Faisal with fever and respiratory distress

Faisal with fever and respiratory distress

1. presented with

   • Cough
     • definition
       • A reflex explosive expiration that prevents aspiration and promotes the removal of secretions and foreign particle from lung.
     • causes
       • Acute
         • Inhaled foreign body
           • Respiratory tract infection
       • Chronic
         • either
           • Productive
             • Blood stained
               • Lung cancer
               • Pulmonary embolism
               • TB
             • purulent
               • COPD
               • Bronchiectasis
             • pink, frothy
               • Pulmonary edema
         • or
           • Non-productive
             • Asthma
               • Postnasal drip
                 • GERD
                   • Drugs (ACE inhibitors)
                     • Sarcoidosis

2. later diagnosed with

   • Pneumonia
     • Definition
       • Pneumonia is inflammation of the lung parenchyma
         • resulting in
           • consolidation
             • due to
               • exudate within lung tissues and airspaces.
     • classifications
       • Etiological types
         • Infective
           • Mycoplasmal / Chlamydial
             • Tuberculosis
               • Fungal
                 • Bacterial
                   • Viral
         • Non-infective
           • Toxins
             • Chemical
               • Aspiration
                 • Radiation
                   • Hypostatic
       • Duration
         • either
           • Acute
         • or
           • Chronic
             • causative agents
               • Histoplasmosis
                 • Blastomycosis
                   • Coccidioidomycosis
       • Morphological types
         • include
           • Lobar
             • Characteristics
               • 90% strept pneumonea
                 • Other organism; Klebsiella in extremes of ages, DM)
                   • High fever, cough with sputum, pleuritic chest pain
             • 4 stages
               • Congestion (24 hr)
                 • Red hepatization (48 hr)
                   • Gray hepatizaiton (96 hr)
                     • Resolution (8days)
                       • Few macrophages, normal
                     • Neutrophils & Macrophages
                   • Exudation +RBC
                 • Vasodilatation→ congestion.
             • Middle age (20 - 50)
               • Primary in healthy individuals
                 • Common in males
                   • Entire lobe consolidation
                     • Limited by anatomic boundaries
                       • Usually unilateral
           • Interstitial pneumonitis
           • Bronchopneumonia
             • Extremes of age
               • Secondary
                 • Both genders
                   • Patchy consolidation
                     • Not limited by anatomic boundaries
                       • Usually bilateral
             • Characteristics
               • Staph, Strept and H. Influenza
                 • Suppurative inflammation filling bronchi, bronchioles and alveoli
             • 4 stages
       • Clinical Setting
         • include
           • Primary or Secondary to another disease
           • Aspiration pneumonia
             • characteristics
               • usually occurs in
                 • unconscious patients
                   • prolonged bedrest
                     • Alcoholics
               • Mostly affects posterior lobes, especially the superior segments of the lower lobes
                 • Often lead to abscesses
           • In immunocompromised patient
             • Causative agents
               • Pneumocystis jrovecii
                 • Cytomegalovirus
                   • Fungi
           • Hospital-acquired (nosocomial)
             • or
               • Community-acquired
                 • could be
                   • Atypical
                     • causative agents
                       • viral
                         • mycoplasma pneumoniae
                           • chlamydia
                     • Unlike in "typical" acute pneumonias
                       • Sputum production is modest
                         • No physical findings of consolidation
                           • WBC count is only moderately elevated
                             • Bacteria could not be isolated
                   • Typical
                     • Causative agents
                       • streptococcus pneumoniae
                         • haemophilus influenzae
                           • moraxella
                             • staphylococcus
                               • klebsiella pneumoniae
                                 • pseudomonas aeruginosa
                                   • legionella pneumophilia
             • Occurs in patients with debilitation or have catheters or are on ventilators
               • causative agents
                 • MRSA, P. aeruginosa, Klebsiella, E. coli, S. pneumonia, H. influenza
     • Treatment
     • complications
       • Respiratory distress
         • Pleural effusion
           • Empyema
             • Lung abscess
               • Atrial Fibrillation
     • investigations
       • Chest X-ray
         • CBC
           • Arterial blood gas
             • Serum electrolytes
               • Blood urea nitrogen
                 • Glucose levels
                   • Blood or sputum culture

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