Pneumonia

Pneumonia

1. Classification

   • CAP
   • HAP
   • Others
     • Aspirated
     • Atypical

2. SnS for CAP

   • Symptoms
     • Fever ± chills n rigors
     • Productive Cough
     • Pleuritic chest pain
     • Ear Pain
     • Myalgia
     • Arthralgia
   • Signs
     • Vitals
       • Tachypnea
       • Tachycardia
       • Hypotension
       • Pyrexia
       • Cyanosis (Hypoxemia)
     • Focal Chest
       • Reduce Chest Expansion
       • Increased Tactile Fremitus
       • Dullness on Percussion
       • Increased Vocal resonance
       • Bronchial Breath sounds
       • Coarse crepitations

3. Ddx

   • PE
     • Acute Hx
     • SOB
     • Pleuritic Chest pain
   • CCF
     • Bibasal crepitation
       • RHF
   • Pulmonary Vasculitis
     • Haemoptysis
     • NO response to antibiotics
   • Lung cancer

4. Complications

   • Resp Failure
     • ALI (Acute Lung Injury)
     • ADRS (Adult Respiratory Distress Syndrome)
   • Sepsis
   • Delirium
   • Excebation of co-morbidity
   • Parapnuemonic Effusion
     • Empyema
   • Lung Abscess
   • Tachyarrhythmia

5. Pathogens

   • Standard
     • Strep Pneumo
     • Haemophilus Influenza
     • Staph Aureus
     • Viral (Influenza)
   • Atypical
     • Mycoplasma Pnuemoniae
     • Chlamydia Pneumoniae
     • Legionella Pnuemophillia
   • According to most common

6. Diagnostic testing

   • Blood Test abnormalities
     • FBC
       • + WCC
         • Neutrophilia
           • Bacterial
         • Lymphocytosis
     • U&E
       • Hypo Na+
       • Acute kidney injury
         • + Creatnine
         • + Urea
     • LFT
       • + Transaminases
     • Glucose
       • Hyperglycemia
       • Hypoglycemia
     • ++CRP
   • Radiology
     • CXR
       • Patchy Infiltrate
       • Lobar/Multi Lobar
       • Pleural Effusion
         • Parapnuemonic
         • Empyema
   • MIcrobe
     • Bloods
       • C&S
     • Urinary Antigen

7. Risk Tools

   • CURB65
     • Confusion
     • Urea
       • >7 mmol/L
     • Resp Rate
       • RR > 30/min
     • BP
       • < 90/60 mmHg
     • >65 y/o
     • Score
       • 0-1
         • OutPx
       • 2
         • Supervised outPx
       • 3-5
         • Inpatient
         • ICU @ 5
   • PSI
     • Poor Prognostic Features
       • Altered Mental Status
       • RR > 30/min
       • Sys BP < 90mmHg
       • Temp
         • <35C
           • Worse
         • > 40C
       • Arterial pH
         • < 7.35
       • Urea NItrogen
         • 11 mmol/L
       • Sodium
         • <130 mEq/L

8. Treatment

   • Antibiotic
     • OutPx
       • Co-amoxyclav P.O.
     • InPx
       • Co-amoxyclav I.V.
       • Clarithromycin P.O.
     • ICU
       • Piptazobactam I.V.
       • Clarithromycin I.V.
   • Management
     • Early Antibiotics (broad Spec)
     • Maintain O2
     • Maintain BP (IV fluids)
     • Steroids (if COPD)
     • Influenza Vaccine
       • Inactivated for Adults
       • At Risk groups
       • Yearly
       • Healthcare Personel
     • Pnuemococal Vaccine
       • chronic/structural lung disease
       • Previous Pneumo
       • Post Splenectomy

9. Empyema

   • Def
     • Collection of Pus in Pleural Cavity
   • Sequalle of Pneumo
   • Duration
     • Weeks B4 presentation
   • Fluid
     • Exudate
     • Acidic
     • - Glucose
     • + WCC
   • Sign
     • ++ CRP
     • - Serum Albumin
   • Tx
     • Chest Drain
     • Antibiotics
     • Surgical Decortication

10. HAP

    • Def
      • HAP
        • Hospital Acquired Pneumo
      • VAP
        • Ventilator Acquired Pneumo
    • Dx Criteria
      • HAP
        • > 48 Hrs After admission
        • Early
          • < 5 days
        • Late
          • > 5 days
      • VAP
        • 48 - 72 hrs after intubation
      • CXR
      • Fever
      • Leucocytosis/penia
      • Purulent Sputum
    • Organism
      • Gram -ve
        • E.coli
        • Klebsiella
        • Enterobacter
        • Pseudomonas
      • Staph Aureus
        • MRSA
      • Legionella
    • Tx
      • Piptazobactam
      • Vancomycin (for MRSA)

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