Miller Pneumonia and ARDS Flashcards
What are the most frequent pathogens for HAP and VAP?
P. aeruginosa and S. aureus
In aspiration pneumonia, what is the common pathogen?
Gram negative bacilli such as E.coli K. pneumonia and P.aeruginosa
Clinical presnetation of pneumonia?
- Cough
- Breathlessness
- Chest pain
- Sputum
- Fatigue
With pneumonia, what two symptoms can predict outcome?
- Delirium has an increased risk of mortality
- Pleuritic chest pain has increased risk of pleural effusion
Diagnosis of pneumonia?
- LRTI with acute onset
- New infiltrates on CXR
- ID cause if admitted to hospital
Treatment of non severe CAP Pneumonia?
- Beta lactam + Macrolide
- or respiratory fluoroquinolone alone
Treatment of severe CAP?
- Beta lactam + Macrolide
- Beta lactam + respiratory fluoroquinolone
If a patient has severe CAP and are recently hospitalized and have a risk for MRSA, what should be added to their treatment?
Vancomycin
If patient with severe CAP is hospitalized nd at risk of psuedomonas what should be added?
Piperacillin-tazobactam
If aspiration is a worry in a patient with severe CAP and have poor dentition, what should be added to their treatment?
Broad coverage beta lactam such as ampicillin-sulbactam or quinolone
Adjunctive therapies for cap?
- Corticosteroids restricted to patients with severe CAP
- must rule out flu
- Oxygen
- Non invasive ventilation if needed
Complications of pneumonia?
- increased short term and long term risk of cardiovascular disease
- decline in cognition and functional status
- Increased susceptibility for infection
How do we prevent pneumonia?
Pneumococcal and influenza vaccines
Most common conditiosn with pleural effusion?
- HF
- Bacterial pneumonia
- Pulmonary embolism
- Malignancy
- Viral disease
- Post cardiac surgery
all are exudative except heart failure
What is sensitive and specific for diagnosing effusion?
Dullness to percussion
How do you treat pleural effusions?
- Thoracentesis
What is light’s criteria?
- 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
Risks for ARDS?
- Old age
- Alcohol abuse
- Cigarettes
- Air pollution
- Hypoalbuminemia
- Trauma
- Men > Women
- Black/latino > white
What is happening with ARDS?
- 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)
Clinical presentation of ARDS?
- Dyspnea
- Moderate or severe respiratory distress
- Elevated RR tachy decreased O2
- Differentiate from HF, Pneumonia, IPF
How do you treat ARDS?
- Supportive
- Diagnose and tx infection
- respiratory support
- fluid management
- rescue therapies such as ECMO, NO, glucocorticoids
Complications of ARDS?
- Most recover near normal pulmonary function within 6-12 months
- decrement in physical function
- neurocognitive and mood disorders
- PTSD
