Management Of Community Acquired Pneumonia - Revision history

wikademia>Wikademia: 5 revisions

2009-04-21T01:14:46Z

5 revisions

← Older revision	Revision as of 01:14, 21 April 2009
(No difference)

wikademia>Wikademia: moved Management Of Community Acquired Pneumonia to Management of community acquired pneumonia

2009-03-23T11:23:56Z

moved Management Of Community Acquired Pneumonia to Management of community acquired pneumonia

← Older revision		Revision as of 11:23, 23 March 2009
Line 1:		Line 1:
	~~==Diagnostic Tests==~~		#REDIRECT [[Management of community acquired pneumonia]]
	*CBCD, electrolytes, glucose, BUN, Cr
	*ABG on RA
	*blood cultures (draw 2 before treatment, at least 10 min. apart)
	*sputum gram stain and culture
	*CXR (PA and lateral)
	*acid fast stain of sputum if cough > 1 month or suspicious CXR for TB
	*thoracocentesis if pleural effusions present
	**stain, culture, pH, leukocyte count, differential

	~~==General~~ Management==
	*analgesics/antipyretics
	*ensure adequate hydration
	*oxygen therapy to O2 sat ≥ 90%
	*consult RT, PT, OT, speech language pathologist, dietician as needed

	~~==Hospitalization==~~
	*When to admit
	**Age >65 yrs
	**Decreased immunity (cancer, diabetes, AIDS, splenectomy)
	**Mental status changes
	**Increased A-a gradient
	**Two or more lobes involved
	**No home
	**Organ failure (↑Cr, bone marrow suppression, severe hypotension, liver failure)
	**WBC > 30,000/mm3 or < 4000/mm3 (sepsis)

	~~==Treatment==~~
	*if no pathogen identified, empirically treat
	**NO COMORBIDITIES: po macrolide or doxycycline
	**WITH COMORBIDITIES: po beta-lactam plus macrolide, or fluoroquinolone, quinolones (levofloxacin)
	**if suspect ASPIRATION: amoxicillin-clavulanate or levofloxacin and metronidazole
	*treat empirically until pathogen identified by sputum or blood culture, then use specific therapy

	*OUTPATIENT: treat for 10 - 14 days
	**Followup with GP, CXR in 8-12 weeks

	*INPATIENT: treatment length based on response to therapy, comorbid illnesses, complications
	**usually treat bacterial infections until patient is afebrile for >72 hours
	***resolution of respiratory symptoms, fever, PaO2 level, WBC, and findings on serial CXR

	*give influenza and pneumococcal vaccine on day of ~~discharge~~
	*smoke cessation

	~~===Poor prognostic factors===~~
	*age, men, nursing home
	*comorbidities: cancer, liver, CHF, CVD, renal
	*O/E: LOC, RR, BP, pulse, temperature
	*labs: pH, pO2, ↓hematocrit, ↑BUN, ↓Na, ↑glucose, pleural effusion
	~~==Other OSCE modules==~~
	~~{{OSCE2}}~~
	~~[[Category: Primary Care Medicine]][[Category:OSCE~~]]

wikademia>Donek at 00:57, 25 June 2008

2008-06-25T00:57:51Z

← Older revision		Revision as of 00:57, 25 June 2008
Line 50:		Line 50:
	==Other OSCE modules==		==Other OSCE modules==
	{{OSCE2}}		{{OSCE2}}
	[[Category:Medicine]][[Category:OSCE]]		[[Category: Primary Care Medicine]][[Category:OSCE]]

wikademia>Koppertone: /* Poor prognostic factors */

2007-05-18T03:13:40Z

Poor prognostic factors

← Older revision		Revision as of 03:13, 18 May 2007
Line 48:		Line 48:
	*O/E: LOC, RR, BP, pulse, temperature		*O/E: LOC, RR, BP, pulse, temperature
	*labs: pH, pO2, ↓hematocrit, ↑BUN, ↓Na, ↑glucose, pleural effusion		*labs: pH, pO2, ↓hematocrit, ↑BUN, ↓Na, ↑glucose, pleural effusion
			==Other OSCE modules==
	{{OSCE2}}		{{OSCE2}}
	[[Category:Medicine]][[Category:OSCE]]		[[Category:Medicine]][[Category:OSCE]]

wikademia>Koppertone: /* Treatment */

2007-05-18T01:07:27Z

Treatment

← Older revision		Revision as of 01:07, 18 May 2007
Line 43:		Line 43:
	*smoke cessation		*smoke cessation

	Poor prognostic factors		===Poor prognostic factors===
	*age, men, nursing home		*age, men, nursing home
	*comorbidities: cancer, liver, CHF, CVD, renal		*comorbidities: cancer, liver, CHF, CVD, renal

wikademia>Koppertone at 05:04, 16 May 2007

2007-05-16T05:04:15Z

← Older revision		Revision as of 05:04, 16 May 2007
Line 1:		Line 1:
			==Diagnostic Tests==
			*CBCD, electrolytes, glucose, BUN, Cr
			*ABG on RA
			*blood cultures (draw 2 before treatment, at least 10 min. apart)
			*sputum gram stain and culture
			*CXR (PA and lateral)
			*acid fast stain of sputum if cough > 1 month or suspicious CXR for TB
			*thoracocentesis if pleural effusions present
			**stain, culture, pH, leukocyte count, differential

			==General Management==
			*analgesics/antipyretics
			*ensure adequate hydration
			*oxygen therapy to O2 sat ≥ 90%
			*consult RT, PT, OT, speech language pathologist, dietician as needed

			==Hospitalization==
			*When to admit
			**Age >65 yrs
			**Decreased immunity (cancer, diabetes, AIDS, splenectomy)
			**Mental status changes
			**Increased A-a gradient
			**Two or more lobes involved
			**No home
			**Organ failure (↑Cr, bone marrow suppression, severe hypotension, liver failure)
			**WBC > 30,000/mm3 or < 4000/mm3 (sepsis)

			==Treatment==
			*if no pathogen identified, empirically treat
			**NO COMORBIDITIES: po macrolide or doxycycline
			**WITH COMORBIDITIES: po beta-lactam plus macrolide, or fluoroquinolone, quinolones (levofloxacin)
			**if suspect ASPIRATION: amoxicillin-clavulanate or levofloxacin and metronidazole
			*treat empirically until pathogen identified by sputum or blood culture, then use specific therapy

			*OUTPATIENT: treat for 10 - 14 days
			**Followup with GP, CXR in 8-12 weeks

			*INPATIENT: treatment length based on response to therapy, comorbid illnesses, complications
			**usually treat bacterial infections until patient is afebrile for >72 hours
			***resolution of respiratory symptoms, fever, PaO2 level, WBC, and findings on serial CXR

			*give influenza and pneumococcal vaccine on day of discharge
			*smoke cessation

			Poor prognostic factors
			*age, men, nursing home
			*comorbidities: cancer, liver, CHF, CVD, renal
			*O/E: LOC, RR, BP, pulse, temperature
			*labs: pH, pO2, ↓hematocrit, ↑BUN, ↓Na, ↑glucose, pleural effusion

	{{OSCE2}}		{{OSCE2}}
	[[Category:Medicine]][[Category:OSCE]]		[[Category:Medicine]][[Category:OSCE]]

wikademia>Koppertone: New page: {{OSCE2}} Category:MedicineCategory:OSCE

2007-05-16T04:46:53Z

New page: {{OSCE2}} Category:Medicine Category:OSCE

New page

{{OSCE2}}
[[Category:Medicine]][[Category:OSCE]]