Paul Wade Pneumonia Flashcards
What are the two scales to assess the severity of Pnuemonia?
The PSI and the CURB 65. The PSI stands for pneumonia severity index and the CURB 65 stratifies the mortality risk.
What investigations are conducted in pneumonia?
- X Rays (essential),
- urea (measure of renal function)
- oxygen saturation,
- FBC (greater than 15*109 indicates a bacterial infection.
Electrolytes and creatinine should be monitored as well. Liver function tests should be conducted and CRP levels would be elevated above 50mg/L.
What is pneumonia caused by?
- Staphylococcus aureus
- Streptococcus pneumonia
- Leigonella and Mycoplasm.
The difference is that it may not be possible to distinguish the pathogen as there are very few differences in symptoms
What is pneumonia?
Respiratory tract infection of the lower respiratory tract.
Explain the CURB 65? Hence what governs the choice of abx treartmen before a species is confirmed?
C – Confusion – if confused prior, this does not count. Ask questions like Age, year, DOB, year, count backwards from 20-1.
U-Urea > 7mmol/L – only assessed in hospital
R- Respiratory rate >30 breaths per min
B- Blood pressure is low 90/60 <
65- older than the age of 65
Score of 0 = 0.7% of death
Score of 1 = 2.1% of death
Score of 2 = 9.2 % of death
Score of 3-5 = 15-40 % of death
Antibiotics are essential as patients without it if the severity is 3 or above. Most prescribing is empiric, as the pathogen causing the disease is unidentifiable so a broad spectrum antibiotic is given.
The choice of antibiotic is dependent on:
Organ function
Allergies Likelihood of patient resistance.
explain the PSI?
PSI takes into account over 20 different variables – for patients who can be managed as outpatients
What should be monitored?
Pulse, respiratory rate, oxygen saturations, temperature and mental stats need to be checked atleast twice a day. Repeat CRP at day 3 or day 4 and repeat the chest radiography 4 days after.
Hospital management of pneumonia?
Chest radiograph (CXR can be conducted, whilst also carrying out a pulse oximetry test.
IV fluids can be given if necessary. VTE prophylaxis can be given if the patient is bed bound. The patient should be allowed to cough up any sputum.
How to manage non-severe pneumonia?
Patients are advised to rest, have plenty of fluids and smoking until the infection is better. Paracetamol or other analgesics can be given due to any inflammation. The patients respiratory rate can be checked via pulse oximetry.
Low severity Pneumonia. Where is this treated, what is the treatment dose and are there any alternatives?
Treated at: Home
Preferred Treatment: Amoxicillin 500mg TDS Orally
Alternative: Doxycycline 200mg loading dose, then 100mg orally or clarithromycin 500mg BD orally
Low Severity/Low CURB 65 (0-1) with other risk factos present. Where to treat, what dose and what alternative?
Treated at: Hospital
Preferred Treatment: Amoxicillin 500mg TDS Orally, alternatively 500 mg IV TDS if oral not possible
Alternative: Doxycycline 200mg loading dose, then 100mg orally or clarithromycin 500mg BD orally
Moderate severity Pneumonia. Where to treat, what to give and what alternatives?
Treat at: Hospital
Preferred Treatment: 500mg-1g oral TDS Amoxicillin + clarithromycin 500mg BD orally. If oral not possible, 500mg tds IV amoxicillin or 1.2 QDS benzylpenicillin and clarithromycin 500mg IV BD
Alternative: Doxycycline 200mg loading dose, then 100mg orally or levofloxacin 500mg oral OD or Moxifloxacin 400mg OD
High severity Pneumonia. Where to treat, what to give, and what the preferred treatment is
Treat at: Hospital
Preferred Treatment: Co-amoxiclav 1.2g tds IVand clarithromycin 500mg BD IV, if legionella suspected adding levofloxacin
