:

6 . ()

.. 2550

(Pneumonia)

- 5

2550

2

14

23
30

31
32

33
36 1

10



10

( Pneumonia)

exudate
lobar pneumonia

Viral Pneumonia

(Chemical aspiration)

(larynx)



1.

2. epiglottal reflex

3.

cough reflex

4. cilli

5.
macrophage

6. immune substance

7.


macrophage

consolidation 3

 vital capacity compliance

right-to-left-shunt ventilation-perfusion

mismatch

lobar pneumonia

1.

2.

3.

16




inflammatory debris

air trapping
collateral

ventilation

Streptococcus
pneumoniae, Staohylococcus aureus, Hemophilus influenzae,

Streptococcus pyogenes ( gr.A), Mycoplasma pneumoniae,

Klebsiella enterobacter, Mycobacterium tuberculosis

Streptococcus pneumoniae

3-4 Staphylococcus
1 Chlamydia
trachomatis 4

 6

eosinophil

Klebsiella pseudomonas

leukemia, lymphoma

Pneumocystis carinii
AIDS, leukemia

E.coli, klebsiella Herpes

staphylococcus group B streptococcus

10-14



Chlamydia,

Pneumocystis carinii melioidosis endemic area

2

1. ( Primary pneumonia )

2. ( Secondary pneumonia )



( Measles )

1.
Acut respiratory infection
5

2.

3.

4. suprasternal, subcostal,
xiphisternum intercostal


5.

bronchial breath sound, vocal fremitus vocal

resonance fine crepitation sonorous

rhonchi

6. Pleuropulmonary pain


( parietal pleura )
( diaphragmatic pleura )

3
4

7.

8.

2 - 5 3

1. ( Very severe pneumonia )

1.1

1.2

1.3 Wheezing
Stridor

( Larynx )
( trachea )

1.4

1.5

6

1.6 38

2. ( Severe pneumonia )
2.1
2.2

2.3

2.4 38
3. ( pneumonia )
3.1
3.2

3.3 38

1. 60 /
2.

3.

4. Grunting
5.

( Very Severe disease )

1.
2.

3.

4.

5. ( Stridor )
6. wheezing

7. 38 35.5

1.


2.

7

2.1 Acute laryngotracheobronchitia

( barking cough )
stridor

2.2 2
2-3
expiratory wheezing

diminished breath sound expiration

fine crepitation

2.3

fine
crepitation 2

3.

3.1

Band Segmented PMN Toxicgranules

PMN 2

Lymphocytes

Polymorph
1- 2
Lymphocytes

3.2

3.3 (Sputum Exam, Sputum

culture )

 false negative

Predominate bacteria
8

3.4

2030 %

3.5 Pleural fluid culture

3.6

3.7

( Hypoxia )

60

49
21 % ( Campbells criteria )

4.






pneumatocele

staphylococcus consolidation
streptococcus pneumoniae

peribronchial interatitial infiltration

1.

1.1

70-80

antidiuretic
hormone
pulmonary edema

1.2

1.3

1.

2.

3.

direct tracheal suction,

bronchopulmonary lavage
2.

1.

1.
70

2.
3.

4. 10

5. pulse oximeter 90

1. Nasal canular nasal catheter

1-6 /


( O2 Sat ) 24-44

2. Face mask

Nasal canular

nasal catheter Face mask

reservoir
bag 5- 8 /
40-80

3. Oxygen tent

3.1 Hood tent

8-10 /

60-70

3.2 Croupette chamber cooling /

circulating unit nebulizer

 10-12 /

60 Croupette



11

2.

sonorous rhonchi wheezing

3.

glyceryl guiacolate




4. bromhexine acetylcysteine



acetylcysteine

hyperactive airway

3.






1.

1.1 3

gr.B streptococcus
penicillin G 5 /

./ 100 - 150 ./ ./ 8-12

3-7 Staphylococcus

aureus penicillinase-resistant

penicillin 100-150 ././ 8-12

12

1.2 7 3-5

Streptococcus pneumoniae, H.influenzae

Staphylococcus aureus (

)

100-200 ././ 6
3 amoxicillin 50 ././ 6-8

48


/
H.influenzae type B

cefuroxine cefotaxime 75-150 ././

chloramphenicol 50-100 ././

amoxicillin+clavulanic acid 50 ././

Staphylococcus aureus penicillinase

resistant penicillin cloxacillin 100-150 ././

1.3 6

Chlamydia trachomatis
( staccato
paroxysm )
crepitation expiration wheezing

hyperexpansion

interstitial infiltration 2
mediastinum

 chlamydial pneumonia
eosinophil cout > 300 cell/cu.mm.
ABG PaO2 PaCO2
nasopharygeal secretion

antibody C. trachomatis
indirect immunofluorescence Chlamydia specific
IgA IgM antibody

erythromycin 30-40 ././ (

250 ./ ) 14 3-5
erythromycin 2
13

1.4 3-5
Streptococcus pneumoniae gr.A -hemolytic

Streptococcus penicillin v 1 /./

amoxicillin ( 40-50 ././ )
penicillin G 1 /./

ampicillin 100-200 ././ 3

amoxicillin 7

mycoplasma pneumonia

differential count
neutrophil cold agglutinin

erythromycin 30-50 ././ 3-4

250 ./

2.

enteric bacilli

penicillinase resistant penicillin cloxacillin

aminoglycoside
respiratory
secretion

RSV

antiviral agent ribavirin

1.
BCG

2.

3.

4.

4.1 Bacterial vaccine pneumococcal

vaccine, Hemophilus influenzae type B vaccine

4.2 Respiratory virus vaccine influenza vaccine

RSV vaccine
14

20 132

64 3

6
2549 10.15 .

11

HN 0155559 AN 11586 -

49

2549 14.00 .





-

2
15

2 1

20

38.5 48

Conjunctiva

Nasal septum Polyps

120

48
Crepitation , Wheezing 2 16

1. Complete Blood Count ( CBC ) 6 2549

Hct

WBC

Platelets count
Neutrophil

Cells/cu.mm
Cells/cu.mm

%
%

12 - 16

35.7

17,410

341,000

400,000

24.7

25 - 35

0.9

55 - 75

10,000

Basophli
gm%

5,000 -

140,000 -

Monocyte

36 - 48

Lymphocyte
Eosinophil

1-3

0-1

2-6
12.2

66

0.9

7.5