Pneumonia
Summary
Symptoms
CURB-65 --> ABX --> O2 --> IV fluids --> VTE prophylaxis --> analgesia
--END OF SUMMARY--
Symptoms
- Sharp (pleuritic) chest pain
- Dyspnoea
- Cough
- Haemoptysis
- Purulent sputum
- Fever
- Rigors
- Hospital stay
- Contact
- Immunocompromised
- Non-vaccinated
- Febrile/ tachypnoeic/ tachycardic, hypotensive
- Confusion (elderly)
- Consolidation (dull percussion/ diminished expansion, tactile fremitus/ vocal resonant/ bronchial breath sounds)
- Pleural rub
- Bedside: Sputum culture, ECG
- Bloods: FBC+CRP, UEC, ABG, LFT, blood culture, viral serology
- Imaging: CXR, bronchoscopy+lavage (if immunocompromised)
- Others: Pleural fluid culture
CURB-65 --> ABX --> O2 --> IV fluids --> VTE prophylaxis --> analgesia
--END OF SUMMARY--
Definition
Infection of lungs by bacteria or viruses.
Aetiology
Community Acquired Pneumonia (CAP)
Hospital Acquired Pneumonia (HAP)
Asipiration Pneumonia
Immunocompromised patient
Clinical Features
Sx
Signs
Investigations
Bedside
Management
Complications
Source
Better Health Channel VIC 2014
OHCM 9th Ed 2014
Infection of lungs by bacteria or viruses.
Aetiology
Community Acquired Pneumonia (CAP)
- S. pneumoniae (most common)
- H. influenzae
- M. pneumoniae, Chlamydia = atypical bact
- Influenza, adenovirus, RSV
Hospital Acquired Pneumonia (HAP)
- Gram -ve enterobacteria (most common) eg E coli
- S Aureus (most common)
- Legionella spp = atypical bact
Asipiration Pneumonia
- Stroke, myasthenia, bulbar (brainstem) palsies, LOC, oesophageal disease
Immunocompromised patient
- All of the above + Pneumocystis jiroveci, CMV, EBV, mycobacteria.
Clinical Features
Sx
- Fever
- Rigors
- Malaise
- Anorexia
- Dyspnoea
- Cough
- Purulent Sputum
- Haemoptysis
- Pleuritic pain
Signs
- Cyanosis
- Confusion (may be the only sign in elderly)
- Tachypnoea
- Tachycardia
- Hypotension
- Consolidation (limited expansion, dull percussion, bronchial sounds, INC tactile/ vocal fremitus)
- Pleural rub
Investigations
Bedside
- O2 sats
- FBC, UEC, LFT, CRP, blood cultures
- CXR
- Culture: sputum, pleural fluid
- Bronchoscopy/bronchoalveolar lavage (if immunocompromised)
Management
- ABx (IV if severe)
- O2 (PaO2 > 8.0, Sats)
- IV fluids (anoerexia, dehydration, shock)
- Analgesia (if pleurisy)
- Pneumococcal vaccine (>65y, chronic heart/ liver, renal, diabetes mellitus, immunocompromised, children)
- CURB-65 C: confusion U: uraemia R: RR>30 B: SBP<90, 65: age. 1 point for each. 0-1, d/c, 2 - admit, 3-5 - consider ICU
Complications
- Pleural effusion
- Empyema
- Lung abscess
- ARDS
- Septicaemia
- Brain abscess
- Pericarditis/ Myocarditis
- Cholestatic jaundice
Source
Better Health Channel VIC 2014
OHCM 9th Ed 2014