Miller Pneumonia and ARDS

Question 1

What are the most frequent pathogens for HAP and VAP?

Answer 1

P. aeruginosa and S. aureus

Question 2

In aspiration pneumonia, what is the common pathogen?

Answer 2

Gram negative bacilli such as E.coli K. pneumonia and P.aeruginosa

Question 3

Clinical presnetation of pneumonia?

Answer 3

• Cough
• Breathlessness
• Chest pain
• Sputum
• Fatigue

Question 4

With pneumonia, what two symptoms can predict outcome?

Answer 4

• Delirium has an increased risk of mortality
• Pleuritic chest pain has increased risk of pleural effusion

Question 5

Diagnosis of pneumonia?

Answer 5

• LRTI with acute onset
• New infiltrates on CXR
• ID cause if admitted to hospital

Question 6

Treatment of non severe CAP Pneumonia?

Answer 6

• Beta lactam + Macrolide
• or respiratory fluoroquinolone alone

Question 7

Treatment of severe CAP?

Answer 7

• Beta lactam + Macrolide
• Beta lactam + respiratory fluoroquinolone

Question 8

If a patient has severe CAP and are recently hospitalized and have a risk for MRSA, what should be added to their treatment?

Answer 8

Vancomycin

Question 9

If patient with severe CAP is hospitalized nd at risk of psuedomonas what should be added?

Answer 9

Piperacillin-tazobactam

Question 10

If aspiration is a worry in a patient with severe CAP and have poor dentition, what should be added to their treatment?

Answer 10

Broad coverage beta lactam such as ampicillin-sulbactam or quinolone

Question 11

Adjunctive therapies for cap?

Answer 11

• Corticosteroids restricted to patients with severe CAP
  
  • must rule out flu
• Oxygen
• Non invasive ventilation if needed

Question 12

Complications of pneumonia?

Answer 12

• increased short term and long term risk of cardiovascular disease
• decline in cognition and functional status
• Increased susceptibility for infection

Question 13

How do we prevent pneumonia?

Answer 13

Pneumococcal and influenza vaccines

Question 14

Most common conditiosn with pleural effusion?

Answer 14

• HF
• Bacterial pneumonia
• Pulmonary embolism
• Malignancy
• Viral disease
• Post cardiac surgery

all are exudative except heart failure

Question 15

What is sensitive and specific for diagnosing effusion?

Answer 15

Dullness to percussion

Question 16

How do you treat pleural effusions?

Answer 16

• Thoracentesis

Question 17

What is light’s criteria?

Answer 17

• 99.5% sensitive for diagnosing exudative effusion and differentiates exudative from transudative effusions
• Pleural fluid protien to serum protein ratio >0.5
• pleural fluid LDH to serum LDH >0.6
• Pleural LDH >0.67 upper limit normal for serum LDH
• If fluid is below it is transudate
• If fluid levels are above its exudate

Question 18

Risks for ARDS?

Answer 18

• Old age
• Alcohol abuse
• Cigarettes
• Air pollution
• Hypoalbuminemia
• Trauma
• Men > Women
• Black/latino > white

Question 19

What is happening with ARDS?

Answer 19

• Increase permeability of capillaries and lung tissue
• Leads to interstitial edema which moves to alveolil
• more dead space in the lung and decreased compliance due to inflammatory debris
• Proliferative phase (healing)
• Fibrotic phase (some enter)

Question 20

Clinical presentation of ARDS?

Answer 20

• Dyspnea
• Moderate or severe respiratory distress
• Elevated RR tachy decreased O2
• Differentiate from HF, Pneumonia, IPF

Question 21

How do you treat ARDS?

Answer 21

• Supportive
• Diagnose and tx infection
• respiratory support
• fluid management
• rescue therapies such as ECMO, NO, glucocorticoids

Question 22

Complications of ARDS?

Answer 22

• Most recover near normal pulmonary function within 6-12 months
• decrement in physical function
• neurocognitive and mood disorders
• PTSD