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Cardio-Respiratory Block > Pneumonia - Diagnosis & Management > Flashcards

Pneumonia - Diagnosis & Management Flashcards

1
Q

Define Pneumonia

A
  • An acute lower respiratory tract illness associated with fever, symptoms and signs in the chest and abnormalities on chest x-ray
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2
Q

Give four classifications of pneumonia causes

A

Community acquired pneumonia
Hospital acquired pneumonia
Aspiration
Immunocompromised

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3
Q

Give three main causes of community acquired pneumonia

A

Strep pneumonia
Haemophilus influenza
Mycoplasma pneumonia

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4
Q

Give some other causes of community acquired pneumonia

A
  • Staphylococcus aureus, Legionella, Moraxella catarrhalis and chlamydia account for most of the remainder
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5
Q

Give three viral causes of community acquired pneumonia

A

Influenza, Respiratory syncytial virus, human parainfluenza

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6
Q

Give two main causes of hospital acquired pneumonia

A
  • Staph aureus and gram –‘ve enterococci
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7
Q

Give four other causes of hospital acquired pneumonia

A
  • Pseudomonas, Klebsiella, Bacteroides and Clostridia
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8
Q

What conditions cause aspiration pneumonia?

A
  • Those with stroke, myasthenia, bulbar palsies, decreased consciousness, oesophageal disease
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9
Q

What bacteria cause immunocompromised pneumonia

A
  • Strep pneumonia, Haemophilus influenza, Staph aureus, M cattarhalis, M pneumonia
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10
Q

Outline the symptoms of pneumonia

A
  • Fever, rigors, malaise, anorexia, dyspnoeal, productive cough (rusty phlegm suggests pneumococcus), purulent sputum, haemoptysis and pleuritic pain
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11
Q

Give the signs of pneumonia

A
  • 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.
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12
Q

What is the point of the CURB-65

A

Measurement of pneumonia severity and management guide

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13
Q

What are the CURB-65 criteria

A

Confusion (abbreviated mental test 7mmol/l
Respiratory rate >30/min
BP >90/60mmHg
Age >65

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14
Q

Give three other features of pneumonia which can increase the CURB risk

A

co-existing disease, bilateral/multilobar involvement, paO2

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15
Q

How does the scoring work for CURB-65?

A

Score:
1- home treatment if possible
2- hospital therapy
3- Indicates severe pneumonia and should consider ICU referral

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16
Q

Give the tests used in acute pneumonia

A
  • 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
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17
Q

Outline the management of pneumonia

A

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.

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18
Q

How do you assess ABCs of pneumonia treatment?

A

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

19
Q

Outline bloods needed for pneumonia

A
  • FBC, U&E, LFT, CRP, atypical serology
20
Q

What antibiotics are used for severe pneumonia?

A

Co-amoxiclav 1.2g tds (cefuroxime 1.5g tds) AND clarithromycin 500mg BD (Ciprofloxacin)

21
Q

What analgesia is used in pneumonia?

A

For pleuritic chest pain, eg paracetamol 1g/QDS

22
Q

If there is no improvement in management what must happen?

A

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.

23
Q

Give three complications of pneumonia?

A

Pleural effusion, Empyema, Lung abscess

24
Q

How do you treat mild to moderate community acquired pneumonia?

A

Mild, moderate – Oral amoxicillin 500mg -1g/8h or clarithromycin 500mg/12h

25
Q

How do you treat severe pneumonia?

A

Severe – Co-amoxiclav 1.2g.8h IV or cephalosporin IV AND clarithromycin 500mg/12h IV

26
Q

How do you treat legionella pneumophillia

A

Levofloxacin + rifampicin

27
Q

How do you treat chlamydophilia?

A

Tetracycline

28
Q

How do you treat pneumocystitis jiroveci

A

Co-trimoxazole

29
Q

How do you treat hospital acquired pneumonia?

A

Aminoglycoside IV (gentamicin) + antipseudomonal penicillin

30
Q

How do you discharge a patient recovering from pneumonia?

A

Patients should be reviewed within 24 hours of planned discharge home and those suitable for discharge should not have more than one of the following characteristics present (unless they represent the usual baseline status for that patient).
These clinical “instabilities” include temperature > 37.8C, heart rate > 100/min, respiratory rate >24/min, systolic blood pressure

31
Q

Demographics for pneumococcal

A

Elderly, alcoholics, post-splenectomy, immune-suppressed patients, chronic HF and pre-exisiting lung conditions

32
Q

Give three clinical features of pneumococcal

A

Elderly, alcoholics, post-splenectomy, immune-suppressed patients, chronic HF and pre-exisiting lung conditions

33
Q

Give imaging of pneumococcal

A

Lobar consolidation

34
Q

What are the demographics of haemophilus influenza

A

COPD

35
Q

Give demographics of staph

A

May complicate influenza infection, young, elderly, IVDU, underlying disease (CF, cancers)

36
Q

Give imaging of staph

A

Bilateral cavitating bronchopneumonia

37
Q

Give demographics of Klebsiella

A

alcoholics, diabetics, malnourished

38
Q

Give demographics of mycoplasma pneumonia

A

Occurs in epidemics every 4yrs, presents insidiously with flu-like (headache, myalgia, arthralgia) symptoms followed by a dry cough

39
Q

Mycoplasma pneumonia imaging

A

Patchy consolidation of 1 lower lobe

40
Q

Give clinical features/diagnosis of mycoplasma pneumoniae

A

PCR sputum or serology

41
Q

Give demographics of legionella

A

Colonizes water tanks kept at

42
Q

Give clinical features/diagnosis of legionella

A

Anorexia, hepatitis, renal failure

43
Q

Give imaging of legionella

A

Bi-basal consolidation

Cardio-Respiratory Block (11 decks)

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