Pneumonia Flashcards
Define pneumonia
It is an acute respiratory illness associated with segmental, lobar, or multi-lobar radiological shadowing (consolidation)
Classifications of pneumonia
Community acquired pneumonia (CAP)
Hospital acquired pneumonia (HAP)
Aspiration Pneumonia
Or pneumonia in an immunocompromised host
Symptoms of pneumonia
Fevers
Rigors
Malaise
Anorexia
Dysponea
Cough
Purulent Sputum
Pleuritic chest pain
Define Hospital acquired pneumonia (HAP)
It is when symptoms develop after 48 hours of hospital admission
What is the commonest cause of Community acquired pneumonia (CAP)
Streptococcus pneumoniae
Followed by:
haemophilus influenzae
mycoplasma pneumoniae
Most of the remainder are:
Staphylococcus aureus
Legionella species
Moraxella Catarrhalis
Chlamydia
Immunocompromised patients follow same pattern however can present with atypical pathogens
Is it possible that Community acquired pneumonia (CAP) be caused by viruses
Yes, they account for 15% of CAP
What is the commonest cause of Hospital acquired pneumonia (HAP)
Gram negative enterobacteria and staphylococcus aureus
Pseudomonas
Klebsiella
Clostridia
Bacteroides
When do aspiration pneumonia occur
Patients with stroke
myasthenia
bulbar palsies,
reduced consciousness (postictal/drunk)
Oesophageal causes (Achalasia/reflux)
Signs of pneumonia
Pyrexia
Cyanosis
Confusion
Tachyponea
Tachycardia
Hypotension
Reduced expansion
Dull percussion note
Increased tactile vocal fremitus/resonance
Bronchial breathing
Pleural rub
What is pleurisy
It is inflammation of the pleura
Commonest symptoms is sharp chest pain on deep inhalation
What is pleural rub
It is an audible sign of pleurisy, check youtube
How to investigate pneumonia
CXR
O2 sats
ABG
BP
Sputum sample
FBC
U&E
LFT
CRP
Blood cultures
What is empyema
It is accumulation of pus in the pleural cavity
What do you need to consider if your are investigating an immunocompromised patient with pneumonia
Aypical organisms
Bronchoscopy
Branchoaalveolar Lavage
What to investigate if there is a influenza epidemic
Throat/nasopharyngeal swabs
What tool you would use to assess severity of pneumonia and explain it to me
CURB-65
Confusion
Urea >7mmol
Respiratory rate >30/min
Blood pressure systolic <90 or diastolic <60
Age > or equal to 65
Score 1 point for each
If 0 or 1 most likely safe at home Rx
If 2 may be need admitting to hospital or Rx at home but supervised by hospital
If 3 or more admit to hospital and check if need to go to ICU especially if score of 4 or 5
Complications of pneumonia
Pleural effusion
empyema
Lung abscess
respiratory failure
septicaemia
brain abscess?
pericarditis
Myocarditis
Cholestatic jaundice
Prevention of pneumonia
Pneumococcal vaccine could be helpful
How would you manage pneumonia
It depends on the presentation
If it is acute ill take a different course of action
but if it is moderate ill start with
Antibiotic therapy
IV fluids
Oxygen
Analgesia
Follow up
Tell me about the antibiotic therapy for pneumonia
Oral if not severe
If severe IV
Tell me about the O2 therapy for pneumonia
Try to keep sats 94% or over
Tell me about analgesic therapy for pneumonia
Given if pleurisy or patient is in pain
When do you want to follow up a patient with pneumonia
In 6 weeks
When would you consider IV fluids for a patient with pneumonia
Like any other patients who require IV fluids
Dehydration
Anorexia
Shock
Management of a pretttyyyy serious pneumonia
Go over ABCDE
Treat hypoxia with oxygen
Treat shock from infection
Investigate like normal pneumonia
Start Abx - sometimes even if cultures are not back
Analgesia for pleurisy
If no improvement consider - continuous positive airways pressure (CPAP) or intubation
