M103 T4 L11 Flashcards by Joanna MacInnes

What are two examples of exacerbated chronic airway disease?

COPD

Bronchiectasis

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What is the only hospital criteria that can be used to diagnose penumonia?

abnormal CXR changes with evidence of infection

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What are the two main types of pneumonia classifications?

anatomical

setting

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What are the three types of anatomical pneumoias?

lobar
broncho-pneumonia
diffuse

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What are the three types of setting pneumoias?

community acquired
hospital acquired
ventilator related

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In what age groups is pneumonia very common?

the very young

the very old

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What test should all patients who present with pneumonia get?

HIV test

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What are the signs of pneumonia when assessing the chest?

Reduced Air Entry /PN
Bronchial Breathing
Increased Vocal resonance
Crackles

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What information relevant to pneumonia is taken from a blood test?

any evidence of infection / inflammation
renal function
liver function
blood cultures
HIV test

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What tests are done for patients presenting with pnemonia?

sputum
Viral throat swab/ Mycoplasma 
Urine –legionella Ag
Arterial blood gas
blood test

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What might the blood look like from a patient presenting with pnemonia?

high WBC count

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Why is renal function assesed?

to identify if there is an associated acute kidney injury

this an important complication of pneumonia

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When might sputum be tested?

if there is a pneumonia in the context of chronic lung disease

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When might arterial blood gas be tested?

if the patient is requiring oxygen
if the patient has the toxin saturations
if the patient is metabolically unwell

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How is the severity of pneumonia assessed?

the CURB 65 score

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What does the CURB 65 score assess?

Confusion
raised blood Urea
raised Respiratory rate
hypotension
age

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What is a positive score for raised blood urea in the CURB 65 test?

> 7 mmol/L

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What is a positive score for raised Respiratory rate in the CURB 65 test?

> 30 breaths / min

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What is a positive score for hypotension in the CURB 65 test?

bp less than 95 / 60 when they reach A&E

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What is a positive score for age in the CURB 65 test?

age > 65 years

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What does a CURB score of zero or one mean?

patient has a low risk of dying

can consider all antibiotics and treatment at home

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What does a CURB score of two or three mean?

their risk of dying increases up to 14 percent
patient offered a short hospitalisation
24 - 48 hours of IV antibiotics to ensure ongoing improvement

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What does a CURB score of four or five mean?

chances of dying in hospital are significant

could be admitted into ICU

What is the mortality rate for a patient with a CURB score of four or five?

27.8%

For a patient with no risk factors, how is pneumonia managed in the community?

``` Rest Push fluids Analgesics Antibiotic Safety net Refer if no improvement in 48 hrs ```

How is pneumonia managed in a hospital? (FOAC)

Fluid replacement Oxygen Antibiotics Critical care management

When is oxygen given to patients with pneumonia?

if the patient has respiratory failure

When is fluid replacement administered to patients with pneumonia?

if required to treat one any acute kidney injury and to support system circulation and cardiovascular function

What is the most common cause for Community Acquired Pneumonia?

Streptococcus pneumoniae

Which factors will determine the antibiotics administered to a pnemonia patient?

``` the setting the severity any co-morbidities (esp resp disease) epidemiology any patient allergies ```

Which antibiotic is used to treat a Community Acquired Pneumonia?

Doxycyline if not sever Amoxicillin if severe both if more severe

Which antibiotic is used to treat mild hospital acquired pneumonia?

Amoxicillin | Doxycycline

Which antibiotic is used to treat severe hospital acquired pneumonia?

Amoxicillin or Ceftriaxone /Levofloxacin | AND temocillin

Why is a six week gap left between chest xrays when checking for progress?

X-ray change is always significantly lag behind a clinical response

When would a six week gap NOT be left between chest xrays while the patient is still being treated?

only if the patient is excellently deteriorated

Which factors will increase the time taken for pneumonia to clear?

increased comorbidity bacteremia multilobar involvement enteric gram-negative bacilli pneumonia

What does a MET call involve?

when an emergency patient that is rapidly detiorating has a senior group of doctors arrive to try and quickly to help him get through the next couple of hrs

How can oxygen be delivered?

Nasal cannulae Controlled (fixed percentage - venturi) masks Uncontrolled masks

What are two examples of Uncontrolled masks?

Hudson | Reservoir mask

What are the two ways in which oxygen reaching the patient is measured?

litres per minute | percentage inspired oxygen

How is pneumonia treated in critical care?

``` Nasal HiFlow CPAP NIV (BiPAP) Intubation and invasive Ventilation If everything fails consider ECMO ```

What are the local complications of pneumonia?

pleural effusion empyema lung abscess organising pneumonia

How does CPAP (continuous positive airway pressure) work?

it stops the airways closing | splints the airways open so that worker breathing becomes less work

When is BiPAP used?

type 2 respiratory failure

When is intubation and invasive ventilation used on pneumonia patients?

when non-invasive methods of ventillation don't work

What are advs of Nasal HiFlow?

can give higher oxygen concentration, positive pressure and reduce work of breathing

When is ECMO used?

when the lungs are poorly compliant | when the lungs are hard to ventilate

How is organising pneumonia treated?

with steroids

What might the causes be when a pneumonia patient is failing to respond to treatment?

``` Wrong or incomplete diagnosis Antibiotic problem Complication developing Underlying bronchial obstruction (cancer) Pleural parapneumonic Effusion ```

What problems with antibiotics might patients have which might affect their response to treatment?

might not be taking their antibiotics drug chart might not be done might have absorption issues might be dealing with a resistant organism - might need to change antibiotics to a greater spectrum

How can a sample of a parapneumonic effusion be obtained?

use an ultrasound probe put a needle through the side if there's significant amounts of fluid put the chest drain in let it drain out

How will a pneumonia patient with Pleural parapneumonic Effusion or lung abscesses have a different treatment to usual?

same treatment of antibiotics but for a longer course, up to six weeks by IV

What does a sample of an empyema look like?

visibly purulent effusion

Pus with a pH of less than pH 7.2 is what?

an empyema

If a pneumonia patient isn't responding to treatment, what are the three common differential diagnoses that they might have?

LRTI and lung cancer LRTI and heart failure pulmonary emboli / infarction

What are some unusual reasons pneumonia patients might not be responding to treatment?

if they have specific infections, eg TB | if they have complicating chronic bronchial suppuration, eg. Cystic Fibrosis

What are some rare reasons pneumonia patients might not be responding to treatment?

vasculitis pulmonary eosinophilia cryptogenic organising pneumonia