Pneumonia Flashcards
What is the criteria for respiratory failure?
MOVE:
M- mechanical : Respiratory rate >35/min
O - oxygenation: PaO2 <70 mmHg with FiO2 of 0.4
V - ventilation: PaC02 >55mmHg
E - End inspiratory lung inflation is inadequate for gas exchange
How is community acquired pneumonia diagnosed?
Community-acquired pneumonia is diagnosed by clinical features (e.g., cough, fever, pleuritic chest pain) and by lung imaging, usually an infiltrate seen on chest radiography.
How is hospital acquired pneumonia diagnosed?
Hospital-acquired pneumonia is diagnosed by clinical features (e.g., cough, fever, pleuritic chest pain) and by lung imaging, usually an infiltrate seen on chest radiography at least 48 hours after hospital admission.
What signs and symptoms would make you suspect pneumonia?
Symptoms: cough, fever, pleuritic chest pain, shortness of breath
Signs: lung imaging, usually an infiltrate seen on chest radiography, tachypnea
What is your differential diagnosis of a patient who presents with a cough?
Pneumonitis Bronchitis Upper respiratory infection Lung cancer Pneumonia Bronchiectasis
What is your differential diagnosis of a patient who presents with shortness of breath?
ARDS Cardiogenic pulmonary edema Non cariogenic pulmonary edema Pneumonia Asthma exacerbation Lung cancer Pleuritic pain
What is your first line treatment for community acquired pneumonia?
Ceftriaxone and azithromycin if allergic then clindamycin and aztreonam.
Treatment should last 10-14 days
What is your first line treatment for hospital acquired pneumonia?
Zosyn and Levofloxacin OR Zosyn and Azithromycin OR Zosyn + Levofloxacin + Azithromycin
If concerned for MRSA with pneumonia, what agent is important to add to the treatment regimen?
If concerned for MRSA then add vancomycin or linezolid
If concerned for flu with pneumonia, what agent is important to add to the treatment regimen?
If concerned for flu then add oseltamivir
If concerned for aspiration pneumonia, what agent is important to administer?
Zosyn
What organisms are responsible for community acquired pneumonia?
Streptococcus pneumonia
Mycoplasma pneumonia
Hemaphalous influenza
What organisms are responsible for hospital acquired pneumonia?
Enteric gram-negative bacilli (Pseudomonas aeruginosa)
Gram-positive cocci (Methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus (MRSA))
Other enteric gram-negative bacteria include Enterobacter species, Klebsiella pneumoniae, Escherichia coli, Serratia marcescens, Proteus species, and Acinetobacter species).
Describe management of community acquired pneumonia.
Physical examination Vitals Chest X-ray ABG if oxygen saturation is low Sputum culture Blood culture if fever Oxygen therapy Antibiotic therapy for at least 14 days
What are the indications for hospitalization in a pregnant patient with pneumonia?
SMART-COP Systolic pressure is low Multilobal chest radiographic involvement Albumin is low Respiratory rate is high Tachycardia Confusion Oxygenation is poor pH - Arterial pH is low
