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Chest Infection: covers the diagnosis and management of acute bronchitis…
Chest Infection: covers the diagnosis and management of acute bronchitis and community-acquired pneumonia (CAP)
Acute bronchitis:a lower respiratory tract infection which causes inflammation in the bronchial airways, usually lasts 7-10 days:
S&S
cough, May or may not have sputum, wheeze, or breathlessness, Substernal or chest wall pain may be present when coughing,
CAP:an infection of the lung tissue in which the air sacs in the lungs become filled with microorganisms, fluid, and inflammatory cells, affecting the function of the lungs
S&S
cough predominant symptom, Dyspnoea, sputum production, pleural pain, sweating, fever, shivers, aches and pains
Assessment
History- onset, duration, symptoms, type of cough, breathlessness, wheeze, pleuritic pain, fever, smoking status
Temp, Pulse, BP, respiratory rate, SpO2, assess for confusion
cough predominant symptom
CRB 65 score for mortality risk
The score is calculated by giving 1 point for each of the following prognostic features:
Confusion (new disorientation in person, place, or time; or abbreviated mental test score 8 or less).
Raised respiratory rate (30 breaths per minute or more).
Low blood pressure (diastolic 60 mmHg or less, or systolic less than 90 mmHg).
Age 65 years or more.
scoring 0 low risk, 1-2 moderate risk, 3-4 high risk
Cxray, CRP
sputum culture- moderate severity CAP
exclude covid 19
Examination
Acute bronchitis
Wheeze often present; rhonchi that improve with coughing may be present
May have systemic features with or without a raised temperature.
mildly ill
CXray normal
CAP
Focal chest signs such as decreased or asymmetric breath sounds, bronchial breath sounds, dullness to percussion, course crepitations, vocal fremitus
Typically tachypnoea, tachycardia, dyspnoea, temp 38oC an above, may be hypoxia, confusion in older people
Moderately to severely ill
CXRay abnormal
Treatment
Amoxicillin 500mgs tds or doxycycline 200mg stat dose then 100mg for four days
Abx if immunocompromised or comorbid condition
Smoking cessation
Admission
if systemically unwell- Resps 30 or above per minute, pulse 130 or above, systollic BP less than 90mmhg, SpO2 <92%, or central cyanosis,
PEFR <33% predicted, altered level of consiousness, exhaustion due to use of accessory muscles
Suspected PE or pneumothorax
Features of foreign body aspiration
Differential
PE
Asthma
Post infectious cough
exac of COPD
Covid 19
heart failure
lung malignancy
pertussis