Resp - Pneumonia Flashcards
Anatomical classification
- Bronchopneumonia: patchy consolidation of different loves
- Lobar pneumonia: fibrosupurative consolidation of a single lobe
Bugs- HAP vs CAP
- CAP: pneumococcus, mycoplasma, haemophilus, S aureus, moraxella, chlamydia, legionella, viruses (15%)
- HAP: >48h after hospital admission, gram -ve enterobacteria, S aureus
Bugs: immunodeficiency pts
-usually bugs + PCP, TB, fungi, CMV/HSV
Symptoms
-Fever, rigours, malaise, anorexia, dyspnea, cough, haemoptysis, purulent sputum, pleuritic pain
Signs
- Raised RR and HR
- Cyanosis
- Confusion
- Consolidation: decreased expansion, dull percussion, bronchial breathing, crackles, pleural rub
Ix
- Bloods: FBC, U+E, LFT, CRP, culture, ABG (if ↓SpO2)
- Urine: Ag tests (Pneumococcal, Legionella)
- Sputum: MC&S
- Imaging: CXR —> infiltrates, cavities, effusion
- Special: Paired sera Abs for atypicals (Mycoplasma, Chlamydia, Legionella)
What score do you need to know?
CURB 65
- Confusion
- Urea >7mM
- Resp rate >30/min
- BP <90/60
- > 65
0-1 = home rx 2 = hospital rx >3 = condition ITU
What is the Mx?
- ABX
- O2: PaO2 >8kpa and SpO2 94-98%
- Fluids
- Analgesia
- Chest physio
- Consider ITU if shock, hyper apnea, hypoxia
- F/U at 6 wks with CXR and check for underlying Ca
ABX- CAP (mild-sev + atypical)
-Mild: amoxicillin 500mg TDS PO for 5d or clarithro 500mg BD PO for 7d
-Mod: amoxicillin 500mg TDS and clarithro 500mg BD PO/IV (clarithro alone if pen allergy) for 7d
-Sev: Co-amoxiclav 1.2g TDS IV / cefuroxime 1.5g TDS IV and clarithro 500mg BD IV for 7-10d (Add fluclox if staph suspected).
-Atyp Chlamydia: tetracycline PCP: Co-trimoxazole
Legionella: Clarithro + rifampic
HAP ABX (mild and severe + aspiration)
- Mild / <5d: Co-amoxiclav 625mg PO TDS for 7d
- Severe / >5d: Tazocin ± vanc ± gent for 7d
- Aspiration: Co-amoxiclav 625mg PO TDS for 7d
