Pneumonia

Question 1

In outpatient Tx (CAP), what are the indications for SCx?

Answer 1

risk factors for MRSA or empiric treatment of MRSA

Question 2

Patient specific risk factors for Strep Pneumo as etiology of CAP?

Answer 2

Neutropenia, asplenia, EtOH

Question 3

Components of CURB-65 score?

Answer 3

-Congusion.
-Urea >20.
-RR>=30.
-BP<90/60.
-65yo+

Question 4

CURB-65 score & plan?

Answer 4

0-1 = OP.
2 = IP.
3-5 = ICU.

Question 5

PSI (Pneumonia Severity Score) indicating IP treatment?

Answer 5

> =70

Question 6

Minor risk factors for “Severe” CAP (need 3+)?

Answer 6

-RR>=30.
-P/F<=250.
-Multilobar infiltrates.
-AMS.
-Urea >=20.
-WBC<4.
-Plt<100.
-Temp<36.
-Hypotension requiring aggressive IVF.

Question 7

Abx for inpatient, non-severe CAP?

Answer 7

1. Macrolide + Ceftriaxone/Amp-Sulbactam
2. FQ

Question 8

Indications for anaerobic coverage for CAP?

Answer 8

Empyema or abscess

Question 9

Abx for inpatient, severe CAP?

Answer 9

B-lactam (Rocephin, Cefoxatime, Amp/Sul) + Azithro/FQ. Note: FQ not monotherapy anymore.

Question 10

Dx if (+) SCx, on vent, but no clinical PNA?

Answer 10

Ventilator-associated tracheobronchitis. No Abx needed.

Question 11

Tx (VAP)

Answer 11

MRSA Coverage, plus Gm(-) coverage. 2 agents if high risk features.

Question 12

4 interventions to prevent VAP?

Answer 12

-HOB > 30*.
-SBTs daily.
-+/- Selective decontamination of oropharynx.
-+/- Subglottic suctioning.

Question 13

Difference in outcomes in HFNC vs NIPPV?

Answer 13

NIPPV benefits mortality, HFNC doesn’t. Both improve ETT, Los, etc.