Pneumonia Flashcards
Complications of pneumonia pneumonic
SLAPPED HER
Septic shock
Lung abscess
AKI, ARDS
Pneumothorax
Post-infective bronchiectasis
pleural Effusion
DVT
Hypotension
Empyema
Respiratory failure
Causes of CAP
Strep pneumoniae - 80%
H.influenzae
Moraxella catarrhalis
Staph aureus
Bacterial causes of HAP
Staph aureus
Gram negative enterobacteria
Klebsiella pneumoniae
Psuedomonas spp
What immunocompromised patients more likely to get pneumonia?
AIDS, lymphomas, leukaemias, immunosupressant drugs
Causes of pneumoniae in immunocompromised?
Pneumocystits jirovecii - PCP, opportunisitc infection in AIDS
Adenovirus
CMV
Herpes simplex
Myobacterium TB
What increases the risk of aspiration pneumonia?
Impaired swallowin from neurological disease eg stroke, dementia, Parkinsons disease
Decreased consciousness, oesophageal disease or iatrogenic intervention
Oropharyngeal anaeroobes
Symptoms of pneumonia
SOB
Purulent cough - green/rust
Haemoptysis
Fever +/- rigors
Chest pain - pleuritic
SYSTEMIC - MALAISE, anarexia, fatigue
Signs of pneumonia
Cyanosis, increased RR, confusion
Fever, tachycardia, dullness on percussion, increased tactile fremitus, decreased chest expansion, bronchial breathing, decreased air entry, vocal resonance, pleural rub
What is tactile fremitus? When does it increase?
The vibrations heard in the chest on speech - increases when density of lung tissue increases eg pneumonia
How to assess severity of pneumonia?
CURB 65
Confusion - AMTS score under 8
Urea over 7mmol/L
Resp rate >30
BP <90/60
65 yrs +
What CURB 65 scores are boundaries for what care?
1 point for each positive aspect
0-1 = outpatient care
1-2 = admission
>3 consider ITU treatment
What shows on bloods with pneumonia?
FBC - raised WCC
CRP
LFT deranged in legionella and sepsis
U+Es - assess severity - urea, hyponatremia in legionella
Serology - mycoplasma
Culture
Glucose
Investigations for pneumonia
Sputum - gram stain, culture and sensitivity
CXR
ECG
Urine - pneumococcal or legionella (atypical) antigen
ABG - type I resp failure
What see on CXR pneumonia
Lobar/multilobar infiltrates
Air bronchogram
Pleural effusion
Consolidation
Repeat 6 weejs after treatment to ensure resolution
Management of pneumonia
Oxygen - >96%
IV fluids
Antibiotics - local guielines
Analgesia and antipyretics
Nebulised saline
NIV, intubation or ventialtion in ITU if severe
Antibiotics used in aspiration pneumonia
Amoxicillin and metronidazole or co-amoxiclav for aspiration pneumonia
Atypical causes of CAP
Atypical
Chlamydia pneumoniae
Legionella pneumoniae - fresh water
Mycoplasm pneumoniae
Antibiotic for - uncomplicated CAP
Amoxicillin
What antibiotic use for HAP? What if over f5 days after admission?
Co amoxiclav
> 5 days use tazocin, or broad spectrum quinolone or cephalosporin=
What antibiotics use if allergic to amoxicillin
Clarithromycin or doxycycline
HAP and VAP when
HAP >48 hrs after admission
VAP >48 hrs ventilated
Fungal causes pneumonia
PCP, histpolasma, cryptococcus neogromans, aspergillus
Q fever - coxiella burnetti
Psittacosis - Chlamydiophila psitticai
CRP criteria antibiotisc
<20 none
20-100 delayed prescription
>100 give antibiotics
Risk factors pnuemonia
<5 >65
ASpiration risk eg neuro drisease
Smoker
Chronic resp disease COPD, CF
IVDUs
DM.CVD
Recentr viral resp tract infection
