pneumonia Flashcards
define pneumonia
inflammation of the air sacs in the lungs due to fluid exudation into the alveoli
what causes pneumonia
infection
typically bacterial but can be viral
2 types of pneumonia
- community-acquired pneumonia
- hospital-acquired pneumonia
what is community acquired pneumonia
pneumonia acquired outside hospital environment or healthcare services.
what is hospital acquired pneumonia
an acute lower respiratory tract infection that is by definition acquired after at least 48 hours of admission to hospital and is not incubating at the time of admission.
what is atypical pneumonia
caused by atypical organisms not detectable by gram stain
which bacteria cause CAP
- Streptococcus pneumoniae
- Haemophilus influenzae
which bacteria cause HAP
- Pseudomonas aeruginosa
- E coli
- klebsiella
all are gram negative aerobic bacilli
which bacteria causes atypical phemonia
mycoplasma pneuominae
viral causes of pneumonia
H. flu
CMV
If question has water cooler/air conditioner what bacteria is it most likely to be
Legionella
If question mentions HIV patient what is the cause of pneumonia most likely to be
likely pneumocystis jiroveci which is a fungal infection
risk factors for pneumonia
- immunocompromised
- IVDU
- pre existing resp disease
- v young/old
pathophysiology of typical pneumonia
bacteria invades and exudate forms inside alveoli lumen
results in sputum
pathophysiology of atypical pneumonia
bacteria invades and exudate forms in interstitium of alveoli
results in dry cough
symptoms of pneumonia
- productive Cough
- nasty coloured sputum
- SOB
- fever
- pleuritic chest pain
symptoms of atypical pneumonia
dry cough
low grade fever
signs of pneumonia
↑ RR + HR, ↓BP, ↓ O2 sats,
Dull to percuss, Increased tactile fremitus
what is present on auscultation of pneumonia patient
- Wheezing
- Coarse crackles
- Bronchial breath sounds
- Increased vocal resonance
3 main investigations for pneumonia
- chest x ray
- sputum culture
3.. FBC
what does FBC for pneumonia show
elevated WBC
what does chest x ray for pneumonia show
- localised/widespread consolidation
- effusion
- abscesses
- empyema
how to assess severity of CAP
CURB 65
- confusion
- urea nitrogen >7mmol/L
- RR > 30
- BP < 90/60
- 65+ age
how to score using CURB 65
score out of 5
1. - outpatient 3% mortality
2 - consider short hospital stay + Abx
3. -15% mortality - hospital
how to treat CURB score of 0-1
Oral amoxicillin for 5d (or macrolide if penicillin allergy)
how to treat CURB score of 2
Dual therapy with amoxicillin + macrolide (IV or oral) for 7-10d.
how to treat CURB score of 3-5
IV co-amoxiclav + macrolide
other treatment options for pneumonia
- Maintaining O2 Sats between 94-98%
- In COPD patients: maintain O2 sats between 88-92%
- Analgesia: paracetamol or NSAIDs
- IV fluids
which patients is aspiration pneumonia seen in
patients with stroke, bulbar palsy and MG
what is aspiration pneumonia
aspiration of gastric contents into lungs
