Pneumonia Flashcards
Gold standard for pneumonia diagnosis
CXR
Common symptoms of pneumonia
Fever/Chills
Dyspnea
Purulent Sputum
CXR signs
Three classifications of pneumonia (as per dr. islam)
Major Immunodeficiency
Tuberculosis
Relatively normal hosts w/out active TB
Four types of pneumonia seen in non TB, IC patients
HAP
VAP
HCAP
CAP
Criteria for hospital acquired pneumonia
48+ hours following admission
Criteria for VAP
48 hours following endotracheal intubation
Criteria for HCAP
Long term care facility
Dialysis
Outpatient Chemo
Health Care Worker
Criteria for CAP
Outside hospital or extended care facility
Suspect TB and isolate with two+ of the following symptoms…
Hempptysis
Cough more than 2 weeks
Night sweats
More than 10 lbs lost in 10 months
If suspecious CXR for TB, what do you do?
Order AFB smears
How to determine if a pneumonia patient should be hospitalized?
CURB 65. Hospitalize with a score of 2+
Confusion, Urea, RR, BP, 65
A SMART COP score of ___ indicated need for respiratory (probs ventilator) support
3 or more
A higher PIRO score indicates that a patient will require…
A longer ICU stay and more mechanical ventillation days
Two major indicators for ICU admission/Severe CAP
Invasive mechanical ventilation
Septic shock with the need for vasopressors
Three minor indicators for ICU admission/Severe CAP
BP over 90
PaO2/FiO2 under 250
Multilobar Disease
Risk factors for severe pneumonia
Alcoholism COPD Immunosuppression Heart Disease Institutionalization Over 70 yo Inhaler/PPI use
Important physical exam findings in pneumonia
Irregular vitals + Confusion
High RR over 30, Low BP, Pulse over 125, irregular temp
Three mechanisms by which bacteria reaches the lungs
Inhalation
Aspiration
Hematogenous
If a pneumonia is bad enough to send a patient to the ICU, what bonus tests should you run
Legionella and pneumococcal UAT
Six ost common causes of bacterial pneumonia
S pneumo H influenzae Chlamydia pneumo Myco pneumo Legionella S aureus
Criterion for a good sputum sample
under 10 squamous cells
over 25 WBC
Low Powered Field
What should you look for to IS a lingular pneumonia?
Obscuration of the cardiac apex
Effect of bacterial and viral pneumonia on procalcitonin levels?
Bacterial – Rises
Viral – Lowers via IFN-g
Practical use for watching the PCT levels?
Use to assess duration of antibiotic therapy
Consider ABs with a PCT above…
0.25 ug/L
Who needs a follow up Chest X ray in 4-6 weeks
Everyone over 40
All Smokers, Former Smokers
General guidelines for antibiotic management of CAP
Give empiric treatment within 4-8 hours
Increased risk of pseudomonas with …
structural lung disease (bronchiectasis)
Corticosteroid Therapy
Broad spectrum AB activity for a week in the past month
Malnutrition
Drug treatment for an overall healthy outpatient with no ABs in the past 3 months…
Macrolide OR Doxy
Drug treatment for outpatient patient with cardiopulmonary disease, beta-lactam reaction in past 3 mos, alcoholism, immunosuppressive rx, or day care exposure
Respiratory Quinalone
OR
beta-lactam AND macrolide/doxy
How long should an outpatient pneumonia patient be on antibiotics
5-7 days
Rx for inpt. CAP
Resp. Quinolone
OR
(Ceftriaxone/Ceftazimide) + Azithro/Doxy
ICU treatment for CAP
(Ceftriaxone/Ceftazimide) + Azithro/Respiratory Quinalone
How to treat suspected aspiration pneumonia
Unasyn/Zosyn
Augmentin/Clindamycin
Respiratory Quinalone
Important considerations if CAP pneumonia treatment isn’t effective
Bronchoscopy
Further Diagnostic Testing
Escalation/Change of Therapy
When can you switch from IV to PO
Improved cough, dyspnea
Afrbrile on two occasions 8 hrs apart
Decreasing WBC count
Fxnal GI tract
Criteria for discharge..
In the past 24 hours, no more than one of…
Fever, Tachycardia, tachypnea (over 24)
Drop in BP, O2 Sat
Can’t maintain oral intake
Altered Mental Status
Which risk stratification determines outpatient vs inpatient
CURB 65
Treatment for HCAP
Vancomycin
