Pneumonia Flashcards
what is pneumonia?
inflammation of lung parenchyma
causes of pneumonia
bacteria viruses fungi parasites aspiration
what are the types of pneumonia?
hospital or community acquired
typical or atypical
immunocompromised
aspiration
CAP
contracted in community
divided into typical and atypical
typical
classical symptoms
productive cough
fever
pleuritic chest pain
most common cause of typical pneumonia?
strept. pneumoniae
haemophilus influenzae
moraxella catarrhalis
atypical
more gradual onset
subacute onset
present with pulmonary and extrapulmonary symptoms
zoonotic and non-zoonotic causes
zoonotic causes of atypical pneumonia
chlamydophia psittaci
coxiella burnetiid
francisella tularensis
non-zoonotic causes of atypical pneumonia
mycoplasma pneumoniae
legionella pneumophilia
chlamydophila pneumoniae
HAP
contracted >48 hours after hospital admission that was not incubating at time of admission
causative organisms of HAP
gram negative bacilli - pseudomonas aeruginosa, staph aureus, legionella pneumophilia
aspiration pneumonia pathogenesis
caused by inhalation of oropharyngeal or gastric contents
brings bacteria into the lungs
who gets aspiration pneumonia?
patients who are unable to protect their airway - reduced consciousness, neuromuscular disorders, oesophageal conditions, mechanical interventions
PPIs increased risk
what are the causative organisms of aspiration pneumonia?
strep. pneumoniae staph aureus haemophilus influenzae enterobacteriaceae hospital gram-negative bacilli
immunocompromised pneumonia
risk of infective organisms not usually seen in other patient groups
wider range of causative organisms
immunocompromised causative organisms
mycobacterium complex non-TB mycobacterium pneumocystis jirovecii aspergillus fumigatus cryptococcus neoformans varicella zoster CMV parasites
clinical features of pneumonia
cough SOB signs of consolidation malaise purulent sputum dysnpoea pleuritic pain dull percussion reduced breath sounds bronchial breathing coarse crepitations increased vocal fremitus tachycardia hypotension confusion cyanosis
complications
parapneumonic effusion pneumothorax abscess empyema sepsis AF
investigations
observations sputum sample urinary sample ECG FBC U&Es CRP blood cultures CXR don't delay antibiotics with tests
what are the pneumonia scoring systems?
CRB-65 and CURB-65
used to stratify patients risk of mortality
determines best place of care
CRB-65
used in primary care confusion respiratory rate >30 BP <90 or <60 over 65 years old
interpreting CRB-65
score 0 = outpatient, low risk of mortality <1%
score 1-2 = secondary care, intermediate risk mortality - 1-10%
score of 3+ = urgent admission - high risk mortality (>10%)
CURB-65
used when patient presents to hospital confusion urea >7mmol/L respiratory rate >30 BP <90 or <60 aged over 65
interpreting CURB-65
score 0-1 = outpatient, low risk of mortality - <3%
score 2 = secondary care, intermediate risk mortality (3-15%)
score of 3-5 = ICU, high risk of mortality >15%
definition of confusion
AMT <8 or new onset of disorientation in time, place or person
management
ABC approach
oxygen titrated
IV fluids - maintenance
appropriate analgesia - paracetamol, NSAIDs or opiates
