M103 T4 L11 Flashcards
What are two examples of exacerbated chronic airway disease?
COPD
Bronchiectasis
What is the only hospital criteria that can be used to diagnose penumonia?
abnormal CXR changes with evidence of infection
What are the two main types of pneumonia classifications?
anatomical
setting
What are the three types of anatomical pneumoias?
lobar
broncho-pneumonia
diffuse
What are the three types of setting pneumoias?
community acquired
hospital acquired
ventilator related
In what age groups is pneumonia very common?
the very young
the very old
What test should all patients who present with pneumonia get?
HIV test
What are the signs of pneumonia when assessing the chest?
Reduced Air Entry /PN
Bronchial Breathing
Increased Vocal resonance
Crackles
What information relevant to pneumonia is taken from a blood test?
any evidence of infection / inflammation renal function liver function blood cultures HIV test
What tests are done for patients presenting with pnemonia?
sputum Viral throat swab/ Mycoplasma Urine –legionella Ag Arterial blood gas blood test
What might the blood look like from a patient presenting with pnemonia?
high WBC count
Why is renal function assesed?
to identify if there is an associated acute kidney injury
this an important complication of pneumonia
When might sputum be tested?
if there is a pneumonia in the context of chronic lung disease
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
How is the severity of pneumonia assessed?
the CURB 65 score
What does the CURB 65 score assess?
Confusion raised blood Urea raised Respiratory rate hypotension age
What is a positive score for raised blood urea in the CURB 65 test?
> 7 mmol/L
What is a positive score for raised Respiratory rate in the CURB 65 test?
> 30 breaths / min
What is a positive score for hypotension in the CURB 65 test?
bp less than 95 / 60 when they reach A&E
What is a positive score for age in the CURB 65 test?
age > 65 years
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
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
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
