Categories
The most important categorisation clinically
Community acquired x Nosocomial pneumonia
What empiric ATB therapy would you use for out-patient treated CAP in patient with type 2 diabetes and COPD GOLD 1
Beta-lactam + Macrolide
(Respiratory fluoroquinolone for patients with beta-lactam allergy)
What lung sounds are typical in patients with pneumonia?
Name at least 3 typical pneumonia pathogens and 2 atypical
Typical: S. pneumoniae, S. aureus, K. pneumoniae, Moraxella Catarrhalis, H. influenzae, E. coli
Atypical: Legionella spp., Mycoplasma pneumoniae, Chlamydophila pneumoniae, Chl. psittaci
Name at least 3 supportive medication for patient with pneumonia
1) cough management - antitussic/mucolytic
2) antipyretics
3) Analgesia
4) preventive anticoagulation in indicated cases
Name at least two scoring systems used in pneumonia patients
CURB-65 - helps decide whether treat as in- or out-patient
PSI - severity index, usually used in ICU setting
S-CAP/SMART-COP - severity index
HCAP - healthcare associated pneumonia
What laboratory test should you do before start of ATB
Basic lab - iontogram, CRP, PCT, liver and renal test, blood count with diff. (consider ABG)
microbiology - sputum culture, urine antigens + culture, consider blood culture, (PCR test sputum)
Name at least three complications of pneumonia
Fluidothorax
Empyema
Pneumothorax
ARDS
Pulmonary embolism
What to do when your previous strategy didn't work
Reconsider: could it be something else?
retake history
Bronchoscopy with targeted samples
CT (ideally before bronchoscopy)