Pneumonia Flashcards
COMMUNITY-ACQUIRED PNEUMONIA (CAP)
- commonly caused by?
streptococcus pneumoniae (commonest), Haemophilus influenzae.
HOSPITAL ACQUIRED PNEUMONIA
- defined as?
- commonly caused by?
o Defined as >48hr admission in hospital.
o Most commonly gram –ve bacilli or staph aureus, then pseudomonas.
ASPIRATION PNEUMONIA
- defined as?
o Most commonly streptococcus pneumonia.
what tool is used to determine if someone should come into hospital?
what does the scoring system result in?
in hospital have CURB65 - What does U stand for?
admit if oxygen saturation is less than?
CRB-65
Confusion
Resp rate >30
BP <90 systolic or <60 diastolic
>65
Urea >7
3 or 4 = urgently admit to hsop
1 or 2 = refer/ consider for same day assessment w/ PO ABx
0 = treat at home
92%
resp rate criteria is different in CRB 65 and Sepsis
Resp rate = >30
Sepsis = >20
NICE also mention point-of-care CRP test. With the following recommendation with reference to the use of antibiotic therapy:
CRP <20 ?
CRP 20-100 ?
CRP >100 ?
- CRP < 20 mg/L - do not routinely offer antibiotic therapy
- CRP 20 - 100 mg/L - consider a delayed antibiotic prescription
- CRP > 100 mg/L - offer antibiotic therapy
Complications of Pneumonia?
Respiratory failure (Type 1) – common
Hypotension (dehydration and vasodilation – give fluids)
AF – common in elderly, goes away with Tx of pneumonia or give digoxin or B-blocker if not.
Those eligible for pneumococcal vaccine?
- All adults over the age of 65.
- Diabetes mellitus not controlled by diet.
- Chronic heart, renal or lung conditions.
- Immunocompromised.
Abx Treatment for Pneumonia
empirical therapy for CAP ?
empirical therapy for HAP ?
CAP
amoxicillin +/- clarithromycin
HAP
co-amoxiclav +/- gentamycin OR tazocin
Commonest bacterial pneumonia (80% of cases)?
Tx?
streptococcus pneumoniae
amoxicillin, or cephalosporin.
Particularly common in COPD patients?
Haemophilus influenza
Occur in young, elderly, IVDU or patients with underlying disease (leukaemia, lymphoma). ?
Tx?
Staphylococcal Pneumonia
Tx: flucloxacillin
air conditioned rooms and hospitals?
Tx?
Legionella Pneumophila
Tx: fluroquinolone or clarithromycin.
skin rashes and anaemia ?
Tx?
Mycoplasma Pneumomiae
Tx – erythromycin in children and amoxicillin in adults
birds/parrots ?
Chlamyd’s psittaci
commensal on skin ?
staph. aureus
aspiration pneumonia?
mixed anaerobes
what do you treat streps with ?
what do you treat staphs with?
streps: amoxicillin
staphs: flucoxacillin
A 3-year-old girl presents to the emergency department with lethargy, cough and breathlessness for the last 2 weeks. The mother tells you that the cough has been getting worse, but it is not productive of sputum. Her observations show fever, tachycardia and tachypnoea. Based on her age and the worsening of the cough, you suspect that the infecting organism is Mycoplasma pneumonia. Chest x-ray shows right lower zone consolidation.
What is the most appropriate oral therapy?
amoxicillin co-amoxiclav benzylpenicillin erythromycin aciclovir
erythromycin
Which of the following factors is least useful in assessing patients with a poor prognosis in community-acquired pneumonia?
AMTS Urea CRP Resp rate Age
CRP
occurs in HIV positive patients with a low CD4 count.?
Tx?
pneumocystis jirovecii pneumonia (PCP)
treated with oral co-trimoxazole or IV pentamidine in severe cases.
Management of low-severity community acquired pneumonia (CURB score of 1 or 2)
1st line ?
if penicillin allergic?
amoxicillin is first-line
if penicillin allergic then use a macrolide or tetracycline
NICE now recommend a 5 day course of antibiotics for patients with low severity community acquired pneumonia
A 63-year-old gentleman presents to the Emergency Department with a productive cough and shortness of breath for the past five days. His basic observations are: heart rate 90/min, blood pressure 100/55 mmHg, respiratory rate 26/min. His abbreviated mental test score (AMTS) is 9/10. His respiratory examination reveals right-sided dullness to percussion and increased vocal resonance.
Urea = normal
A plain chest radiograph shows consolidation of the right middle lobe. Based on this information how should he be managed?
Admit to ITU
Admit to hosp for amoxicillin 500mg TDS
Discharge with no treatment
Discharge with amoxicillin 500mg TDS
Discharge with amoxicillin 500mg TDS
His CURB 65 score is 1, as only his diastolic blood pressure is below the threshold. However, he is symptomatic so he should be treated with antibiotics as an outpatient.
A 74-year-old man presents with confusion and is found to have evidence of right lower lobe pneumonia on chest x-ray. On examination the respiratory rate is 36 breaths per minute, pulse rate is 90 per minute and the blood pressure is 106/48 mmHg. Initial bloods show a urea of 12 mmol/l.
His CURB 65 score is:
1 2 3 4 5
what does this score mean for management?
5
A score of 5 necessitates admission to hospital for treatment with IV antibiotics
A 48-year-old salesman presents with a 5 day history of cough and
pleuritic chest pain. He has no past medical history of note. On examination his temperature is 38.2ºC, blood pressure is 120/80 mmHg, respiratory rate 18/min and pulse 84/min. Auscultation of the chest reveals bronchial breathing in the left base and the same area is dull to percussion. What is the most suitable management?
oral amoxicillin
oral co-amoxiclav
oral erythromycin
admit
oral amoxicillin
A 70-year old lady presented to the emergency department with a three day history of increasing shortness of breath and cough productive of green sputum. She had a previous medical history of hypertension and diverticular disease of the colon. Her medication comprised of amlodipine. She was a non-smoker. On examination, she was muddled with an abbreviated mental test score (AMTS) of 6/10. Her temperature was 37.4 degrees Celsius, her pulse was 115 beats per minute and regular, her blood pressure was 88/55 mmHg, her respiratory rate was 20 breaths per minute and her oxygen saturations were 92% on room air. There were coarse crackles at the right lung base.
Urea 13
Chest radiograph: patchy shadowing at the right base
What is the CURB-65 score?
1 2 3 4 5
4
A 76-year-old man has recently been stepped-down from ITU following re-exploration surgery after partial right nephrectomy due to haemorrhage. On the ward, he has become very chesty and drowsy after eating a meal. His oxygen sats are 86% on air and respiratory rate is 34/min. He has an urgent portable chest X-ray which shows new patchy opacification in the right lower lobe and he is started on IV tazocin and IV fluids.
Which of the following factors would predispose him the most to this deterioration?
hosp admission >48 hours COPD upright position Recent intubation on iTU Previous chest infection
recent intubation in ITU
Recent intubation is a risk factor for aspiration pneumonia
how do you treat Aspiration pneumonia?
IV cefuroxime + metronidazole
