Pneumonia

Classification
1. CAP
2. HAP
3. Others
  1. Aspirated
  2. Atypical
SnS for CAP
1. Symptoms
  1. Fever ± chills n rigors
  2. Productive Cough
  3. Pleuritic chest pain
  4. Ear Pain
  5. Myalgia
  6. Arthralgia
2. Signs
  1. Vitals
    1. Tachypnea
    2. Tachycardia
    3. Hypotension
    4. Pyrexia
    5. Cyanosis (Hypoxemia)
  2. Focal Chest
    1. Reduce Chest Expansion
    2. Increased Tactile Fremitus
    3. Dullness on Percussion
    4. Increased Vocal resonance
    5. Bronchial Breath sounds
    6. Coarse crepitations
Ddx
1. PE
  1. Acute Hx
  2. SOB
  3. Pleuritic Chest pain
2. CCF
  1. Bibasal crepitation
    1. RHF
3. Pulmonary Vasculitis
  1. Haemoptysis
  2. NO response to antibiotics
4. Lung cancer
Complications
1. Resp Failure
  1. ALI (Acute Lung Injury)
  2. ADRS (Adult Respiratory Distress Syndrome)
2. Sepsis
3. Delirium
4. Excebation of co-morbidity
5. Parapnuemonic Effusion
  1. Empyema
6. Lung Abscess
7. Tachyarrhythmia
Pathogens
1. Standard
  1. Strep Pneumo
  2. Haemophilus Influenza
  3. Staph Aureus
  4. Viral (Influenza)
2. Atypical
  1. Mycoplasma Pnuemoniae
  2. Chlamydia Pneumoniae
  3. Legionella Pnuemophillia
3. According to most common
Diagnostic testing
1. Blood Test abnormalities
  1. FBC
    1. + WCC
      1. Neutrophilia
        Bacterial
      2. Lymphocytosis
  2. U&E
    1. Hypo Na+
    2. Acute kidney injury
      1. + Creatnine
      2. + Urea
  3. LFT
    1. + Transaminases
  4. Glucose
    1. Hyperglycemia
    2. Hypoglycemia
  5. ++CRP
2. Radiology
  1. CXR
    1. Patchy Infiltrate
    2. Lobar/Multi Lobar
    3. Pleural Effusion
      1. Parapnuemonic
      2. Empyema
3. MIcrobe
  1. Bloods
    1. C&S
  2. Urinary Antigen
Risk Tools
1. CURB65
  1. Confusion
  2. Urea
    1. >7 mmol/L
  3. Resp Rate
    1. RR > 30/min
  4. BP
    1. < 90/60 mmHg
  5. >65 y/o
  6. Score
    1. 0-1
      1. OutPx
    2. 2
      1. Supervised outPx
    3. 3-5
      1. Inpatient
      2. ICU @ 5
2. PSI
  1. Poor Prognostic Features
    1. Altered Mental Status
    2. RR > 30/min
    3. Sys BP < 90mmHg
    4. Temp
      1. <35C
        Worse
      2. > 40C
    5. Arterial pH
      1. < 7.35
    6. Urea NItrogen
      1. 11 mmol/L
    7. Sodium
      1. <130 mEq/L
Treatment
1. Antibiotic
  1. OutPx
    1. Co-amoxyclav P.O.
  2. InPx
    1. Co-amoxyclav I.V.
    2. Clarithromycin P.O.
  3. ICU
    1. Piptazobactam I.V.
    2. Clarithromycin I.V.
2. Management
  1. Early Antibiotics (broad Spec)
  2. Maintain O2
  3. Maintain BP (IV fluids)
  4. Steroids (if COPD)
  5. Influenza Vaccine
    1. Inactivated for Adults
    2. At Risk groups
    3. Yearly
    4. Healthcare Personel
  6. Pnuemococal Vaccine
    1. chronic/structural lung disease
    2. Previous Pneumo
    3. Post Splenectomy
Empyema
1. Def
  1. Collection of Pus in Pleural Cavity
2. Sequalle of Pneumo
3. Duration
  1. Weeks B4 presentation
4. Fluid
  1. Exudate
  2. Acidic
  3. - Glucose
  4. + WCC
5. Sign
  1. ++ CRP
  2. - Serum Albumin
6. Tx
  1. Chest Drain
  2. Antibiotics
  3. Surgical Decortication
HAP
1. Def
  1. HAP
    1. Hospital Acquired Pneumo
  2. VAP
    1. Ventilator Acquired Pneumo
2. Dx Criteria
  1. HAP
    1. > 48 Hrs After admission
    2. Early
      1. < 5 days
    3. Late
      1. > 5 days
  2. VAP
    1. 48 - 72 hrs after intubation
  3. CXR
  4. Fever
  5. Leucocytosis/penia
  6. Purulent Sputum
3. Organism
  1. Gram -ve
    1. E.coli
    2. Klebsiella
    3. Enterobacter
    4. Pseudomonas
  2. Staph Aureus
    1. MRSA
  3. Legionella
4. Tx
  1. Piptazobactam
  2. Vancomycin (for MRSA)

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Pneumonia

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	Created by Amirul Aiman over 6 years ago