Resp Flashcards
what is hospital acquired pneumonia
pneumonia that has occurred 48 hrs after hospital admission
common causes of community acquired pneumonia
streptococcus pneumoniae (!)
mycoplasma pneumoniae
haemophilus pneumoniae
atypical organisms that cause pneumonia
mycoplasma pneumoniae
legionella pneumophilia
chlamydia psittaci
chlamydia pneumoniae
common causes of hospital acquired pneumonia
staphylococcus aureus
pseudomonas aeruginosa
klebsiella
causes of aspiration pneumonia
anaerobes from gut flora
risk factors for pneumonia
smoking
recent travel
immunocompromised
faulty air conditioning (legionella)
pet birds (chlamydia psittaci)
pneumonia symptoms (typical)
fever
SOB
productive cough (yellow/green sputum)
pleuritic chest pain
pneumonia symptoms (atypical)
dry cough
headache
diarrhoea
myalgia
hepatitis
confusion (legionella)
pneumonia signs (typical)
resp distress
cyanosis
reduced chest expansion
dull percussion over areas of consolidation
basal coarse crepitus
bronchial breathing
increased vocal resonance
pneumonia signs (atypical)
mycoplasma pneumoniae
- transverse myelitis
- erythema multiforme
- associated with AIHA
legionella
- hyponatraemia
- abnormal LFTs
pneumonia investigations
sputum MCS
FBC (high WCC)
high CRP
ABG (type 1 resp failure)
pleural fluid MCS via thoracentesis
CXR (consolidation with fluid levels)
atypical:
blood film
urinary antigens
LFTs
what would cxr show for pneumonia
lobar pneumonia
- consolidation within one lobe
bronchopneumonia
- consolidation all over the lungs
how is pneumonia severity assessed
CURB-65
confusion
urea > 7mmol/L
resp rate > 30
BP <90
age >65
mx of pneumonia
depends on CURB-65 score
1 = GP + oral antibiotics
2 = A&E + IV antibiotics
3+ = hospital admission + IV antibiotics + consider ITU
community acquired pneumonia antibiotics
typical:
- amoxicillin
- co-amoxiclav if severe
atypical:
- clarithromycin
typically amoxicillin and clarithromycin are given together if causative organism not yet identified
hospital acquired pneumonia antibiotics
staph aureus:
- flucloxacillin
MRSA:
- vancomycin
pseudomonas:
- tazocin + gentamicin
anaerobes:
- metronidazole and amoxicillin
special considerations when prescribing for pneumonia
if pt has penicillin allergy give doxycycline
in HIV pts give co-trimoxazole
pneumonia differentials
bronchitis
bronchiectasis
lung cancer
complications of pneumonia
pleural effusion
sepsis
ARDS
acute bronchitis typical organisms
rhinovirus
parainfluenza
influenza A or B
respiratory syncytial virus
coronavirus
risk factors acute bronchitis
smoking
cystic fibrosis
COPD
acute bronchitis signs and symptoms
non-productive or minimally productive cough
dyspnoea
MILD fever
acute bronchitis investigations
diagnosis based on clinical presentation
maybe CXR
Mx in acute bronchitis
otherwise healthy pts:
- paracetamol and ibuprofen as required
- hydration
cough persisting > 2 wks:
- inhaled corticosteroids
- inhaled beta 2 agonist may be useful if wheeze
- antitussives if cough interfering with sleep
pts with underlying lung pathology:
- oral abx (7 days of amoxicillin or doxycycline)