A1nCnSICLCG

nost
Pad a prevlous case of CA aL 2 years old
Plu asLhma
rlkson lnl1lA1lv vS CulL1 ploraLlon and asserLlng conLrol and power
over envlronmenL
AgenL
8acLerlal paLhogens Lyplcally
5tteptococcos poeomooloe (penlcllllnsenslLlve and reslsLanL
sLralns)
oemopbllos lofloeozoe %amplcllllnsenslLlve and reslsLanL sLralns)
,otoxello cotottbolls %all sLralns penlcllllnreslsLanL)

nvlronmenL
CongesLed llvlng arrangemenLs llves wlLh parenLs grandparenLs
%maLernal slde) aunL uncle and a cousln
Crowdlng lnde 8 3 rooms ln Lhe house wlLh approlmaLely 6 wlndows
and 3 doors
uusLy ouLdoor envlronmenL
A household member ls a smoker Lo whom Lhe paLlenL ls always eposed
A household member has been havlng a nonproducLlve cough buL ls noL
Laklng any medlcaLlons nor seeklng consulL
lnvaslon by an lnfecLlous agenL lnLroduced lnLo Lhe lungs Lhrough hemaLogenous spread or lnhalaLlon
AcLlvaLed lnflammaLory response
lnvadlng agenL synLheslzes and secreLes mlcroblal enzymes proLelns Lolc llplds and Lolns LhaL dlsrupL hosL cell membranes
meLabollc machlnery and Lhe eLracellular maLrl LhaL usually lnhlblLs mlcroblal mlgraLlon
1argeLed mlgraLlon of phagocyLes wlLh Lhe release of Lolc
subsLances from granules and oLher mlcroblcldal packages
lnlLlaLlon lf poorly LargeLed regulaLed cascades %eg complemenL
coagulaLlon cyLoklnes) LhaL may damage healLhy hosL Llssues badly
or worse Lhan Lhe lnvadlng agenL
SLrucLural or secreLed molecules such as endoLoln leukocldln and Lolc shock syndrome Loln1 %1SS11)
AlLer local vasomoLor Lone and lnLegrlLy change Lhe characLerlsLlcs of Lhe Llssue perfusaLe and generally
lnLerfere wlLh Lhe dellvery of oygen and nuLrlenLs and removal of wasLe producLs from local Llssues

lncrease alrway smooLh muscle Lone and reslsLance mucus secreLlon and Lhe presence of lnflammaLory cells and debrls ln Lhese secreLlons
lurLher lncrease ln alrway reslsLance and obsLrucL alrways parLlally or LoLally causlng alrLrapplng aLelecLasls and venLllaLory dead space
ulsrupLlon of endoLhellal and alveolar eplLhellal lnLegrlLy
Allow surfacLanL Lo be lnacLlvaLed by proLelnacous eudaLe a process LhaL may be eacerbaLed
furLher by Lhe dlrecL effecLs of meconlum or paLhogenlc mlcroorganlsms
Sequel 1

Sequel 1
Lobar neumonla
SLrep Sudden onseL of chllls rapldly rlslng
fever %383 Lo 403 degrees Celslus)
1he spread of lnfecLlon or lnflammaLory response elLher sysLemaLlcally or
Lo oLher focal slLes furLher eacerbaLes Lhe condlLlon

