LRTI - Pneumonia Flashcards
Types of pneumonia?
Community acquired
Hospital acquired
Aspiration
Immuno-compromised
Symptoms?
Fever
Pleuritic chest pain
Cough with purulent sputum
Dyspnoea
What is the problem with symptoms?
They are vague and fit other LRTIs easily
Signs of examination?
Inspection:
Tachypnoea
Central cyanosis
Percussion:
Dullness on percussion of affected lobes
Auscultation:
Bronchial breath sounds
Inspiratory crepitations
Increased vocal resonance
Why is there dullness on percussion and increased vocal resonance?
Consolidation of lobe
Investigations?
CxR FBC Blood culture Sputum culture Throat swab Urinary legionella antigen
Why is a throat swab done?
To look for atypical organisms
What will a CxR see?
Lobar or multilobar infiltrates
Cavitation
Pleural effusion
Why are tests done?
Establish diagnosis
Identify pathogen
Assess severity
Common bacterial causes
Strep pneumoniae
H influenza
M catarrhalis
Atypical bacterial causes?
Legionella Staph aureus Mycoplasma pneumoniae Chlamydia Viruses
How is severity assessed?
CURB 65
Confusion Blood UREA RR - <30 Diastolic BP -<60 Over 65
Score for low risk patient and action plan?
0- 1 treat in community
Amoxicillin
OR
Clarithromycin/doxycycline
Score for medium risk patient and action plan?
2 - Hospital treatment needed
Amoxicillin and Clarithromycin combo
OR
Levofloxacain if penacillin allergic
Score for high risk patient and action plan?
> 3 - ITU due to high risk of death
Co-amoxiclav and clarithromycin
OR
Levofloxacin if allergic
Why is co-amoxiclav used in severe?
Broader spectrum
Other non-pharma treatment options?
Intubation and ventilation
Supplemental O2
IV fluids
Antipyretics/Analgesia
Treatment for children?
Nothing if mild
Stepped approach
1 - oral amoxicillin
2 - oral macrolide
3 - Only use IVs if vomiting
Common differentials?
TB Lung cancer Pulmonary embolism Cardiac failure Pulmonary vasculitis
How to tell TB and pneumonia apart?
TB tends to affect upper lobes
Follows a previous illness commonly so patient will be ill for a few weeks
Why is a pulmonary embolism confused with pneumonia?
Makes infarcts appear on CxR that look like pneumonia
What is pulmonary vasculitis?
Destruction of vessels in lung/pulmonary system
Complications of pneumonia ?
Empyema Lung abcess Septicaemia Acute kidney injury Haemolytic anaemia ARDS
Why can pneumonia cause anaemia?
In mycoplasma caused pneumonia - RBCs are destroyed
What is ARDS? What to do if patient gets this?
Acute respiratory distress syndrome
Damage to alveoli leads to a massive inflammatory response and fibrosis of interstitium
Transfer to ICU
