Pneumonia Flashcards
How do you manage a pneumonia patient brought to you?
1. Resuscitation and Initial Management:
- Supplemental Oxygen:
Administered if SpO₂ (oxygen saturation) is low.
T… With high o2 flow of 60%
Goal: Maintain SpO₂ between 94-98% for most patients, and 88-92%for those with Chronic Obstructive Pulmonary Disease (COPD), to avoid hyperoxia.
- Intravenous (IV) Fluids:
Administered to hypotensive patients to stabilize blood pressure and improve circulation.
- Parenteral Antibiotics:
Administered as soon as possible, preferably within 4 hours of hospital admission, to quickly combat the infection.
Switch to Oral Antibiotics: Considered once the patient’s temperature has been stable for 24 hours.
Antibiotic Adjustment:
Based on culture and sensitivity results if available, to ensure the most effective treatment is used.
- Thromboembolism Prevention:
Important for preventing blood clots, particularly in immobilized or severely ill patients.
Antibiotic Therapy Based on Severity:
Mild Pneumonia:
Moderate Pneumonia:
Severe Pneumonia:& Staphylococcus aureus, Methicillin-Resistant Staphylococcus aureus
And their duration
Mild Pneumonia:
Patients Not Previously on Treatment:
- Oral Antibiotics: Amoxicillin, Clarithromycin, or Doxycycline.
- Duration: Typically 5 days.
Moderate Pneumonia:
- Oral Antibiotics: Combination Therapy: Amoxicillin (or Co-amoxiclav) plus Clarithromycin or Doxycycline.
Severe Pneumonia:
- Intravenous (IV) Antibiotics:
Co-amoxiclav or a Cephalosporin (e.g., Ceftriaxone) plus Clarithromycin for 7 days.
- Staphylococcus aureus Suspected: Add Flucloxacillin ± Rifampicin.
- Methicillin-Resistant Staphylococcus aureus (MRSA): Use Vancomycin or Teicoplanin.
Management of Atypical Pneumonia: like
Legionella pneumophila:
Chlamydophila Species:
Hospital-Acquired Pneumonia (HAP):
Aspiration Pneumonia:
Management of Atypical Pneumonia:
Legionella pneumophila:
Treatment:
Fluoroquinolone (e.g., Levofloxacin) plus Clarithromycin or Rifampicin if severe.
Chlamydophila Species:
Treatment:
Tetracycline is recommended.
Pneumocystis jirovecii:
Treatment:
High-dose Cotrimoxazole is the drug of choice.
- Hospital-Acquired Pneumonia (HAP):
Treatment:
Aminoglycoside (e.g., Gentamicin) plus an Antipseudomonal Penicillin (e.g., Piperacillin-Tazobactam) or a Cephalosporin (e.g., Ceftriaxone or Cefepime), depending on the severity.
- Aspiration Pneumonia:
Treatment:
Cephalosporin plus Metronidazole to cover both aerobic and anaerobic bacteria.
- Pneumonia in Neutropenic Patients:
Treatment:
Aminoglycoside plus an Antipseudomonal Penicillin or Cephalosporin.
Consider adding an Antifungal if there is no improvement after 48 hours.
COVID-19 pneumonia is caused by SARS-CoV-2, a novel coronavirus, and primarily spreads through respiratory droplets and contaminated surfaces. Certain conditions increase the risk of severe infection, and early in the disease, the virus is highly present in the upper respiratory tract.
Clinical Features: of covid 19
Symptom Categories:
How many percent is asymptomatic, symptomatic and severe
Asymptomatic: About 81% of cases.
Mild Symptoms: Approximately 14%.
Severe Symptoms: Around 5%
Symptoms of covid 19
Common Symptoms:
Fever
Cough
Shortness of Breath
Other Symptoms:
Fatigue
Myalgia (muscle pain)
Sore Throat
Loss of Taste or Smell
Diagnosis & treatment of covid 19
RT-PCR: Recommended test for detecting the virus.
Swabs Used:
Nasopharyngeal Swab (NP)
Oropharyngeal Swab (OP)
Chest Radiography Findings:
Common Findings:
Consolidation
Ground-Glass Opacities
Often bilateral and in lower zones of the lungs.
Treatment:
Investigational Treatments: Many are still under investigation.
Approved Treatments:
Remdesivir
Steroids (e.g., Dexamethasone)
Ivermectin (though evidence for effectiveness is limited)
Anticoagulation (to prevent blood clot complications)
Vitamin D and C (under investigation for potential benefits)
Antiviral Medication: Lopinavir/Ritonavir
Mechanical Ventilation: For severe cases.
Avian Influenza Virus Pneumonia
Transmission:
Direct or Close Contact: With infected poultry.
Symptoms?
Range of Symptoms:
From conjunctivitis to influenza-like illness
Severe respiratory illness with multi-organ failure
Early symptoms may include nausea, vomiting, and bleeding.
Common strains of Avian Influenza Virus Pneumonia
Common Strains:
H7N9
H5N1
Diagnosis and management of Avian Influenza Virus Pneumonia
Diagnosis and Management:
Chest X-ray (CXR) Findings: Show consolidation.
Management:
Contain Outbreak: Control and prevent spread.
Ventilation and Oxygen Administration
Antivirals: Oseltamivir, Peramivir, and Zanamivir
Complication of pneumonia
Respiratory failure, type 1 (PaO2<8Kpa)
Treatment is with high flow O2 (60%)
Regular arterial blood gas monitoring and consider ventilation if rising PaCO2 or acidotic
Hypotension
Due to dehydration and or vasodilatation from sepsis
Manage with intravenous challenge with colloid/crystalloid
Central line may be used with pressure monitoring
Atrial fibrillation
Common in elderly
Usually resolve with treatment
Β-blocker or digoxin may sometimes be used for ventricular rate control
Pleural effusion
Accumulation of fluid into pleural space
If larger and patient is symptomatic, or the fluid infected, then has to be drained
Empyema is pus in pleural space
Suspect it when patient with resolving pneumonia develops a recurrent fever
Aspirated fluid is typically yellow and turbid, PH <7.2
Should be drained
Lung abscess: from localized suppurative infection causing cavity
Present with swinging fever, cough, purulent, foul-smelling sputum
Treatment: prolonged antibiotic (4-6 wks), postural drainage
- Septicaemia which may cause infective endocarditis, meningitis, etc
- Pericarditis and myocarditis
- Jaundice, usually cholestatic, or due to side effect of antibiotics (flucloxacillin or amoxiclav)
