Pneumonia Flashcards
What are the main classifications/types of pneumonia?
- atypical
- community-acquired
- hospital-acquired
- aspiration
- pneumocystitis jirovecii
Define pneumonia
A lower resp. tract infection associated w fever, symptoms and signs in the chest, and abnormalities on the CXR
Summarise the epidemiology of pneumonia
incidence = 5-11/1000
age: very young, or old (only 30 % are <60yrs)
Name the clinical symptoms of pneumonia
- fever
- rigors
- malaise
- anorexia
- dyspnoea
- cough
- purulent sputum
- haemopytsis
- pleurtic pain
Name the signs of pneumonia
- pyrexia
- cyanosis
- confusion (in elderly)
- tachypnoea
- tachycardia
- hypotension
- signs of consolidation
- pleural rub
What are the signs of consolidation?
- reduced expansion
- dull percussion
- increased tactile vocal fremitus
- bronchial breathing
What is a pulmonary consolidation?
region of normally compressible lung tissue that has filled with liquid instead of air.
liquid can be pulmonary edema, inflammatory exudate, pus, inhaled water, or blood
Consolidation must be present to diagnose pneumonia: the signs of lobar pneumonia are characteristic and clinically referred to as consolidation
How is the severity of pneumonia assessed?
CURB-65
Confusion
Urea (>7mmol/L)
Resp. rate BP <90/30
65<
What are the primary investigations for ?pneumonia
How is pneumonia managed?
- Abx (non-severe: oral ; severe: IV)
- O2 (keep sats>96%
- Fluids (anorexia, hypotension, shock)
- analgesia (if pleurisy)
- VTE prophylaxis
What is VTE prophylaxis?
venous thromboembolism prophylaxis
= consists of pharmacological & non-pharmacological measures to diminish risk of
- deep vein thrombosis (DVT)
- pulmonary embolism (PE).
- Pulmonary embolism remains the largest cause of preventable death in hosp.
Name some drugs used for VTE prophylaxis
- unfractionated heparin (UFH)
- low molecular weight heparin (LMWH)
- fondaparinux (selective anti-Xa inhibitor)
- dabigatran (thrombin inhibitors)
- rivaroxaban, apixaban (anti-Xa inhibitors)
Name some possible complications of pneumonia
Resp
- resp failure (type 1)
- pleural effusion
- empyema
- lung abscess
CVS
- hypotension
- AF
- pericarditis/myocarditis
Systemic
- septicaemia
- jaundice
What are the factors that increase the risk of death?
- comorbidity
- multilobar/bilateral
- PaO2<8kPa
Why might a pt develop hypotension as a complication of pneumonia?
how might this be managed?
possibly due to dehydration + vasoconstriction (due to sepsis)
IV fluids –> central line –> ITU: inotropic support
Why might a pleural effusion occur as a complication of pneumonia?
inflammation of the pleura by adjacent pneumonia may cause fluid exudation into the pleural space. If accumulation > reabsorption –> pleural effusion
if small, resolves spontaneously; if larger: drain
What symptoms might cause you to suspect empyema as a complication of pneumonia?
pneumonia pt w recurrent fever
treat: chest drain
What is a pulmonary cavitation?
Pulmonary cavities are thick-walled abnormal gas-filled spaces within the lung.
They are usually associated with:
- nodule
- mass
- area of consolidation.
A fluid level within the space may be present.
Plain radiography and CT form the mainstay of imaging.
Why might septicaemia occur as a complication of pneumonia?
bacterial spread from lung parenchyma into the bloodstream
How do the different pathogens causing pneumonia present?
Klebsiella most commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics
Pseudomonas aeruginosa is a common pathogen in bronchiectasis and cystic fibrosis. It is a common cause of hospital-acquired pneumonia, especially in those patients in the ITU on a ventilator. It doesn’t cause the X-ray changes seen in this scenario. Instead, ‘ground-glass’ attenuation can often be noticed on a CT scan.
Mycoplasma pneumoniae causes flu-like symptoms such as a headache, arthralgia and myalgia followed by a dry cough which are not seen in this case. Chest X-ray often shows patchy consolidation of one lower lobe.
Legionella pneumophilia also causes flu-like symptoms such as fever, myalgia. It can also cause extra-pulmonary symptoms such as hepatitis, diarrhea and vomiting. Bi-basal consolidation can be seen on chest X-ray.
Staphylococcus aureus is often seen in intravenous drug users (IVDU), young, elderly or people with an underlying disease such as leukemia or cystic fibrosis. The patient’s history of alcoholism points more towards Klebsiella
Discuss (3)Improve
