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Pneumonia (Complications (Lung (Lung abscess (Definition Cavitating area…
Pneumonia
Complications
Systemic
Sepsis
Lung
Lung abscess
Definition
Cavitating area of localised, supperative
infection within the lung
Aetiology
Vascular (pulmonary infarct)
Infection (poorly tx pneumonia, septic emboli)
Aspiration
Bronchial obstruction (foreign body)
Neoplastic (bronchial tumour)
Subphrenic/hepatic abscess
Clinical presentation
Swinging fever
Cough (purulent, foul smell sputum)
Pleuritic chest pain
Haemoptysis
Weight loss
Malaise
Diagnosis
Bloods (FBC, CRP, U+E, LFTs, cultures)
Microbiology (sputum MCS and cytology)
CXR (cavitating lesion with fluid level)
CT (staging)
Bronchoscopy and biopsy
Management
Abx (guided by sensitivities)
Aspiration, surgical excision
Empyema
Definition
Pus in the pleural space
Clinical presentation
Recurrent fever post-pneumonia
Diagnosis
CXR (pleural effusion)
Pleural aspirate (yellow&turbid,
acidic pH, low glucose, high LDH)
Management
Chest drain
Pleural effusion
Pathophysiology
Inflamm of pleura and fluid exudation
Management
Conservative (if small)
Drainage if large
T1 respiratory
failure
Management
High-flow O2 (sats 94-98%, PaO2>8KPa, ABG monitor)
ITU (O2 not improve, CO2 rises)
Epidemiology
Common
Brain
Brain abscess
Heart
Pericarditis
Myocarditis
Hypotension
Pathophysiology
Dehydration + vasodilatation (sepsis)
Management
IV fluid challenge (250mL in 15min)
Central line and IV fluids
ITU (vasopressors, inotropes)
AF
Management
Usually resolves with tx of pneumonia
Short term B-blocker/digoxin
Liver
Cholestatic
jaundice
Pathophysiology
Sepsis
Secondary to abx
(co-amoxiclav, flucloxacillin)
Classification
Community acquired (CAP)
S. pneumoniae
Also H. influenzae, M, pneumonae, S. aureus,
Legionella, M, catarrhalis, Chlamydia, gram -ve
Hospital acquired (HAP)
Gram -ve enterobacteriae, S aureus
Pseudomonas, Klebsiella, Bacteroides. Clostridia
Aspiration
Reduced conciousness, reduced motor function,
impaired swallow, poor dental hygeine
Immunocompromised
S pneumonae, H. influenzae, S. aureus, M catarrhalis,
M/ pneumonae, Gram -ve, PCP
Fungi, viruses, mycobacteria (TB)
Diagnosis
Examination
Fever
Inspiratory coarse crackles
Tachycardia
Tachypnoea
Bronchial breathing
(consolidation)
Dull percussion
(consolidation)
Investigations
Bloods
(FBC, CRP, U+E, ABG,
troponins, amylase, D-dimer)
Investigations
CXR
Diffuse or lobar opacification
Mass lesions
Air bronchogram
(can take 6wk to resolve)
Bedside
BP
ECG
O2 sats
Peak flow
(if known resp disease)
History
Differentials
Pulmonary oedema
PE
Pulmonary vasculitis
Lung Ca
Acute pancreatitis
TB
Management
Assessment
(CURB-65)
Components
C
onfusion
U
rea >7
R
R >30
BP
<90 (S) or <60 (D) Age >
65
y
Interpretation
3+: severe, admit (ITU/HDU)
2: moderate, admit (ward)
0-1: mild, consider home tx
Definitive
CAP
MIld
Analgesia
PO abx (e.g. amoxicillin or erythromycin)
GP FU
Moderate
Analgesia
PO/IV abx (amoxicillin or clarithromycin)
Severe
IV co-amoxiclav/cefuroxime AND clarithromycin
Vancomycin if MRSA suspected
Atypical
Legionella - fluoroquinolone + clarithromycin
Chlamydia - tetracycline
PCP - co-trimoxazole
HAP
IV aminoglycoside, penicillin IV + cephalosporin
(gram -ves, pseudomonas and anaerobes)
Aspiration
IV cephalosporin + metronidazole
(S pneumonae + anaerobes)
Immunocompromised
IV aminoglyoside, penicillin/cephalosporin, antifungals
(gram +ve cocci, gram -ve bacilli, fungi)
Initial (ABCDE)
Follow up
Mild - GP FU
Mod/severe: FU 6wk with CXR
Aetiology
Bacterial (80-90%)
S pneumonae (commonest)
M pneumonae, H influenzae, Legionella,
C psittaci, S aureus
Viral (10-20%)
Influenza, RSV
Fungi
Clinical
presentation
Typical
Cough
SOB
Haemoptysis
Myalgia
Fatigue
Malaise
Chest pain
Associated symptoms
Cough, SOB, haemoptysis, fever, malaise
Radiation
Character
Pleuritic
Timing
Exacerbating/relieving factors
Exacerbating - inspiration, movement
Relieving - stillness
Onset
Insidious
Site
Chest, upper abdomen
Severity
Varied
Atypical
Sore throat
Headache
Nausea
Abdominal pain
Diarrhoes
Confusion (elderly)
Definition
Symptoms and signs of
LRTI plus CXR changes
Prevention
Pneumococcal
vaccine
At risk groups
DM
Immunocompromised
(spleen fuction, AIDS, chemotherapy)
Chronic disease
(liver, heart, renal, lung)
65y
CI :
Pregnancy
Lactation