to ingest medications
normally functioning gastrointestinal tract
What are the current guidelines for CAP duration of therapy
Minimum of 5 days
afebrile 48-72 hrs
1 or less CAP-associated signs of clinical instability
What is the 2nd most common nosocomial infection in US
HAP
What are mortality rates for HAP
30-50%
What is on the pathogen list for CAP
Pseudomonas aeruginosa E. Coli Klebsiella pneumoniae Acinetobacter species Staphylococcus aureus (MRSA)
What are Clinical Stability Criteria
Temp LE 100 HR LE 100 RR LE 24 Systolic GE 90 PaO2 GE 90 PO2 GE 60 Oral Intake Mental Status
