1. Strep Pneumo 2. Staph aureus

Tyler Clin Med Flashcards by Sarah Mahonski

Typical Community acquired pneumonia NOT associated with co morbidity

i. Strep pneumo

How well did you know this?

Not at all

Perfectly

Atypical Community acquired pneumonia NOT associated with co morbidity

Chlamydophila pneumonia
C. psittaci
Legionella
M. Pneumo
Coxiella

How well did you know this?

Not at all

Perfectly

CAP CAUSE in individual with alcoholism comorbidity

Strep pneumo
oral anaerobes
klebsiella
acinetobacter

How well did you know this?

Not at all

Perfectly

CAP source with COPD comorbidity

S. pneumo
Moraxella Catarrhalis
H. flu

How well did you know this?

Not at all

Perfectly

CAP source post CVA aspiration

Oral flora

2. S. pneumo

How well did you know this?

Not at all

Perfectly

Post Bronchi obstruction CAP cause

Anaerobe

strep pneumo

How well did you know this?

Not at all

Perfectly

CAP from post flu

Strep Pneumo

2. Staph aureus

How well did you know this?

Not at all

Perfectly

CAP in someone with neutropenia or immunocompromised

Pseudomonnas

How well did you know this?

Not at all

Perfectly

Community acquired pneumonia from injection drug use

staph aureaus

How well did you know this?

Not at all

Perfectly

How do you determine Community acquired pneumonia tx?

History and comorbidities

How well did you know this?

Not at all

Perfectly

How is community acquired pneumonia treated in hospital setting? (not in ICU)

if not in ICU receive IV ceftriaxone 1 gm daily with 500 mg of azithromycin 500 mg daily

-levofloxacin can also be used

How well did you know this?

Not at all

Perfectly

What abx is starting to see resistance patterns?

azithromycin

How well did you know this?

Not at all

Perfectly

Treatment considerations for ventilator acquired pneumonia are the same as?

Hospital acquired pneumonia

How well did you know this?

Not at all

Perfectly

What patients are at risk for multi drug resistant pneumonia?

Hospital acquired pneumonia and ventilator acquired pneumonia

How well did you know this?

Not at all

Perfectly

When is a thoracocentesis indicated for pleural effusion

all effusions that have more than 1 cm layering in the decubitus view

How well did you know this?

Not at all

Perfectly

How do you treat pleural effusion related to Heart failure?

try diuretics

2. Do thoracentesis if effusions are asymmetrical, fever, chest pain, or effusion doesn’t resolve

How well did you know this?

Not at all

Perfectly

How do you treat pleural effusion related to infections?

Thoracentesis ASAP

How well did you know this?

Not at all

Perfectly

What is Light’s Criteria used for?

Transudative vs Exudative source of effusion

How well did you know this?

Not at all

Perfectly

Exudates fulfill at least 1 of which 3 criteria in lights criteria?

High pleural fluid protein/serum protein ratio
Pleural fluid LDH greater than 2/3 upper limit of normal
Pleural/serum LDH ratio >0.6

How well did you know this?

Not at all

Perfectly

What are the transudate criteria?

They DO NOT HAVE ANY OF THESES

High pleural fluid/serum protein ratio (greater than .5)
Pleural fluid LDH greater than 2/3 upper limit of normal
Pleural/serum LDH ratio >0.6

because of this ~25% transudates are diagnosed as exudates

What lab tests should you do for an exudative effusion?

pH
glucose
white blood cell count with Dif
microbiologic studies
cytology

Acute respiratory distress syndrome develops rapidly and patient will present with …? (3)

Severe Dyspnea
Diffuse pulmonary infiltrate
hypoxemia

What are the key diagnostic criteria for ARDs?

Diffuse bilateral pulmonary infiltrate on CXR
PaO2/FiO2 <300 mmHg
Absence of elevated left atrial pressure
Acute onset within 1 week of clinical insult or new or worsening respiratory sx (respiratory failure within 7 days)

PaO2= arterial partial pressure of oxygen in mmHg

FiO2= inspired O2 fraction

What would you see in the clinical case and pathophysiology of ARDs?

Alveolar edema and neutrophil inflammation
hyaline membrane development from diffuse alveolar damage
Alveolar edema causes atelectasis and reduced lung compliance
Hypoxemia, tachypnea, progressive dyspnea, hypercarbia ( from loss of alveolar exchange)
CXR shows bilateral lung opacities

What are the phases of ARDS?

