Pneumonia - Complications****

Question 1

Resp failure:

It is Type 1 RF. What does this mean in terms of PaO2?

How is it treated?

Why are frequent ABG’s done?

Answer 1

PaO2 <8kPa - A measurement of oxygen pressure in arterial blood. It reflects how well oxygen is able to move from the lungs to the blood, and it is often altered by severe illnesses.

High-flow oxygen

To check for acidosis

Question 2

Hypotension (systolic <90):

2 reasons why this happens

Rx?

Answer 2

Combination of dehydration and vasodilation due to sepsis

Fluids

Question 3

Atrial Fibrillation:

What age group is this common in?

Rx?

Answer 3

Elderly

Beta-blockers/digoxin if no improvement

Question 4

Pleural effusion:

What is it?

Rx if the patient becomes symptomatic/infected (empyema)?

Answer 4

Get fluid exudation into pleural space

Drainage

Question 5

Empyema:

What is it?

When should it be suspected?

Clinical features on CXR

What would the aspirated fluid look like?

Rx?

Answer 5

PUS in the pleural space

Patient with resolving pneumonia who develops a recurrent fever

CXR - pleural effusion

Yellow, low in glucose and high in LDH

Chest drain under radiological guidance

Question 6

Lung abscess:

What is it?

Causes? - list some

S+S - 1

How does it change percussion on examination?
Sign on nails?

Answer 6

Necrotic tissue leaves pus-filled cavity

Inadequate pneumonia Rx 
Aspiration
Bronchial obstruction 
Pulmonary infarction
Septic emboli 

Non-specific respiratory and systemic symptoms

Dullness to percussion
Clubbing

Question 7

Lung abscess:

Investigations:

• CXR - what do you see?
• Bloods - 4
• 2 types of cultures you’d do?

Answer 7

Cavitation with fluid level - look up

FBC
U+E
LFT
CRP

Blood and sputum culture

Question 8

Lung abscess:

Medical management - 1

Surgical management - 1

Answer 8

ABs for 8 wks

Drainage or surgical excision

Question 9

Septicaemia:

Where does it arise from?

What does it lead to?

Answer 9

Spread from lung parenchyma into the bloodstream

Leads to meningitis and infective endocarditis

Question 10

Why may they get jaundice?

Answer 10

Due to cholestasis from:

• Sepsis
• Secondary to antibiotic therapy (particularly flucloxacillin and co-amoxiclav)