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Guidelines > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

When to roti cxray

A

If nt improving
Persisting/worsening symptoms
Underlyinh malignancy need to be excluded

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2
Q

Inv in hospitalized pts

A

Blood cs
Abg if <90 and chronic lung disease
Glucose, urea. Electrolytes
Cbc lft

Severe cap- legionella

Biomarkers not advised

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3
Q

Initial assessment

A

Curb 65- for hospitalization

Major/minkr criteria- icu or non icu

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4
Q

Rx in opd

A

With comorbidities- azee+beta lactam

Without comorb- eithrr of them

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5
Q

Non icu rx

A

Combination

If bl hsn- fq- if no tb

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6
Q

Icu rx

A

No rf for pseudo- bl+fq
If pseudomonas- anti pseudpmonas
Combination- ag+anti pseud fq

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7
Q

What to see if pt is not responding in 3 days

A

Cause
Dr
Atypical

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8
Q

How many days rx

A

Ip’ 7
Op 5
If pseudo/gnb/aureus- longer
Abcess , meningitis, empyema

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9
Q

When do ungive steroids

A

Septic shock

Ards sec to cap

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10
Q

Quantitative vs semi Quantitative

A

Equally useful

Invasive lrt sample is preffered

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11
Q

How do u give abx in hap/vap

Late onset

A

By hospital flora
Late onset- combination therapy-mdr
Change later acc to c/s
Initial -Colistin not recommended

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12
Q

How do u deescalate in vap

A

If positive culture, next sample sterile
Abx for 7 days
Cpis on day 7 - if less than 6 stop
More than 6- continue 10-14 days

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13
Q

Inhaled abx

A

Aersoloized as adjunctive when mdr and toxicity is concern

Not as monotherapy

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14
Q

Ventilator ass trachea bronchitis

A

No rx required

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15
Q

When linezolid is used

A

Renal failure
Vanco intolerant
Resistance

Doc mrsa- vanco/ teico

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16
Q

Rx of acinetobacter mdr

A

Carbopenem

Coniston

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17
Q

Mdr pseudomonas

A

Combined carba+fq/ag

18
Q

Systemic features

A

Fever
Chills and rigors
Malaise

19
Q

Diagnosis of cap

A

Resp symptoms
One systemic feature
New focal chest sign
No other explanation

20
Q

Algorithm for cap

A

Xray- consolidation absent - other diagnosis
Plus- curb 65
Less than 1 - spo2 92 and 90 in 50 less and more age respectively
If less ipd
If normal opd

21
Q

Hap criteria

A 
Chest radio opacities (new, progressive,  persistent , cavity)
2 of following- fever 100.4
Tlc 12000 4000
Sensorium
Sputum purulent or change
Worsening gas exchange 
New onset cough/dyspnoea/ tachy/ rales
22
Q

What to do if not improving in hap

A 
If positive culture 
Change abx
Snes- dosing
New infection 
Complication- empyema, abcess
Non infective caus

If negative- roti cultures, fungal
Other sources if sepsinon infectious causes

23
Q

Curb 65

Interpretation

A

0-1 home mx
2- admission vs close opd
3-5 admission

Confusion
Urea 7 20
Rr 30
BP 90/60
!)age 65
24
Q

Interpretation of crb 65

A

Less than 1- opd

More ‘- ipd

25
Q

Other criterias

A 
Smart cop
Cop
Cap-piro
Rea-icu
A-drop
26
Q

Major criteria

Minor

A

Imv/vasopressors

Rr30
Fao2/fio2- less than 250
Multi lobar
Confusion 
Uremia
Tlc lesz than 4000
Thrombocytopenia 1 lakh
Hypothermia less than 36
27
Q

Psi

A 
Demographics
Comorbs
Physical exam
Labs
Total 20 variables

<70- opf
More than 90- ip

28
Q

Early onset vap

late onset vap

A

4 days

29
Q

R/f for mdr bacteria

A

Hospitalization more than 5 days
Antibiotics in 3 months
Resistance in hospital
Wound care/ dialysis/ is drugs

30
Q

Gnb in hap/vap

A

Pseudo
E coli
Kleb
Acineto

31
Q

Objective bed side criteria fir hap/vap

A

Modified cpis

Secretions
Infiltrates 
Temp
Leukocytes
Temp
Pao2/fio2 ratio
Micro
Morethan 6- pneumonia
32
Q

Biomarkers in vap

A

Strem 1
Pct
Crp

33
Q

Empiric therapy for late onset

A

One of anti pseudomonas pen/ 3or4th gen ceph/ carbapebem
Plus ag or fq(cipro/levo)

Mrsa cover- if high prevalence

34
Q

Def of vat

A

Temp
Leukocytosis/ penia
Secretions inc - without radiology deteroiation

35
Q

Risk dlfactors for mrsa/pseud

A

Prior isolation
Recent hosp
Iv abx in lSt 30 days

36
Q

When do u give anaerobic coverage

A

Only in abcess/empyema

37
Q

Prevention

A 
Oral decontamination
Hand hygiene
Closed auction 
Niv
Echanger
Cuff p less than 25
Elevation
38
Q

Idsa

A

Non severe ip
Standard- bl+macro/fq
Prior isolation of paeud/ mrsa- add and wait for cultures
Recent hosp/ r/f - cultures and wait

Severe- same but add coverage if risk factors plus

39
Q

Crp

A

Less than 3 normal
More than 10 infection.
3-10 - various

40
Q

Vap bundle

A 
Hob elevation
Sedation vacation
Assessment to extubate
Ulcer prophylaxis
Dvt prophylaxis

Guidelines (4 decks)

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