Pneumonia Flashcards
Whats associated with high fever, rapid onset and herpes liabilis
streptococcus pneumoniae
what bacteria is common in COPD patients?
haemophilus influenza
what is pneumonia?
an infection of the lower resp tract causing inflammation of the alvelar sacs
symptoms?
- fever
- rigors
- malaise
- anorexia
- dyspnoea
- cough
- purulent sputum
- haemoptysis
- pleuritic pain
signs ?
- fever
- cyanosis
- tachypnoea
- tachycardia
- hypotension
- pleural rub
- signs of consolidation (dull percussion, diminished expansion)
investigations?
- blood culture
- CXR
- ABGS
- sputum sample
- bloods
Why is a blood culture done?
to determine what type of pneumonia it is
what would be seen on CXR?
new shadowing
Why are ABGS done?
to confirm type 1 or type 2 resp failure
what type of pneumonia uses CURB 65 to determine the severity
community acquired pneumonia
what does CURB 65 stand for
C- new onset of confusion U- urea>7 R- rr>30 B- bp systolic <90, diastolic <60 age >65
Score 0-1 CURB 65
treat as outpatient
Score 2 CURB 65
treat at hospital
Score 3+ CURB 65
severe and often require ITU
Complications of pneumonia?
- resp failure
- pleural effusions
- empyema
- death
pathogens in community acquired pneumonia
- streptococcus pneumoniae
- haemophilus influenza
- mycoplasma pneumoniae
bacteria most common in young people
mycoplasma pneumoniae
bacteria most common in old
streptococcus pneumoniae
bacteria most common in bird owners
chlamydia Psittaci
bacteria most common in sheep workers
coxiella burnetti
bacteria associated with red jelly sputum
klebsiella pneumonia
bacteria associated with rusty sputum
pneumococcal pneumonia
bacteria associated with COPD exacerbations
haemophilus influenza
bacteria associated with returning travelers
legionella pneumophila
Treatment for CURB 65 rating 0
amoxicillin (500mg x3 daily) OR clarithromycin (500mg x2 daily) OR if allergic to penicillin Doxycycline (200mg loading dose then x1 100mg) ALL ORAL
Treatment for CURB 65 rating 1-2
Amoxicillin (500mg x3 daily) AND
Clarithromycin (500mg x2 daily)
OR if allergic to penicillin
Doxycycline (200mg loading dose, 100mg x1 daily)
Treatment for CURB 65 rating 3-5
Co-amoxiclav (IV 1.2g x3 daily) AND Clarithromycin (IV 500mg x2 daily) OR if allergic to penicillin Cephalosporin IV AND clarithromycin (500mg x2 daily)
What should be added to treatment if suspected legionella pneumoniae?
fluoroquinolones
What is hospital acquired pneumonia?
Patient contracts pneumonia atleast 48 hours after being admitted in hospital
What organisms usually cause early onset hospital acquired pneumonia? (<4 days in hospital)
- streptococcus pneumonia
- haemophilus influenzae
- staph aureus
What organisms usually cuase late onset hospital acquired pnuemonia>
- all of the early onset
- Klebsiella Pneumonia
- Legionella pneumoniophilia
- Pseudomonas aeruginosa
Treatment for early onset hospital acquired pneumonia
Narrow spectrum antibiotics
- Co amoxiclav
- Cefrtriaxone
- Ciprofloxacin
Treatment for late onset hospital acquired pneumonia
Broad spectrum antibiotics
- gentamycin
- vancomycin
- antipseudomonal cephaloisporin
Whats aspiration pneumonia?
Pneumonia caused by breathing vomit, a foreign object or a harmful substance
Treatment for aspiration pneumonia?
Co amoxiclav will cover gram neg and anaerobic bacteria but would be better to check exactly what bacteria using culture
according to NICE guidelines, how should the patient respond to treatment from week 1 - month 6
week 1- fever resolve week 4- chest pain and sputum reduced week 6- cough and sputum reduced month 3- most symptoms resolved, only tired month 6- back to normal
