Pneumonia Flashcards
What is pneumonia and it’s common associations?
• An acute lower respiratory tract illness associated with fever, symptoms and signs in the chest, and abnormalities on the CXR.
What is the mortality rate of patients in hospital with pneumonia?
• Approx. 21%
What are the 4 classifications of pneumonia?
- Community-acquired pneumonia (CAP)
- Hospital-acquired
- Aspiration
- Immunocompromised patient
What is the commonest cause of CAP? What are the next 2 most common?
- Streptococcus pneumoniae
* Haemophilus influenzae / Mycoplasma pneumoniae
What are the two commonest causes of hospital-acquired pneumonia?
- Gram negative enterobacteria
* Staphylococcus aureus
What percentage of CAP cases do viruses account for?
•15%
What diseases can lead to aspiration acquired pneumonia? (4)
• Stroke / myasthenia / bulbar palsies / oesophageal disease
Give two infectious agents that cause pneumonia in immunocompromised patients.
- Strep. pneumoniae
* H. influenzae
What are the clinical symptoms of pneumonia? (9)
- Fever
- Rigors
- Malaise
- Anorexia
- Dyspnoea
- Cough
- Purulent sputum
- Haemoptysis
- Pleuritic pain
What are the clinical signs of pneumonia? (8)
• Pyrexia / cyanosis / confusion / tachypnoea / tachycardia / hypotension / signs of consolidation / pleural rub
What are the signs of consolidation? (5)
• Diminished expansion / dull percussion / tactile vocal fremitus / vocal resonance / bronchial breathing.
What are the three important steps that need to be established when testing a patient with suspected pneumonia? (3)
- Establish diagnosis
- Identify pathogen
- Assess severity
What tests would you carry out on a patient with suspected pneumonia? (6)
- CXR - lobar or multi lobar infiltrates, cavitation or pleural effusion.
- Assess oxygenation - oxygen saturation (ABG) and BP •Blood tests
- Sputum microscopy and culture
- Pleural fluid aspiration
- Bronchoscopy and bronchoalveolar lavage - if patient is immunocompromised or in ITU
How is severity measured in a patient with pneumonia?
• Establishing their CURB-65 score
What is assessed in the CURB-65 test? (4)
• Confusion • Urea >7mmol/L • Respiratory rate _>30/min • BP One point for each factor.
What is the scoring system of CURB-65?
- 0-1 = home treatment possible
- 2 hospital therapy
- _>3 severe pneumonia indicates mortality 15-40% - consider ITU
What complications may arise from pneumonia?
Pleural effusion / empyema / lung abscess / respiratory failure / septicaemia / brain abscess / pericarditis / myocarditis / cholestatic jaundice
How is pneumonia treated? (6) What should be done if there is failure to improve or CRP remains high? How many weeks later should the follow up be?
- Antibiotics (orally or IV (if severe))
- Oxygen (keep PaO2 >8.0 and/or saturation _>94%)
- IV fluids (anorexia, dehydration, shock)
- VTE prophylaxis
- Analgesia if pleurisy
- Consider ITU if shock, hypercapnia, or uncorrected hypoxia
- Repeat CXR and look
- 6 weeks
What would be checked via a blood test?
- FBC
- U&E
- LFT
- CRP
- Blood cultures
What groups are at risk and should receive the pneumococcal vaccine? (4)
- _>65 yrs old
- Chronic heart, liver (eg cirrhosis), renal (eg renal failure, nephrosis, post-transplant) or lung conditions.
- Diabetes mellitus
- Immunosuppression, e.g. decreased spleen function (splenectomy, asplenia, sickle cell or coeliac disease), AIDS, or on chemotherapy or prednisolone
What is a contraindication of the pneumococcal vaccine?
•Pregnancy, lactation
What is the antibiotic treatment of pneumonia?
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