Please enable JavaScript.
Coggle requires JavaScript to display documents.
Pneumonia (Mental Model
Fever & Cough
productive cough (CXR (-):…
Pneumonia
Mental Model
Fever & Cough
CXR (-): Bronchitis
-
Tx: PO Abx :pill:
- pt goes home :house_with_garden:
-
-
-
CAP (community)
- pts who haven't been to hospital
- ≥90 days from visiting building
HCAP (health care associated)
= Ventilator associated
= Hospital Acquired, for our purposes
- HAP = no PNA on admission
- <48hrs has PNA
- was admitted for something else
- pt exposed to building :hospital:
- <90 days visits (excluding HC workers)
- dialysis
- hospital
- nursing home
Tx:
- antipseudomonal
- Pip/Tazo
- Carbapenem
- Cefepime
AND
- MRSA coverage
-
CAP All treated the same way
- S. Pneumo
- M. Catarralis
- H. Flu
- Klebsiella (and other GNR gram neg rod)
- aspiration risk
- alcoholics
- suppressed mentation
- S. Aureus
- post viral
- new PNA 1 wk after viral illness
- Legionella
- immunosuppressed
- old smoker :older_man::skin-tone-2::smoking: who also has immunosuppression
Tx:
- 3rd gen cephalosporin
- + Macrolide
OR
- resp. fluoroquinolone :sunflower:
Actual Dx
Fever & Cough
CXR
sputum Cx
- never high yield enough
- <10 epi cells & >25 PMN = good sample
- normally, the spit is polymicrobial
blood Cx
- good practice, but won't change Abx regimen
- only (+) in 10% of PNA
CXR (-)
Bronchitis: "ambulatory PNA"
- :warning:don't use 3rd gen ceph
- Macrolide : Azithro
OR
- Doxycycline :bicyclist:
OR
- Resp. Fluoro: Moxi :sunflower:
:pencil2: (Pretest FM): Abx not indicated for acute uncomplicated bronchitis. :forbidden::pill:
- Healthy person w/ bad cough (no matter duration)
- Reserve for COPD :smoking:, CHF :broken_heart:, SAS
CXR (+)
Cavitation: foul smelling sputum
- not all cavitations are abscesses
Consolidation: PNA
-
PNA
- assess exposure to building
- Timing
- (>90d building exp. or <48hr admission)
-
CAP
Tx: 3rd gen Ceph
- Ceftriaxone
&
- Macrolide: Azithro
OR
- Resp. Fluoro: Moxi :sunflower:
HIV +
CD4 <200
elevated LDH
AIDS
Suspect if CXR is patchy
- not consolidated
- subacute presentation (slow develop)
-
Who gets admitted? :hospital:
- Clinical acumen (gut feeling) is just as good as these scoring systems.
- Scoring systems, however are objective
CURB 65
- ED
- Any 1 positive = admission
PNA severity Index
- IM
- complicated (online calc)
- gives objective assessment
- infection in the lung
- need to know bugs, though we usually hit w/ empiric coverage
- can't really know what the bug is
- spectrum of PNA
- organisms of PNA
- how to treat PNA vs something worse
- Specifics: PCP, Flu, admission criteria
- we can't (but in step 1 were taught) determine the PNA based on clinical presentation
- nothing in the PEx, Hx tells us the underlying bug