Pneumonia

Introduction

• Pneumonia is the most common infectious cause of death in the United States. It occurs in persons of all ages, although the clinical manifestations are most severe in the very young, the elderly, and the chronically ill.

Pneumonia Classifications

• Community acquired (CAP) Pneumonia: developing in patients with no contact to a medical facility.Healthcare associated (HCAP): Pneumonia developing in patients not in an acute care medical facility but two or more risk factors for MDR pathogens.Hospital-acquired (HAP): Pneumonia developing >48 hours after hospital admission.Ventilator associated ( VAP): Pneumonia developing >48 hours after intubation and mechanical ventilation.

Clinical Presentation of Pneumonia

• Signs and symptoms Abrupt onset of fever, chills, dyspnea, and productive cough Rust-colored sputum or hemoptysis Pleuritic chest painPhysical examination Tachypnea and tachycardia Dullness to percussion Increased tactile fremitus, whispered pectoriloquy, and egophony Chest wall retractions and grunting respirations Diminished breath sounds over the affected area Inspiratory crackles during lung expansionChest radiograph: Dense lobar or segmental infiltrateLaboratory examination Leukocytosis with a predominance of polymorphonuclear cells, Low oxygen saturation on arterial blood gas or pulse oximetry.

Management: Tx: Diagnosed by CURB 65

• C-Confusion

U- Blood urea. Increase20mg/dl

R- Respiratory rate

B- BP <90/160

If above any four, admit patient to ICU

If 2-4 points then

• Oxygen inhalation
• Tab Paracetamol (Panadol) SOS, Inf Paracetamol (Provas) IV Stat
• Tab Clarithromycin 500mg 1xBD-8days
• Tab Azithromycin (Macrobac) 1xBD-8days

Severe cases

• Tab Moxifloxacin (Mofest) 400mg 1xBD 10days
• Older patients Tab Levofloxacin (Leflox) 500mg-7days
• Pregnant: Tab Cefuroxime (Zinacep) 250mg 1xBD-8days