Pneumonia Flashcards
Symptoms of pneumonia
cough sputum dyspnoea chest pain: may be pleuritic fever
Signs of pneumonia
fever, tachycardia, tachypnoea
reduced oxygen saturations
reduced breath sounds, bronchial breathing, dull to percuss, coarse crepitations
Legionella pneumonia presentation
dry cough, no fever, headache, confusion, diarrhoea, hyponatraemia
Mycoplasma pneumonia presentation
upper respiratory involvement, skin changes, encephalitis, uveitis, myocarditis, haemolytic anaemia
CRB-65 scoring
and CURB-65
Confusion
Respiratory rate of >=30 bpm
BP of <90/60
65 years old or more
0 = low risk of death 1-2 = intermediate 3-4 = high risk (>10%)
CURB-65 includes urea (>7 mmol/l)
Management of those with CRB-65 score of 0 vs others
If 0 –> home-based care
Other score –> hospital assessment
CURB-65 score of 2 or more management
Hospital-based care
CURB-65 score of 3 or more management
ICU assessment
CURB-65 score of 0 or 1 management
Home-based care
Management of low-severity community acquired pneumonia
amoxicillin (5 days)
Management of moderate severity community acquired pneumonia
amoxicillin + macrolide (7-10 days)
Management of high severity community acquired pneumonia
co-amoxiclav, ceftriaxone or piperacillin with tazobactam AND a macrolide
Investigations
Pulse oximetry CRP CXR Blood + sputum cultures, pneumococcal and legionella urinary antigen tests if intermediate or high risk Bloods - FBC, U&Es, CRP ABG if low sats or has COPD
Typical bacterial causes
Streptococcus pneumoniae = most common Haemophilus influenzae Staphylococcus aureus Group A streptococci Moraxella catarrhalis
Atypical bacteria causes
Mycoplasma pneumoniae, Chlamydia, and Legionella
Viral causes
Influenza A and B, respiratory syncytial virus, adenovirus, and some coronaviruses
Indications for flu vaccine
65 years old or over Pregnancy Live in care home Carers for elderly/disabled Health staff Chronic conditions - asthma, COPD, chronic heart disease, CKD, chronic liver disease, chronic neuro conditions, diabetes, spleen issues Immunosuppressed BMI of 40 or above
Indications for pneumococcus vaccine
Babies
65 and over
Occupational risk e.g. welders
Chronic conditions + immunosuppressed (same as flu)
CXR findings
Consolidation
Lobar collapse
Pleural effusion
Causes of hospital acquired pneumonia
Pseudomonas aeruginosa
MRSA
Other non-pseudomonal Gram-negative bacteria
Causes of pneumonia in immunocompromised people
More atypical causes e.g. fungal, mycobacteria, viruses, pneumocystis jirovecii
