Respiratory Flashcards
Define pneumonia
Acute LRTI associated with fever, symptoms and signs in the chest, and consolidation visible on chest x-ray
Inflammation of lung parenchyma (alveolar spaces) due to infective agent
Predisposing factors to pneumonia
Smoking Alcoholism Immunodeficiency Diabetes COPD CKD CLD >65 /<16
What are the 3 types of pneumonia?
Organising
Broncho
Lobar
Signs and symptoms of pneumonia
Signs: Pyrexia Cyanosis Confusion (can be only sign in the elderly) Tachypnoea Tachycardia Hypotension Signs of consolidation (reduced expansion, dull percussion, bronchial breathing) Pleural rub
Symptoms: Fever Rigors Malaise Anorexia Dyspnoea Cough Purulent sputum Haemoptysis and pleuritic pain
Complications of pneumonia
T1RF AF Pleural effusion Brain/lung abscess Pericarditis Myocarditis Cholestatic jaundice Sepsis/septic shock
Differentials of pneumonia
LRTI
COPD/obstructive airway diseases
Bronchiectasis
Investigations for pneumonia
Bedside:
Sputum, urine sample
Bloods:
ABG, FBC, WCC, CRP, U&Es urea, mycoplasma, serology, cultures
Imaging:
CXR
Consider: Pleural tap (culture fluid), chest CT, bronchoscopy
What are the elements of CURB-65?
What does it measure?
Measures severity of CAP
1 point for each of: Confusion of new onset (AMT<8) Urea >7mmol/L Respiratory rate >30bpm Blood pressure <90mmHg systolic/<60mmHg diastolic >65
01 - PO antibiotic/home treatment
2 - hospital therapy
>/=3 - consider ITU
Management of pneumonia
Antibiotics (oral or IV) Oxygen (aim for PaO2 >8/sats >94%) IV fluids VTE prophylaxis Nutrition Analgesia if pleurisy Physiotherapy Consider ITU (shock, hypercapnia, uncorrected hypoxia) Follow up at 6 weeks + CXR
What are the 4 broad categories of pneumonia?
Community acquired pneumonia
Hospital acquired pneumonia
Aspiration pneumonia
Immunocompromised pneumonia
Common causative agents of CAP
Bacteria 85% - Viruses 15%
Strep pneumoniae
Haemophilius influenzae
Mycoplasma pneumonia
Management of mild CAP
CURB 0-1
Oral amoxicillin 500mg-1g/8hrs or Clarithromycin 500/12hr or Doxycycline 200mg loading then 100mg/day
Management of moderate CAP
CURB 2
Oral amoxicillin 500mg-1g/8hrs
AND
Clarithromycin 500mg/12h
Management of severe CAP
CURB 3-5
IV co-amoxiclav 1.2g/8h or IV cefuroxime 1.5g/8h AND IV clarithromycin 500mg/12h
Define hospital acquired pneumonia
Pneumonia contracted >48hrs after admission
What structure is affected in aspiration pneumonia?
Right lower lobe
Common causative agents in aspiration pneumonia
Anaerobes and Strep pneumoniae
Management of aspiration pneumonia
IV cephalosporin
AND
IV metronidazole
Causes of immunocompromised pneumonia
Conventional pathogens + fungi: Pneumocystis, Candida, Aspergillus
Mycobacteria: TB
Viruses: CMV, HSV
AIDs defining infections e.g. PCP
Risk factors for aspiration pneumonia
Swallowing dysfunction
Gastro-oesophageal reflux
Neurological disease
Mechanical- and device-related impairment of the upper digestive tract (e.g. tracheostomy, ETT, nasogastric/percutaneous feeding tube)
Risk factors for DVT
Increasing age Pregnancy Oestrogen (COCP, HRT) Trauma Surgery (pelvic, orthopaedic) Previous DVT Cancer Obesity Immobility Thrombophilia/coagulopathy (e.g. Factor V Leiden)
Signs of DVT
Calf warmth/tenderness/swelling/erythema
Mild fever
Pitting oedema
Dilated superficial leg veins
Complications of DVT
Embolism and PE
Pulmonary HTN
Post-DVT syndrome
Budd-Chiari syndromes
Differentials of DVT
Cellulitis
Ruptured Baker’s cyst
Investigations in DVT
D-dimer
USS
Thrombophilia tests
Underlying malignancy screen
What is Wells’ criteria and what does it measure?
Probability of DVT
Likely: >2 points
Unlikely <2 points
Active cancer
Bedridden recently >3 days or major surgery within 12 weeks
Calf swelling >3cm compared to other leg
Collateral superficial veins present
Entire leg swollen
Localised tenderness along deep venous system
Pitting oedema confined to symptomatic leg
Paralysis, paresis or recent plaster immobilisation of lower extremity
Previously documented DVT
Alternative diagnosis to DVT as likely or more likely
Management of DVT
Anti-coagulate - LMWH, warfarin IVC filters Compression stockings Thrombolysis Surgical removal (trellis device)
DVT prevention and prophylaxis
All hospital patients on admission
Reassessment within 24h and when clinical situation changes
Prophylaxis - LMWH, TED stockings, early mobilisation
Complications of DVT
PE Bleeding during initial treatment Heparin-induced thrombocytopenia (IHT) Heparin resistance/aPTT confounding Post-thrombotic syndrome Bleeding during long-term/extended treatment Osteoporosis due to heparin treatment
Pathophysiology of DVT
Virchow’s triad
Formation of thrombus dependent on any one of Virchow’s triad being present
Stasis of blood flow
Endothelial injury
Hypercoagulability