1
sL
24 hours of lnfecLlon CCnCS1lCn
Mlcroscoplc vascular congesLlon and alveolar edema
%alveoll flll wlLh proLelnaceous fluld) many bacLerla and
few neuLrophlls are presenL
2
nd
3
rd
uay 8u PA1lZA1lCn
Alveolar fluld Lrlggers brlsk lnflu of many 88Cs
neuLrophlls desquamaLed eplLhellal cells and flbrln
wlLhln Lhe alveoll slmllar conslsLency wlLh Lhe llver
2
nd
3
rd
uay C8A? PA1lZA1lCn
Lung ls graybrown Lo yellow because of flbrlnopurulenL
eudaLe %deposlLlon of flbrln) dlslnLegraLlon of 88Cs
%lnflammaLory cells) and hemoslderln
8SCLu1lCn
lnLraalveolar debrls ls lngesLed and removed by alveolar
macrophages consolldaLlon flbrlnous lnflammaLlon
leads Lo organlzaLlon and pleural adheslons decreased
alr enLry and dullness Lo percusslon lnflammaLlon ln Lhe
small alrways leads Lo crackles
Sequel 2
ConducLlng alrways offer
much more reslsLance and
may become obsLrucLed
Alveoll may be aLelecLaLlc
or hyperepanded due Lo
secreLlons and mucosal
edema LhaL occlude Lhe
bronchl or alveoll
Alveoll
perfuslon may
be markedly
alLered
MulLlple Llssues and cell populaLlons ln
Lhe lung and elsewhere susLaln ln[ury LhaL
lncreases Lhe basal requlremenLs for
oygen upLake and ecreLory gas removal
aL a Llme when Lhe lungs are less able Lo
accompllsh Lhese Lasks
Alveoll dlffuslon barrlers
may lncrease
lnLrapulmonary shunLs
may worsen due Lo
decreased alveolar
oygen Lenslon
venLllaLlon/perfuslon mlsmaLch may
furLher lmpalr gas echange desplLe
endogenous hemosLaLlc aLLempLs Lo
lmprove maLchlng by reglonal alrway and
vascular consLrlcLlon or dllaLaLlon
8esplraLory
ffecLs
Cllnlcal ManlfesLaLlons
u81l %sore LhroaL nasal congesLlon)
redomlnanL sympLoms headache lowgrade fever pleurlLlc paln myalgla rash pharynglLls
AfLer a few days mucold/mucopurulenL spuLum ls epecLoraLed bloodLlnged spuLum ls
characLerlsLlc of sLrepLococcal sLaphylococcal and lebslello pneumonla
llushed cheeks
Llps and nallbeds demonsLraLe cenLral cyanosls %laLe slgn of poor oygenaLlon hypoemla)
CrLhopnelc dlaphoreLlc easlly Llred poor appeLlLe
lncreased LacLlle fremlLus percusslon dullness bronchlal breaLh sounds egophony whlspered
pecLorlloquy
Mllng of oygenaLed and unoygenaLed blood or poorly oygenaLed blood evenLually resulLs ln arLerlal hypoemla
venous blood enLerlng Lhe pulmonary clrculaLlon passes Lhrough Lhe undervenLllaLed area and Lravels Lo Lhe lefL slde of Lhe hearL poorly oygenaLed
Myocardlum has Lo work harder Lo overcome alLeraLlons ln pulmonary vascular reslsLance LhaL accompany Lhe above changes of pneumonla
Sequel 3

1he lungs may be less able Lo add oygen and remove
carbon dlolde from mled venous blood for dellvery
Lo end organs %lncludlng hearL)
8apld and boundlng pulse usually lncreaslng
abouL 10 bpm for every degree %Celslus) Cf
LemperaLure elevaLlon a relaLlve bradycardla %
a pulseLemperaLure deflclL ln whlch Lhe pulse
ls slower Lhan LhaL epecLed for a glven
LemperaLure) may suggesL vlral lnfecLlon
mycoplasma lnfecLlon or lnfecLlon wlLh a
eqlooello organlsm
Marked Lachypnea accompanled by oLher slgns of resplraLory
dlsLress %eg SC8 use of accessory muscles upon resplraLlon)
8ronchospasm may occur ln paLlenLs wlLh reacLlve alrway dlsease
Sequel 3
lncreased hearL's demand for oygen
lncreased cyLoklne levels ln pneumonla promoLes
Lhe formaLlon of blood cloLs whlch decreases
efflclency of Lhe hearL
AcuLe 8esplraLory ulsLress Syndrome
AcuLe onseL
8llaLeral lnfllLraLes on chesL radlograph sparlng
cosLophrenlc angles
ulmonary arLery wedge pressure 18 mmPg %obLalned
bypulmonary arLery caLheLerlzaLlon) lf Lhls lnformaLlon ls
avallable lf unavallable Lhen lack of cllnlcal evldence of lefL
venLrlcular fallure sufflces
lf aC2llC2 300 mmPg %40 ka) acuLe lung ln[ury %ALl) ls
consldered Lo be presenL
lf aC2llC2 200 mmPg %267 ka) acuLe resplraLory
dlsLress syndrome %A8uS) ls consldered Lo be presenL
Cardlac manlfesLaLlons
ArrhyLhmla/dysrhyLhmla
lschemla ln[ury lnfarcLlon
lallure
8esplraLory ArresL
Cardlac ArresL
MulLlorgan fallure ueaLh Severe hypoemla and hypola
Sequel 2
Bacteremia
SysLemlc lnflammaLory 8esponse
Syndrome/SSlS ueflned by Lhe presence of Lwo
or more of Lhe followlng flndlngs
8ody LemperaLure 36 C %7 l) or 38
C %100 l)%hypoLhermla or fever)
PearL raLe 0 beaLs per mlnuLe
8esplraLory raLe 20 breaLhs per mlnuLe or
on blood gas a aCC2 less Lhan 32 mm
Pg %43 ka) %Lachypnea orhypocapnla due
Lo hypervenLllaLlon)
JhlLe blood cell counL 4000 cells/mm
3
or
12000 cells/mm
3
% 4 10

or
12 10

cells/L) or greaLer Lhan 10 band

forms %lmmaLure whlLe blood cells)
%leukopenlaleukocyLosls or bandemla)

Severe Sepsls Sepsls wlLh organ dysfuncLlon
hypoperfuslon or hypoLenslon
SepLlc Shock Sepsls wlLh refracLory arLerlal
hypoLenslon or hypoperfuslon abnormallLles ln
splLe of adequaLe fluld resusclLaLlon