Pneumonia Flashcards
what is pneumonia
inflammatory condition of the lungs caused by infection. the inflammation leads to fluid and blood leaking into the alveoli, spreading the infection. this causes consolidation of the lung tissue, impairing gas exchange due to reduced ventilation
what is the most common cause/ type of pneumonia
community acquired pneumonia (most common)
types of pneumonia
community-acquired
hospital-acquired
aspiration pneumonia
pneumonia in immunocompromised patients
typical pneumonia
atypical pneumonia
main causative agent of community acquired pneumonia (most common type)
streptococcus pneumoniae
haemophilus influenzae can also be a causative organism
main causative agent of hospital acquired pneumonia
usually gram-negative enterococci; pseudomonas and Klebsiella. Staphylococcus aureus.
main causative agent of aspiration pneumonia
anaerobes
risk factors for pneumonia
age, smoking, alcohol, lung diseases such as COPD, immunodeficiency
epidemiology in UK
Community-acquired pneumonia is responsible for > 60,000 deaths per year in the UK
symptoms
fever, malaise, shortness of breath, rigors, sweating, cough, purulent sputum, pleuritic chest pain, haemoptysis
atypical pneumonia symptoms
headache, myalgia, diarrhoea,
DRY cough (no sputum)
signs of pneumonia on physical examination
pyrexia,
tachypnoea,
tachycardia,
hypotension,
cyanosis,
decreased chest expansion,
percussion is DULL amd increased vocal tactile fremitus over affected area
coarse crepitations at affected side of lung
CLUBBING
bronchial breathing over affected area
investigations to do for pneumonia
bloods- raised WCC on FBC, u&e’s, LFT, blood cultures, ABG (resp failure?)
CXR
sputum sent for microbiology, culture and sensitivity
urinalysis for pneumococcus
what will be seen on a CXR of a patient with pneumonia
Lobar or patchy shadowing
Pleural effusion
May detect complications (e.g. lung abscess)
what does klebsiella mainly affect (hospital-acquired)
upper lobes
summarise investigations for pneumonia
ABG
Bloods – FBC, U&E, LFT, ESR, CRP
Blood culture
Sputum for microscopy & culture
Polymerase chain reaction: for mycoplasma pneumonia
Urine antigen: for legionella and pneumococcal pneumonia
Chest X-ray: identify lobar, multi-lobar, cavitation and signs of pleural effusion
what scoring system is used to classify severity of pneumonia which aids treatment options etc
CURB-65
C – confusion: An abbreviated mental test of ≤8
U – urea: >7mmol/L
R - Respiratory rate: ≥30/ min
B - blood pressure <90 systolic and/ or <60mmHg diastolic
65 - age: >65year old
CURB-65 score of 0-1 requires home treatment, 2 requires consideration for hospital treatment, however 3-5 would need hospital admission alongside consideration for ITU referral
management of pneumonia
Oxygen to keep O2 saturations above 94%
Fluid management
Analgesia if patients have pleuritic chest pain.
Paracetamol 1g/6 hours (Max. 4g 24hours)
Antibiotics can be given orally for patients who are not nil by mouth and are managed in the community. However, for severe pneumonia Intravenous route is required.
Follow up appointments are organized for 6 weeks and CXR could be repeated at this time if there are complications or symptoms have not resolved.
what vaccine can be done to prevent pneumonia
pneumococcal vaccine
protects against streptococcus pneumoniae
Causative agents of atypical pneumonia
L. pneumophilia
