Pneumonia Flashcards
Causes
Strep pneumonia- 80%; high fever, rapid onset, herpes labialis
Haemophilus influenzae- particularly in COPD
Staph aureus- following influenza infection
Mycoplasma pneumonia- dry cough and atypical xray findings
Legionella pneumophilia- hypnatraemia and lymphopenia
Klebsiella pneumoniae- alcoholics
Pneomocystis jiroveci- HIV; dry cough, exercise induced desaturations
Idiopathic interstitial pneumonia
Group of non-infective causes
Cryptogenic organising pneumonia
- complication of rheumatoid arthritis or amiodarone therapy
Symptoms
Cough
Sputum
Dyspnoea
Chest pain
Fever
Delirium
Signs
Tachypnoea
Tachycardia
Hypoxia
Hypotension
Fever
Confusion
Reduced breath sounds
Bronchial breathing
Investigations
FBC- neutrophilia in bacterial
U&Es- check dehydration, other changes in atypical
CRP- raised in infection
ABG
Chest xray
CURB 65
Confusion (AMTS <8/10)
Urea >7
Resp rate >30
BP systolic <90/ diatstolic <60
Aged >65
CRB 65 management
0- low risk, treatment at home
1 or 2- intermediate risk, hospital assessment considered
3 or 4- high risk, urgent admission to hospital
CURB 65 management
0 or 1- low risk, home-based care
> 2- intermediate risk, hospital based care
> 3- high risk, consider ICU
Management of low-severity CAP
Amoxicillin first-line
Marcolide or tetracycline if pen allergic
5 day course
Management of moderate-severe CAP
Dual antibiotic amoxicillin and macrolide
7-10 day course
Don’t discharge if in past 24 hours
2 or more
- temp >37.5
- RR >24
- HR >100
- systolic BP <90
- O2 sats <90
- abnormal mental status
- inability to eat without assistance
Follow up
Repeat chest xray at 6 weeks after clinical resolution
Ensure consolidation has resolved and no underlying secondary abnormalities
Complications
Sepsis
Pleural effusions
Empyema
Lung abscess
Death
