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Pneumonia: (Key Facts (Complications (Septic shock and MOF (SIRS Inflam…

- - - - Bronchopneumonia
        
        Patchy consolidation of different lobes
      - Lobar Pneumonia
        
        Fibrosuppurative consolidation of a single lobe
        Congestion → red → grey → resolution
    - - Community Acquired Pneumonia
        
        Commonest organisms
        
        Pneumococcus: 50%
        Mycoplasma: 6%
        Haemophilus: esp. if COPD
        Chlamydia pneumonia
        Viruses: 15%
        
        Other organisms
        
        S. aureus
        Moraxella
        Legionella
        
        Rx: amoxicillin + clarithromycin
      - Hospital Acquired Pneumonia
        48hrs after hospital admission
        
        Common organisms
        
        Pseudomonas
        MRSA
        Gm-ve enterobacteria
        
        Rx: co-amoxiclav or tazocin ± vanc
      - Aspiration
        
        ↑ Risk: stroke, bulbar palsy, ↓GCS, GORD, achalasia
        
        Typically posterior segment of RLL
        
        Organisms: anaerobes
        
        Rx: co-amoxiclav
      - Immunocompromised
        
        PCP: co-trimoxazole
        
        TB: RIPE
        
        Fungi: amphotercin
        
        CMV/HSV: ganciclovir
      - Atypical Pneumonia
        
        Refers to organisms which cause atypical generalised
        
        symptoms and bronchopneumonia
        
        Fever, headaches, myalgia
        
        Poor correlation between clinical and x-ray findings
        
        Often intracellular: mycoplasma, Chlamydia, Legionella
  - - - SIRS
        Inflam response to a variety of insults manifest by ≥ 2 of:
        
        Heart rate: >90
        
        Respiratory rate: >20 or PaCO2 <4.6 KPa
        
        WCC: >12x109/L or <4 x109/L or >10% bands
        
        Temperature: >38°C or <36°C
      - Sepsis
        
        SIRS caused by infection
      - Severe Sepsis
        
        Sepsis w/ at least 1 organ dysfunction or hypoperfusion
      - Septic Shock
        
        Severe sepsis with refractory hypotension
      - MODS
        
        Impairment of ≥2 organ systems
        Homeostasis cannot be maintained without therapeutic intervention.
  - - - Confusion (AMT ≤8)
      - Urea >7mM
      - Resp. rate >30/min
      - BP <90/60
      - ≥65
      - Score
        
        0-1 → home Rx
        
        2 → hospital Rx
        
        ≥ 3 → consider ITU
    - - WCC: <4 or >12
      - Temp: >38 or <32
      - PaO2: <8KPa
      - AF
      - Multiple lobar involvement
- - - - Bronchial breathing
      - ↓ AE
      - Focal coarse crackles
      - Pleural rub
      - ↑VR
- - - - Abx
        Analgesia
    - - Oxygen
        Fluids
        Chest physio
    - - Septic shock + MOF: ITU
        Para-pneumonic effusion or empyema: drainage
        Respiratory failure: ventilation
        Abscess: drainage
    - - CXR @ 6 wks
      - Check for underlying Ca and resolution
      - Smoking cessation
      - Pneumovax (23 valent)
        
        ≥65yrs
        Chronic HLRP failure or conditions
        Immunosupp: DM, hyposplenism, chemo, HIV
        Re-vaccinate every 6yrs
  - - - Sputum MC+S, cytology
      - Urine
        
        Pneumococcal Ag
        
        Hb: cold agglutinins → haemolysis
    - - FBC: ↑ WCC
      - U+E: dehydration, ↓Na
      - CRP: trend
      - LFT: ↑LFTs in mycoplasma, Legionella
      - Culture: 25% positive
      - Paired Sera: Mycoplasma, Chlamydia, Legionella
      - ABG
    - - Consolidation w/ air bronchogram
      - Effusion
      - Cavities: esp. S. aureus
  - - - Fever, rigors, anorexia, malaise
      - Cough + sputum ± haemoptysis
      - Pleurisy