Weel 120 - Bronchial sepsis Flashcards
What is palmar erythema?
Red palms.
What further tests would you perform for a diagnosis of severe community acquired pneumonia with sepsis?
- Sputum culture.
- Blood culture x 2.
- Legionella antigen (urine)
- Atypical serology.
A lady with severe pneumonia and sepsis is in the hospital, she has a BP of 75/48, what is your intitial plan of action?
- ‘Agressive’ IV fluids to maintain systolic BP of >100.
- Analgesics.
- 60% FiO2
- IV benzylpenicillin
- IV clairthromycin
What two IV antibiotics would you give as part of the initial treatment plan of pneumonia with sepsis?
- IV benzylpenicillin
* IV clarithromycin
What is the incidence of community acquired pneumonia?
4-10 in 1000
What is the incidence of hospital acquired pneumonia amongst the hospital population?
1 in 100
What is the historical way of classifying pneumonias?
Atypicial and typical.
What is ‘Atypical’ Pneumonia?
- Gradual onset
- Dry cough
- Myalgias
- Headache
What is ‘typical pneumonia’?
- Sudden onset
- Purulent sputum
- High fever
- Focal consolidation
What is ‘focal consolidation’?
The replacement of gas in the lungs with fluid, protein, cells in a single spot in the lungs.
What are the four microbiology classifications on pneumonia?
- Bacteria
- Virus
- Fungal
- Helminths/protozoa (rare)
Describe steptococcus pneumoniae.
- Gram +ve
- Lives in respiratory tract
- Rapid multiplication
- Abrupt onset
- Very ill
- MEDICAL EMERGENCY!
Which strain of bacteria is this describing? • Gram +ve • Lives normally in respiratory tract • Abrupt multiplication • Causes host to be very ill • Is a medical emergency?
Streptococcus pneumoniae
Which form of pneumonia occupies one lobe and what are the three pathogens that most frequently cause it?
Lobar pneumonia
• Streptococcus pneumoniae
• Haemophilus influenza
• Morexxa Catarrhalis
Describe haemophilus influenza.
- Gram -ve
- Usually encapsulated
- Small pleural effusions can occur.
Which bacteria can cause lobar pneumonia, is usually encapsulated and can cause small pleural effusions?
Haemophilus influenza.
Which anatomical description of pneumonia has been most linked to hospital acquired pneumonia?
Bronchopneumonia
What is bronchopneumonia and what are the four most likely organisms to cause it?
It is pneumonia that is the acute inflammation of the walls lining the bronchioles, it is characterised by multiple loci. • Staphylococcus aureus • Klebsiella • E. Coli • Pseudomonnas
Describe Staphylococcus aureus.
- Gram +ve
- Spread via airway or bacteraemia
- Lung tissue lysis can lead to cavitation.
- Septicaemia, abscesses and empyema are common.
Which gram +ve bacteria that causes the majority of hospital acquired pneumonia, is spread via the airway and can cause cavitation, septicaemia, abscesses and empyema?
Staphylococcus aureus.
Describe klebsiella.
- Gram -ve
- Colonise the oropharynx
- Nosocomial
- Comorbity is common
- Very ill
- Haemoptosis
- Poor prognosis.
Which gram-ve bacteria (that causes pneumonia) colonises the oropharynx, is nosocomial causes people to be very ill, have haemoptosis and has a poor prognosis?
Klebsiella
What does nosocomial mean?
Hospital acquired infection.
Describe Escherichia coli.
- Gram -ve
- Often occurs in patients with comorbities who are chronically ill.
- Occurs from aspiration.
- Often affects the lower lobe.
- Poor prognosis.
Which gram -ve bacteria which often infects those with comorbidites who are chronically ill, usually via aspiration, affecting the lower lobe with a poor prognosis?
Escherichia coli
Describe Pseudomonas aeriginosa.
- Gram -ve
- Chronically ill patients often with structural lung disease.
- Produces copious amounts of very green sputum.
- Gradual onset.
Which gram -ve bacteria causes pneumonia in chronically ill patients, often with structural lung disease, produces copious amounts of very green sputum and has a gradual onset?
Pseudomonas aeriginosa.
Describe Legionella pneumophilia.
- gram -ve intracellular bacteria.
- Often from water or air conditioning.
- Affects people who are immunosupressed.
- Causes; dry cough, myalgia, acute renal failure, hepatoslenomegaly, diarrhoea, oliguria, rash, rhabdomyolysis.
What are the 8 symptoms of Legionella pneumophilia?
