Ward Cases - Pneumonia, Pneumothorax, Effusions Flashcards
What does CURB-65 scoring help us with?
Deciding the best place of management for the patient (home, out-patient, in-patient) based upon risk
Risk is determined using Confusion Uremia Respiratory Rate Blood pressure Age > 65
Community Acquired Pneumonia (CAP) category I
- what defines this category
- what is the likely source of infection
- what antibiotics can be used
Outpatient, no cardiopulmonary disease, no modifying factors
S. pneumo M. pnumo Respiratory viruses C. pneumo H. flu
Macrolide
Doxycycline
Community Acquired Pneumonia (CAP) category II
- what defines this category
- what is the likely source of infection
- what antibiotics can be used
Outpatient, cardiopulmonary disease or modifying factors
S. pnuemo M. pneumo C. pneumo Respiratory viruses Enteric GNR Mixed infection
Fluoroquinolone
OR
B-lactam + Macrolide or Doxycycline
What are common cardiopulmonary disease/modifying factors?
CHF COPD Cirrhosis ESRD DM EtOH abuse Malignancy Asplenia Immunosuppressed
Community Acquired Pneumonia (CAP) category III
- what defines this category
- what is the likely source of infection
- what antibiotics can be used
Inpatient, non-ICU
S. pnuemo M. pneumo C. pneumo H. flu Legionella Aspiration Respiratory viruses
B-lactam + macrolide
OR
Fluoroquinolone
Community Acquired Pneumonia (CAP) category IVa
- what defines this category
- what is the likely source of infection
- what antibiotics can be used
Inpatient ICU with NO risk factors for Pseudomonas
S. pneumo Legionella H. flu GNRs S. aureus M. pneumo Respiratory viruses
B-lactam + macrolide
OR
Fluoroquinolone
What are risk factors for community acquired pneumonia?
Previous pseudomonas infection
CF or bronchiectasis
Tracheostomy
Previous anti-pseudomonal antibiotic exposures
Community Acquired Pneumonia (CAP) category IVb
- what defines this category
- what is the likely source of infection
- what antibiotics can be used
Inpatient ICU with risk factors for Pseudomonas
S. pneumo Legionella H. flu GNRs S. aureus M. pneumo Respiratory viruses Pseudomonas
Antipseudamonal b-lactam +
(aminoglycoside + macrolide or fluoroquinolone_
OR Fluoroquinolone
Community Acquired Pneumonia (CAP) category IVb
–what antibiotics get added if the person is at risk for community acquired MRSA
Vancomycin or Linezolid
After influenza infection, prevalence of what infection goes up significantly?
S. aureus
What is the most likely bacterial cause of CAP?
S. pneumonia
What is the most likely cause of CAP in AIDs pts?
S. pneumonia
TRICK QUESTION!
- -s. pneumo is still the main cause
- -pneumocystis jiroveic is fourth or fifth on the differential now
What has the biggest impact on mortality for CAP?
Time to antibiotics
Pneumovax
- Route of administration
- Type of vaccine
- Recommended groups
- Revaccination
Route of administration - IM
Type of vaccine - bacterial cell wall
Recommended groups
- age >/= 65
- Smokers
- High risk conditions
Revaccination - 1 time after 5 years
What are considered to be the high risk conditions/indications for pneumovax?
Cardiopulm disease DM EtOH Asplenia Immunosuppressed Long-term care facility
Inactivated Influenzae
- Route of administration
- Type of vaccine
- Recommended groups
- Revaccination
Route of administration - IM
Type of vaccine - killed virus
Recommended groups
- Age >/= 50
- Children > 6 mo
- Health care pers.
- High risk conditions and their contacts
Revaccination - Annual
What are considered to be the high risk conditions/indications for pneumovax?
Cardiopulm disease DM Renal disease Immunosuppressed Pregnancy
Attenuated Influenzae
- Route of administration
- Type of vaccine
- Recommended groups
- Revaccination
Route of administration - Intranasal
Type of vaccine - live virus
Recommended groups
- Age 2-49
- Health care pers.
Avoid in high risk individuals
Revaccination - Annual
Atypical pneumonia
Mycoplasma
CF pt pneumonia
Pseudomonas
Pneumonia, Birds
C. Psittaci
Aspiration pneumonia
Anaerobes (e.g. peptostreptococcus)
Pneumothorax
- definition
- symptoms
Air/gas in the pleural space
Asymptomatic
Pleuritic chest pain
Cough
Dyspnea
Pathophysiology of pneumothorax
Pressure w/in the intrapleural space is negative
Any communication b/t the air filled lung parenchyma and pleural space will result in accumulation of air within the pleural space until the pressures are equalized (b/t of the gradient)
Result is a collapse of the lung and hyper-expansion of he hemi-thorax, leading to impairment
What are the different types of pneumothorax
Spontaneous
- primary
- secondary
Traumatic
Iatrogenic
Tension!
Explain about the diagnosis of tension pneumothorax
Clinical diagnosis
Hemodynamic instability secondary to poor venous return b/t everything is being pushed over (mass effect)
- -hypotension
- -tachypnea
- -midline shift
EMERGENCY
Pneumothorax findings on P/E
Diminished or absent breath sounds on affected side
Tactile fremitus is diminished or absent
Hyper-resonance to percussion
If large enough, tracheal deviation AWAY from pneumothorax
How is a tension pneumothorax drained?
Needle decompression
2nd ICS midclavicular line
What are the three goals of treating a pneumothorax? Give examples of how each is done.
Prevent death
- aspiration
- chest tube
Relieve symptoms
- obs +/- O2
- aspiration
- chest tube
Prevent recurrence
- pleurodesis (scars 2 pleural surfaces together)
- surgical resection of affected area
