Flashcards in Pneumonia CAP Deck (23)
Pneumonia is classified into one of two categories which are?
Community acquired pneumonia (CAP) and hospital acquired pneumonia (HAP)
CAP is the leading cause of what?
More childhood deaths worldwide than any other illness
Which groups are most susceptible to pneumonia?
The very young and very old
Name three bacteria that can cause CAP
Strep. Pneumoniae (most common!), staph. a, chlamdyia, legionella pneumophila
Name three viral causes of CAP
Influenza, herpes simplex, varicella, coronavirus(SARS)
Name three factors which predispose an individual to pneumonia?
Smoking, old age, HIV, alcohol, recent influenza infection, recent URT infection, pre-existing lung condition, corticosteroid therapy
What 4 symptoms tend to predominate a pneumonia presentation?
Sweats, rigors, shivering and vomiting
What pulmonary symptoms occur?
Breathlessness and cough
What are the characteristics of this cough
Short, painful and dry will progress and be accompanied with mucopurulent (mucus and puss in it) sputum
What does rust coloured sputum normally suggest?
Strep. Pneumoniae infection
What other symptoms of a patient with CAP present with? (Name 2)
Loss of appetite, headache, pleuritic chest pain, chest wall tenderness
What might the doctor hear on auscultation?
Bronchial breathing and crackles
What is the key investigation?
CXR most infections will show a radio opaque consolidation within 12 hours of onset of symptoms
What other investigations should be done?
Pulse oximetry, WBCs, CRP, sputum smear, blood cultures, serology, PCR
You have detected legionella pneumophila, what must you do?
Report it to the local centre for infectious disease control
What scoring system is used to assess disease severity?
C=confusion, U=BUN (blood urea nitrogen) greater than 7mmols/L, R=RR of more than 30, B=BP systolic less than 90 or a diastolic less than 60, 65 or older.
One point for each
What are the key areas if management for CAP?
Oxygenation, prolonged illness and nutritional support
What is the aim for oxygen?
Sats at least 92% or PaO2 of at least 8KPa
IV antibiotics or oral for CAP?
Depends on severity, if not too severe then oral antibiotics are fine
How does CURB-65 score affect management
0-1 suitable for home treatment
2 hospital supervised treatment (short stay or supervised outpatient)
3+ admit, assess for ICU esp if 4/5
What is the antibiotic of choice for uncomplicated CAP and severe CAP?
Amoxicillin 500mg 8 hourly
Clarithromyocin and co-amoxiclav
What is pneumonia?
Acute respiratory illness accompanied with pulmonary shadowing on a CXR