Please enable JavaScript.
Coggle requires JavaScript to display documents.
Pneumonia (Investigations: (Sputum culture and gram stain, U/A: urinary…
Pneumonia
Investigations:
Sputum culture and gram stain
U/A: urinary antigens e.g. legionella and pneumococcal
LFTs
Nose/throat viral swab
CXR: consolidation and/or effusion
Bloods: FBC, UEC, VBG, cultures, LFT's, CRP
Other: pleural fluid aspirate for culture, bronchoscopy and/or lavage if pt in ICU or severely ill
Primary Survey:
DRS
Airway: is it patent?
Breathing: SpO2, RR, provide oxygenation for O2 > 94%, listen for breath sounds
Circulation: HR, BP, cap refill, 2x IV cannula, bloods (FBC, UEC, VBG/ABG, blood culture), Abx, fluids
Disability: GCS/AVPU, pupils, BGL
Exposure: temp
Risk Factors:
Elderly
Smoking
Immunocompromised e.g. diabetes, steroids and malignancy
COPD
ETOH
Further Management:
Abx therapy
Mild: amoxicillin OR doxycycline
Severe: IV benpen + gentamicin + azithromycin OR ceftriaxone + azithromycin
Moderate: IV benpen +/- doxy OR doxycycline alone if allergic
If MRSA: consult ID
Staph: + vancomycin
If suspecting atypicals: ensure macrolide cover
Switch to oral ABx after 2/3 days and/or when clinical features improving and give total of 7 days Tx
Chest physio
Consider need for ventilation
Move to targeted Abx therapy when cultures return
Common infectious agents:
Viruses: influenza, parainfluenza, RSV, adenovirus, metapneumovirus
Atypical bacteria: mycoplasma (young adukts), chlamydia, legionella (air con, immunocompromised)
Typical bacteria: strep pneumoniae, haemohpilus influenza, morexcella, staph aureus (IV drug users), gram neg rods e.g. klebsiella (ETOH), pseudomonas
Fungal: pneumocystis jiroveci (HIV)
Clinical Features:
Common sx: pleuritic pain, SOB, confusion, cough, sputum production, fever, chills
Specific features:
Legionalla: diarrhoea, deranged LFT's
Mycoplasma: deranged LFT's, maculapapular rash
Klebsiella: red jelly sputum and/or lung abscess and empyema
Strep pneumoniae: brown/rust coloured sputum
Signs: decreased breath sounds, tachypnoea, tachycardia, dullness to percussion, increased vocal fremitus, inspiratory crackles, bronchial breath sounds
Atypical sx: dry persistent cough, no sputum, headaches, myalgia, abscence of ciinical signs
Severity Indicators:
CORB
Confusion
Oxygen: PaO2 < 60 OR SaO2 </= 90%
RR >/= 30
BP: SBP < 90 OR DBP < 60
Score >/= is severe --> may require ICU/HDU