Summary
Summary Essential Notes: Respiratory Medicine: Pneumonia
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Signs + symptomsPneumonia Symptoms fever, cough w/ purulent
sputum (rust coloured in
Definition inflammatory condition pneumococcus), dyspnoea, pleuritic
pain
affecting alveoli, usually secondary to a
Signs
bacterial infection
Percussion= dull
Auscultation= crackles, reduced
Pathophysiology breath sounds, bronchial breathing
Detectable methods of invasion Resp failure= cyanosis, tachypnoea
Inhibition of IgA Septicaemia= rigors
Pneumolysins inhibit ciliary beating
Ix
Damage of the epithelial cells by prior
CXR consolidation, infiltrates
infection
Sputum sample organism?
Hijacking the platelet aggregating factor SpO2
receptor pathway to reach alveoli Bloods FBC neutrophilia? Raised
WCC/Inflammatory markers?
Aetiology ABG
1. Strep. pneumoniae Urinary Ag test
(pneumococcus) 80% cases pneumococcal/legionella
associated w/ fever, rapid onset,
pleuritic chest pain + herpes
labialis
2. Haemophilus influenzae COPD
pts
3. Staph. Aureus occurs in pt.
following influenza Mx
4. Mycoplasma pneumoniae Assessment ‘CURB65’
Atypical dry cough + atypical Confusion AMTS ≤ 0 = managed in the
chest/CXR 1
8/10 community
Autoimmune haemolytic anaemia Urea > 7mmol/L 1
Erythema multiforme may be seen RR > 30/min 1 1 = have their SpO2
5. Legionella pneumophilia BP <90/<60mmHg 1 assessed- >92% to
Atypical Hyponatraemia + be safely managed
lymphopaenia in the community +
CXR
6. Klebsiella alcoholic pts
bilateral/multilobar
7. PJP Pts w/ shadowing?
HIV/Immunocompromised Hospital admission
>65 yrs 1
Classification ≥2 = hospital
Anatomical admission- severe
Bronchopneumonia CAP
Lobar (congestion red hepatisation
gray hepatisation) >3 Requires ITU
Aetiological
1. Low severity
Community Acquired Pneumonia Amoxicillin (5 day course of Abx)
(CAP) 2. Moderate- High severity
Hospital Acquired pneumonia Dual Abx therapy
(HAP) >48hrs after admission Amoxicillin + Clarithromycin (7-10 day
o Ventilator-associated course) OR Co-amoxiclav + Tazocin
pneumonia (biofilm forms) Atypical
Chlamydia Tetracycline
Aspiration pneumonia PJP Co-Trimoxazole
Legionella Clarithromycin +
Rifampicin
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