Mr Grant is Struggling to Breathe Flashcards
What is pneumonia
Inflammation of alveoli, usually caused by infection of the Lung Parenchyma
B. CAP
How does pneumonia cause breathlessness
Fluid accumulates in the alveoli and impairs gas exchange
How do you determine whether pneumonia is bacterial or viral
Doing tests for both bacteria and viruses
Distinguishing between Pneumonia and Tuberculosis
Looks the same on an X-ray
Pneumonia is usually quite acute compared to the more chronic TB
Send samples to the lab and grow cultures which you study
VAP
Ventilator acquired pneumonia, muscle tone is weaker due to sleep;
Immune system is weaker (co-morbidity of ventilator)
Predisposes to inhaling pathogens that are in the ventilator and making you sick
Community vs Hospital Acquired Pneumonia
CAP - Pneumonia is acquired anywhere that is not a hospital (or 10 days after discharge from hospital)
HAP - Pneumonia symptoms are acquired more than 48 hours after hospital admission
Pneumonia symptoms
Cough
AND
- New focal chest signs
- Fever
- Dyspnoea
AND
Radiographic evidence
Why is PPE not used when handling pneumonia patients
The pathogens that cause pneumonia are commonly found, and only in affected patients have managed to find themselves affecting the respiratory system
How is pneumonia acquired
Pneumonia causing pathogens are acquired
The body’s defence mechanisms that can normally ward them off (e.g. cough, mucociliary escalator, macrophages) are insufficient
Pneumonia
ALTERNATIVELY, very virulent pathogens (e.g. Covid-19) are acquired
Risk factors of Pneumonia
Age Smoking Immunocompromised Care home residents Alcohol excess Co-morbidities - COPD - Chronic heart disease Child contact
What does low blood pressure indicate during pneumonia
Accumulation of N2O and potentially septic shot; sign of severe infection
Most essential test for pneumonia diagnosis
Chest X-ray
REMEMBER TO ASK ABOUT ALLERGIES AT PRESCRIPTION
REMEMBER TO ASK ABOUT ALLERGIES AT PRESCRIPTION
Enoxaparin
Anti-coagulant
Given to patients that are immobile at hospital (most admitted) to prevent risk of DVT causing pulmonary embolism
Which bug most commonly causes pneumonia
Streptococcus Pneumoniae
Most important treatment for patients with pneumonia
Antibiotics (for bacterial cases)
Even many viral cases will also have a secondary bacterial infection though
Percentage of pneumonia patients who die
10-15%
What does possible and probable mean on a drug chart
Probable means that the case is more sure, possible prescriptions are to treat illnesses that the doctor is not really sure about
Co-amoxiclav
Amoxicillin and Clavulanic acid
**Clavulanic acid is a beta-lactamase inhibitor, protecting the rign on amoxicillin
Complications of pneumonia
Parapneumonic effusion - fluid associated with fluid
Empyema - Pus like fluid
Lung Abscess
Long term
Bronchiectasis - scarring of the airways
Prevention of Pneumonia
Vaccination - Influenza - Pneumonia Vaccine for those at risk - Covid-19 Smoking cessation
CHAOS Achronym Pneumonia
To identify what might be missed and why a case might not be improving
C - Complications; e.g. lung abscess, empyema
H - Host factor; e.g. immunocompromised, HIV
A - Alternative diagnoses; e.g. eosinophilic pneumonia, organising pneumonia
O - Organism Factors; e.g. Diferent pathogen, antibiotic resistence
S - Secondary diagnosis; e.g. PE
How long should pneumonia take to recover
Can take up to 6 months
Radiology of Covid-19 Pneumonia
More subtle changes; more bilateral; tends to be more peripheral
Treatment of Covid-19
Supporting treatment
- Oxygen
- Prevent dehydration
- Fluid Balance
Specific treatement
- Dexamethasone
- Anti-viral (Remdesivir, Molnupiravir which reduces hospitalisation risk)
- Anti-inflammatory
- Monoclonal Antibodies (Sotrivumab)
