Week 1 - Pneumonia

Smoking
 immune system or Diabetes
defences
Age Young or old Other –AIDS, CF
Apex
Bacteria Lungs T1
Community Acquired Viruses – Primary
 Strep pneumoniae (25% resist to pen)
3 lobes 2 lobes
atypical
 Mycoplasma pneumoniae know bdrys etc  RSV
 H. influenzae (20% resist to pen.)
T3  adenovirus
nosocomial
S. pneumo 5rib  parainfluenzae
H. Infleunzae  influenza
Klebsiella lobar  CMV
P. aeruginosa 6rib MCL  measles (kids)
Staph Aureus  psittacosis
Aspergillus

Pneumonia
Symptoms
 fever (ILs and cytokines)
Antibiotics  SOB (V/Q mismatch)
In comm acquired first use Ampicillin + Stage 1 – Congestion (hours)
 Pain (pleural involvement)
erythromycin until pathogen ID’d. Then:  vascular engorgement
 Productive cough
 intra-alveolar fluid
Strep pneumoniae – Ampicillin (l AB  some neutrophil infiltration
cell wall synth), erythromycin (macrolide  lots of bacteria Diagnosis
 protein synth) S&S +
H. influenzae - Ampicillin CXR – Shadows,
lobar lobal consilidation,
Staph aureus - flucloxacillin:  vascular
multi foci (bronchpneumo)
The others – erythromycin permeability Exam- Unwell, cough, sputum
Severe Noso. Ampicillin + 3rd gen Palpate -  expansion
Cephalosporin – Vancomycin l AB) Stage 2 - Red hepatisation (2-3days) Ausc – Crackles Vocal Resonance,
  RBCs, neutrophils, fibrin in Bronchial BS
alveolar spaces Perc – Dull (not stony)
Lab
Sputum Sample – stain (1h),
Ethics culture/sens (3d)
Consent, refusal to Rx etc Stage 3 - Grey hepatisation (2-3d)
Blood Culture (1-10d)
Bronchoscopy washings
 degradation of RBCs
 fibrosuppurative exudate
little necrosis

Complications
Stage 4 – Resolution (3d)
 abscess formation
 enzymatic degradation of exudate 
 fibrosis/scarring Clinical Skill:- Evaluation of CXR granular semifluid debris
 empyema Technical (name orient., rotation)
Airways midline  debris and fibrin ingested by
 bacterial dissemination Mediastinum (heart shadow, hila) macrophages
Periphery – costophrenic angle,
fluid meniscus, diaphragm
DEATH Lung fields lucency/opacity, lesions
etc) Complete
Bones and soft tissue – injury. Recovery 3wk
Lateral CXR – heart chambers,
things behind heart