1) Rash
2) Oliguria
3) Diarrhoea
4) Acute renal failure
5) Hepatosplenomegaly
6) rhabdomyolysis
7) Dry cough
8) Myalgia
What is oliguria?
Oliguria is poor urine output.
What is rhabdomyolysis?
Breakdown of skeletal muscle.
What is mycoplasma pneumoniae?
Occurs in closed populations. Causes the following symptoms; • Arthralgias • Myalgias • Diarrhoea • Endocarditis • Meningitis • Hepatitis • Vomitting • Skin eruptions
Which bacteria that causes pneumonia causes the following symptoms; Arthralgias, myalgias, diarrhoea, vomitting, skin eruptions, myocarditis, meningitis, hepatits?
Mycoplasma pneumoniae.
Which pneumonia causing bacteria can you be infected by birds?
Chlamydia psttacci.
What are the symptoms of infection caused by Chlamydia psttacci and what can you catch it from?
Birds.
Fever, myalgia, macular rash, splenomegaly, severe cough, depression, dyspnoea.
Describe pneumocystis jirovecii.
- Fungus
- Immunocompromised individuals
- Gradual onset SOB
- Dry cough
- Fever
- Weight loss
- Often minimal signs.
What is the most common pathogen that causes pneumonia?
Stretococcus pneumoniae (Pneumococcus)
Which pathogen normally causes epiglottitis?
Haemophilus influenza b
What are the four D’s of epiglottitis?
Drawn, Dysphagia, Dysphonia, Drooling
What is the management of epiglottitis?
It is a medical emergency, secure the airway and give IV cefuroxime.
What is the clinical definition of pneumonia?
Acute LRTI, usually associated with fever, symptoms and signs in the chest with an abnormal x-ray.
Which drugs are risk factors for pneumonia?
- Sedatives - Reduce cough and epiglotic function.
- MST and atropine - Reduces mucociliary movement.
- Steroids and salicylates - Reduces phagocytosis.
What are the generic symptoms of pneumonia?
- Fever (Chills)
- Cough
- Pain
- Dyspnoea
- Myalgias
- General malaise
- Headache
- Vomitting
What are the initial investigations for pneumonia and what is the acronym to remember them?
SUBEC • Sputum - Acid Fast Bascili, General Culture, Gram Stain. • Urine - Legionella antigen, output. • Blood - WBC, Urea, serology, cultures • E - ECG • C - Chest X-ray
What does SUBEC stand for, when talking about pneumonia?
Initial investigations; • S - sputum • U - Urine • B - Blood • E - ECG • C - Chest X-ray
What is the antibiotic treatment for uncomplicated pneumonia?
• p.o. amoxycillin and p.o. clarithromycin
Or,
• p.o. Cephalosporin
What is the antibiotic treatment for complicated pneumonia?
• IV Cefuroxime and p.o clarithromycin
Or,
• I.V. Augmentin and p.o. clarithromycin
What is CURB 65?
Assessment system for pneumonia; C - Confusion U - Urea over >7mmol/L R - Respiratory rate greater than 30/min B - Blood pressure < 60 diastolic 65 - Over 65
What concentration of urea scores a point on CURB 65?
> 7mmol/L
What respiratory rate scores a point on CURB 65?
> 30bpm
What blood pressure scores a point on CURB 65?
<60 Diastolic
In community acquired pneumonia what would be the management plan for a CURB 65 score of 0-1?
In community, Amoxycillin (clarithromycin if allergic to penicillin).
In community acquired pneumonia what would be the management plan for a curb score of 2?
Consider in-patient or supervised out patient, Amoxycillin PLUS clarithromycin.
In community acquired pneumonia what would be the management plan for a curb score of 3+?
- Severe Pneumonia!
- Consider HDU
- IV augmentin and p.o. clarithromycin.
What would the management of ‘atypical’ pneumonia be?
- I.V. Clarithromycin
* I.V. Rifampicin
If cavitation occurred with pneumonia what would the management plan be?
- I.V. cefuroxime
- I.V. Metronidazole
- I.V. Flucloxacillin
What would the management be for aspiration pneumonia?
- I.V. Cefuroxime
* I.V. Metronidazole
What are the five main complications of pneumonia?
1) Abscesses
2) Bronchiectasis
3) Empyema
4) ARDS
5) Pulmonary emboli
What is ARDS?
Acute Respiratory Distress Syndrome
• PaO2/FiO2 <200mmHg
• Bilateral infiltrates