1. Proliferative phase --> day 7-21, could recover or - develop progressive lung injury - evidence of pulmonary fibrosis - often have dyspnea and hypoxemia 2. Fibrotic phase --> set up for chronic respiratory failure - decreased lung compliance, greater pneumothorax risk

What can produce or exacerbate lung injury causing or worsening ARDs?

mechanical ventilator-related over distention of normal lung units with positive pressure

How is alveolar collapse in ARDs on a ventilator prevented?

- low tidal volumes with positive end-expiratory pressure (PEEP) at levels to minimize alveolar collapse - lowers required FiO2 used to achieve adequate oxygenation - place patient in prone position

What can increased pulmonary vascular permeability in ARDs lead to?

interstitial and alveolar edema

When should ARDs patients receive fluids?

Only as needed to achieve adequate cardiac output and tissue O2 delivery

What could potentially reduce the mortality in severe ARDs?

- neuromuscular blockage with cisatracurium for 48 hrs | - Most patients will REQUIRE sedation and paralytic agens

What should NOT be given and has no clinical evidence to treat ARDs?

- glucocorticoids | - nitric oxide

What is the tx of influenza? How soon should they be started?

1. Neuraminidase inhibitors- limit virus escaping host cell | - give within 48 hours for symptoms stopping 1-2 days sooner

1. prior isolation on culture 2. Recent hospitalization and receptor of parental abx are risk for what 2 organisms?

MRSA and Pseudommnas

1. Compromised immune system 2. Recent prior antibiotic use 3. Structural lung abnormalities such as cystic fibrosis or bronchiectasis 4. Repeated exacerbations of chronic obstructive pulmonary disease requiring frequent glucocorticoid and/or antibiotic use are risk factors for what?

Pseudomonas with CAP

What is risk for pseudomonas in Hospital acquired pneumonia

1. Increased age, length of mechanical ventilation, antibiotics at admission, transfer from a medical unit or ICU, and admission in a ward with higher incidence of patients with P. aeruginosa infections. 2. A lower probability of P. aeruginosa was associated with trauma and admission in a ward with high patient turnover

Hospital acquired pneumonia and ventilator acquired pneumonia have risk for what?

1. Increased mortality 2. MDR pathogens and MRSA 3. MDR pathogens without MRSA 4. MRSA alone

What is MDR

nonsusceptibility to at least one agent in three different antimicrobial classes.

What is Extensivly drug resistant?

nonsusceptibility to at least one agent in all but two antimicrobial classes.

What is pan drug resistant?

nonsusceptibility to all antimicrobial agents that can be used for treatment.

* Difficult to wean from the ventilator * Persistent lack of improvement overall * New infiltrates on chest x-ray * Newf evers * New changes in baseline data:CBC,CMP,etc. Are clues to what?

Ventilator associated pneumonia

Early onset VAP and HAP (less than 5 days in hospital) with no other risk factors for MDR organism is likely what?

1. Step pneumonia 2. H. flu 3. Enteric gram neg bacilli

Late onset HAP or VAP with more than 5 days in hospital is likely caused by what?

1. Staph aureus or ESKAPE (E. coli, serrate, klebsiella, actinetobacter, pseudomonas, enterobacter

-Cefepime -piperacillin-tazobactam -meropenem or ertapenem -levofloxin should be used when?

Ventilator associated pneumonia with low risk of MRSA and no risk of MDR

- Cefepime - piperacillin-tazobactam - meropenem - levofloxin +VANCOMYCIN should be used when?

suspected MRSA

When should vancomycin be used?

MRSA/MDR risk, sepsis, hypotension, rapid progression of infiltrates on chest radiograph

Vancomycin + levofloxacin or azithromycin should be used when?

Leginella suspected

Ciprofloxacin or levofloxacin + vancomycin should be used to treat what?

Pseudomonas

What can be substituted for vancomycin?

linezolid

1. Alveolar edema and neutrophil inflammation 2. hyaline membrane development from diffuse alveolar damage 3. Alveolar edema causes atelectasis and reduced lung compliance 4. Hypoxemia, tachypnea, progressive dyspnea, hypercarbia ( from loss of alveolar exchange) 5. CXR shows bilateral lung opacities is what?

Pathophysiology of ARDs