Pneumonia
- related: Pulmonology, ID, pneumonia vaccine, legionella pneumonia
- tags: #pulmonology
Symptoms
- cough, purulent sputum, pleuritic chest pain, dyspnea, chillls, fever, night sweats, weight loss
- hemoptysis: necrotizing infections, lung abscess, TB, Gm neg pneumonia
- Elderly: less immune response. More nonrespiratory response. Confusion, weakness, lethargy, falling, decreased PO intake
Pathogenesis
- Common bugs: strep, H. flu, mycoplasma, chlamydia, legionella
- Pseudomonas: bronchiectasis, recent hospitalization, recent abx
- aspiration pneumonia: most common gm negative
- alcoholism: klebsiella
- MRSA: patients with HCAP. After influenza. Bilateral, necrotizing infection.
Diagnosis
-
Ddx: fungal (histo, blasto, cocci), TB, bronchiolitis obliterates, vasculitis, hypersensitivity pneumonitis, interstitial disease, cancer, CHF, PE
-
CXR if questionable
-
Pulse ox, ABG, sputum clx, RVP, blood clx, urine legionella, pneumococcal antigen
Treatment
Curb 65
- Curb65: 2 in hospital. 3 in ICU
- Confusion
- Urea > 7 mmol or 19.6 mg
- RR > 30
- BP < 90
- Age > 65
- Use pneumonia severity index over Curb65 to determine who should be admitted
