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B - Paediatrics MANAGEMENT > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is pneumonia?

A

An infection of the lower respiratory tract and lung parenchyma

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2
Q

What does pneumonia lead to?

A

Consolidation

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3
Q

To cause pneumonia, what must an organism do?

A

Bypass the host’s normal non-immune and immune defence mechanisms

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4
Q

What are the non-immune mechanisms?

A
  • Aerodynamic filtering of particles
  • Cough reflex
  • Mucociliary clearance
  • Secreted substances including lysozymes, complement and defensins
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5
Q

What carries out the immune mediated response?

A
  • Macrophages
  • Neutrophils
  • Lymphocytes
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6
Q

What percentage of CAP cases in children are caused by viruses?

A

14-35%

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7
Q

What causes variation in the causative organisms?

A

Age

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8
Q

What are the common causative bacteria of pneumonia in neonates?

A
  • Group B strep
  • E. Coli
  • Klebsiella
  • Staph aureus
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9
Q

What are the common causative bacteria of pneumonia in infants?

A
  • Strep pneumoniae

- Chlamydia

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10
Q

What are the common causative bacteria of pneumonia in school age children?

A
  • Strep pneumoniae
  • Staph aureus
  • Group A strep
  • Bordetella pertussis
  • Mycoplasma pneumoniae
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11
Q

What are the risk factors for pneumonia in children?

A
  • Congenital lung cysts
  • Chronic lung disease
  • Immunodeficiency
  • Cystic fibrosis
  • Sickle cell disease
  • Tracheostomy
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12
Q

What features may be present in the history?

A
  • Recent URTI
  • Pleuritic chest pain
  • Temperature >38.5
  • Shortness of breath
  • Cough with sputum in children > 7
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13
Q

What features may be present on examination?

A
  • Signs of respiratory distress
  • Desaturation and cyanosis
  • General ill health and lethargy
  • Auscultation signs of lobar pneumonia
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14
Q

What are some signs of respiratory distress?

A
  • Tachypnoea
  • Grunting
  • Intercostal recession
  • Use of accessory muscles for breathing
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15
Q

What signs may be present on auscultation?

A
  • Dullness to percussion
  • Crackles
  • Decreased breath sounds
  • Tactile vocal Freitas
  • Bronchial breathing
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16
Q

What investigations may be necessary?

A
  • Sputum culture
  • Nasopharyngeal aspirates
  • Blood cultures (in severe cases)
  • Pleural aspirate culture (with significant pleural effusion)
  • Viral titres
  • CXR (not in mild/uncomplicated cases)
17
Q

What may be seen on a CXR?

A
  • Pleural effusion
  • Fluid level
  • Apparent round pneumonia
  • Cavitation
  • Hilar adenopathy
  • Calcification
18
Q

What are the potential differentials for pneumonia?

A
  • Bronchiolitis
  • Asthma
  • Pulmonary oedema
19
Q

What is the treatment for pneumonia?

A

Antibiotics

20
Q

How are antibiotics usually given in pneumonia?

A

Orally

21
Q

When may IV antibiotics be required?

A

When the patient is unable to take oral antibiotics or symptoms are severe

22
Q

What does the specific choice of antibiotic depend on?

A
  • Age of the child
  • Host factors
  • Severity of illness
  • Information about cultures if known
  • CXR findings if known
23
Q

What is the most likely pathogen in under 5 years?

A
  • Strep. pneumoniae
24
Q

What are the most common causes of atypical pneumonia in under 5’s?

A
  • Mycoplasma pneumoniae

- Chlamydia trachomatis

25
Q

What is the first line antibiotic in pneumonia in under 5’s?

A

Amoxicillin

26
Q

What are alternative antibiotics for typical pneumonias in under 5’s?

A
  • Co-amoxiclav

- Cefaclor

27
Q

What are alternative antibiotics for atypical pneumonias in under 5’s?

A
  • Erythromycin
  • Clarithromycin
  • Azithromycin
28
Q

What organism is more common in over 5’s?

A

Mycoplasma

29
Q

What is the first line antibiotic for over 5’s?

A

Amoxicillin

30
Q

What should be used if mycoplasma or chlamydia is suspected?

A

Macrolide antibiotic

31
Q

What antibiotics can be used fo severe pneumonia?

A
  • IV co-amoxiclav
  • IV cefotaxime
  • IV cefuroxime
32
Q

What supportive therapy may be needed by a patient with pneumonia?

A
  • Antipyretics
  • IV fluids
  • Supplemental oxygen
  • Chest drain for fluid or pus collections
33
Q

When might IV fluids be required?

A

If the patient is dehydrated or cannot take oral fluids

34
Q

How might oxygen be delivered?

A

Via nasal cannula or headbox

35
Q

What is the aim of oxygen therapy in pneumonia?

A

To maintain sats >92%

36
Q

What are some potential complications of pneumonia?

A
  • Pleural effusion
  • Empyema
  • Lung abscess
  • Necrotising pneumonia
  • Systemic infection and sepsis
  • Severe respiratory compromise requiring intubation
37
Q

What are the indications for admission to ITU?

A
  • Refractory hypoxia
  • Decompensated respiratory distress e.g. lessening tachypnoea due to fatigue
  • Sepsis
38
Q

When may transfer to ITU be initiated at a lower threshold?

A

For infants or young children

B - Paediatrics MANAGEMENT (106 decks)

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