Archive:Management of community acquired pneumonia: Difference between revisions

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Revision as of 05:04, 16 May 2007

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

@@ 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}}
 [[Category:Medicine]][[Category:OSCE]]

wikademia>Koppertone

Revision as of 05:04, 16 May 2007

Diagnostic Tests

General Management

Hospitalization

Treatment