Pneumonia Flashcards
What is pneumonia?
Acute infection of lung parrenchyma associated with:
- fever
- signs and symptoms in the chest
- abnormalities on CXR
What are the different types of pneumonia?
- Aspiration
- Community Acquired Pneumonia (CAP)
- Immunocompromised
- Hospital Acquired
What are the signs and symptoms of pneumonia?
- Fevers and Rigors
- Anorexia
- Dyspnoea
- Productive cough
- Cyanosis
- Confusion
- Consolidation
- Pleuritic chest pain
What is the pathophysiology of Pneumonia?
Pneumonia is pathologically classified into:
- Lobar
- Bronchopneumonia
LOBAR PNEUMONIA:
- Diffuse inflammation affecting the entire lobe
- Whole lobe becomes consolidated due to accumulation of acute inflammatory exudate in alveoli
BRONCHOPNEUMONIA:
- Widespread patchy inflammation centred on the airways
- Bi lateral, where as lobar pneumonia is uni-lateral concentrated on ONE LOBE
- Seen as patchy areas of consolidation
What is consolidation?
Replacement of air in the alveoli by fluid or other material
In Pneumonia, air is replaced with acute inflammatory exudate
What are the main organisms that cause the CAP?
- Streptococcus Pneumonia is the single most common cause of mild CAP
Severe CAP is caused by:
- Streptococcus Pneumonia
- Legionella Pneumonia
- Staphlycoccus Aureus
Other causes: Influenza, Chlamydia Pneumonia, Mycoplasma Pneumonia, Legionella Pneumonia,
What are the main organisms that cause Hospital Acquired Pneumonia?
- Occurs two or more days after hospital admission
=> Gram -ve bacteria responsible for 60% of cases: - Klebsiella (can also result in collection of pus known as empysema)
- E.Coli
- Pseudomonas
=> Most important causes:
- Streptococcus Pneumonia
- Staphlycoccus Pneumonia
What are the risk factors of Pneumonia?
- Smoking
- Hospital admission
- Immunocompromised
- Having a chronic condition
What are the investigations in suspected Pneumonia?
=> CXR
Should show consolidation in lungs
=> Bloods
FBC, U&E, LFTs, CRP
=> ABG
SaO2 < 92%
=> Serology
How do you assess the severity of Pneumonia?
CURB-65
C - Confusion U - Urea ≥ 7 mmol/L R - Respiratory Rate ≥ 30/min B - SBP ≤ 90 - DBP ≤ 60 mmHg > 65 years old
Each category is worth a point. Score close to 5 means greater severity
What is the management of Pneumonia?
Emperical antibiotic treatment is started immediately - modified once causative organisms is identified
CURB-65 score 1 => pneumonia not severe and no vomiting. Home based care. Give ORAL ANTIBIOTICS
CURB-65 2 => intermediate pneumonia. Hospital care. IV ANTIBIOTICS
CURB-65 3 => severe pneumonia. Intensive care
If full score of 5 => perform Sepsis 6 and refer to ITU
Oxygen must be kept above 8kPa
Give Analgesics in cases of pleurisy and IV fluids in cases of dehydration, shock or anorexia
What is the emergency management of Pneumonia?
Assess using ABC. Treat hypoxia with 24-28% oxygen if there is history of COPD or hypercapnia
Treat hypotension and assess for dehydration
Investigations
Antibiotics - amoxicillin is first line. For high risk, give dual antibiotic treatment amoxicillin + macrolide
Analgesia for pleuritic chest pain
If NO improvement and patient still hypoxic, consider CPAP. Hypercapnia requires non invasive or invasive ventilation
Physiotherapy involved in management to help remove inflammatory exudates
What are the contraindications of the Pneumococcal vaccine?
- Adults > 65
- Chronic heart failure, liver, renal or lung conditions
- Diabetes not controlled by diet
- Immunosuppression
What are the contraindications of the Influenza vaccine?
- Hyposplenism (reduced spleen function)
- Diabetes
- Chronic respiratory
Antibiotics against Streptococcus Pneumonia
Amoxicillin, Clarithromycin, Doxycycline
