Pneumonia - Diagnosis & Management Flashcards
Define Pneumonia
- An acute lower respiratory tract illness associated with fever, symptoms and signs in the chest and abnormalities on chest x-ray
Give four classifications of pneumonia causes
Community acquired pneumonia
Hospital acquired pneumonia
Aspiration
Immunocompromised
Give three main causes of community acquired pneumonia
Strep pneumonia
Haemophilus influenza
Mycoplasma pneumonia
Give some other causes of community acquired pneumonia
- Staphylococcus aureus, Legionella, Moraxella catarrhalis and chlamydia account for most of the remainder
Give three viral causes of community acquired pneumonia
Influenza, Respiratory syncytial virus, human parainfluenza
Give two main causes of hospital acquired pneumonia
- Staph aureus and gram –‘ve enterococci
Give four other causes of hospital acquired pneumonia
- Pseudomonas, Klebsiella, Bacteroides and Clostridia
What conditions cause aspiration pneumonia?
- Those with stroke, myasthenia, bulbar palsies, decreased consciousness, oesophageal disease
What bacteria cause immunocompromised pneumonia
- Strep pneumonia, Haemophilus influenza, Staph aureus, M cattarhalis, M pneumonia
Outline the symptoms of pneumonia
- Fever, rigors, malaise, anorexia, dyspnoeal, productive cough (rusty phlegm suggests pneumococcus), purulent sputum, haemoptysis and pleuritic pain
Give the signs of pneumonia
- Pyrexia, cyanosis, herpes labialis, confusion, tachypnoea, tachycardia, hypotension, signs of consolidation (diminished expansion, dull percussion note, increased tactile vocal fremitus/vocal resonance, bronchial breathing) and a pleural rub.
What is the point of the CURB-65
Measurement of pneumonia severity and management guide
What are the CURB-65 criteria
Confusion (abbreviated mental test 7mmol/l
Respiratory rate >30/min
BP >90/60mmHg
Age >65
Give three other features of pneumonia which can increase the CURB risk
co-existing disease, bilateral/multilobar involvement, paO2
How does the scoring work for CURB-65?
Score:
1- home treatment if possible
2- hospital therapy
3- Indicates severe pneumonia and should consider ICU referral
Give the tests used in acute pneumonia
- CXR
- Oxygen saturation and arterial blood gases
- FBC, U&E, LFT, CRP, atypical serology
- Urine pneumococcal (and legionella) antigen
- Viral throat swabs
- Blood cultures if pyrexial
- Pleural fluid may be aspirated for culture
- Bronchoscopy and bronchoalveolar lavage if the patient is immunocompromised or on ICU
Outline the management of pneumonia
Management
Assess using ABC
A+B Treat hypoxia (sats Venturi mask
C Treat hypotension/shock from infection. Assess for dehydration (common if acutely unwell and fever), consider IV fluid support
Investigations
Test
- CXR
- Oxygen saturation and arterial blood gases
- FBC, U&E, LFT, CRP, atypical serology
- Urine pneumococcal (and legionella) antigen
- Viral throat swabs
- Blood cultures if pyrexial
- Pleural fluid may be aspirated for culture
- Bronchoscopy and bronchoalveolar lavage if the patient is immunocompromised or on ICU
Antibiotics
Co-amoxiclav 1.2g (cefuroxime 1.5g tds) AND clarithromycin 500mg/12h (Ciprofloxacin)
Analgesia
For pleuritic chest pain, eg paracetamol 1g/QDS
No improvement - If hypoxic despite oxygen, consider CPAP to recruit lung parenchyma and improve oxygenation. But if patient is hypercapnic they will require NIV or invasive ventilation.
How do you assess ABCs of pneumonia treatment?
Assess using ABC
A+B Treat hypoxia (sats Venturi mask
C Treat hypotension/shock from infection. Assess for dehydration (common if acutely unwell and fever), consider IV fluid support
Outline bloods needed for pneumonia
- FBC, U&E, LFT, CRP, atypical serology
What antibiotics are used for severe pneumonia?
Co-amoxiclav 1.2g tds (cefuroxime 1.5g tds) AND clarithromycin 500mg BD (Ciprofloxacin)
What analgesia is used in pneumonia?
For pleuritic chest pain, eg paracetamol 1g/QDS
If there is no improvement in management what must happen?
If hypoxic despite oxygen, consider CPAP to recruit lung parenchyma and improve oxygenation. But if patient is hypercapnic they will require NIV or invasive ventilation.
Give three complications of pneumonia?
Pleural effusion, Empyema, Lung abscess
How do you treat mild to moderate community acquired pneumonia?
Mild, moderate – Oral amoxicillin 500mg -1g/8h or clarithromycin 500mg/12h
