Catherine Casey S. Jones,
|
|
- Easter Johns
- 5 years ago
- Views:
Transcription
1 Community Acquired Pneumonia Catherine Casey S. Jones, PhD, RN, ANP-C, AE-C Catherine Casey S. Jones, PhD, RN, ANP-C, AE-C Texas Pulmonary & Critical Care Consultants, PA & Adjunct Professor at Texas Woman s University in Dallas Disclosures No financial relationship with any pharmaceutical manufacturer or medical device company 1
2 Objectives Compare the different types of pneumonia according to the patient s current location or residence and risk factors. Assess the patient s susceptibility for hospitalization using CURB-65. Recommend appropriate therapy for individuals with community acquired pneumonia. Types of Pneumonia Community acquired pneumonia (CAP) Hospital acquired (nosocomial) pneumonia (HAP) occurs 48 hours or more after admission Ventilator acquired (VAP) more than hours after endotracheal intubation Types of Pneumonia Healthcare-associated - (HCAP) - Nursing homes Dialysis centers Outpatient clinics Within 90 days of discharge from acute or chronic care facility Recent IV antibiotic therapy, chemotherapy or wound care within the past 30 days Aspiration pneumonitis & pneumonia 2
3 Prevalence million in U.S. hospitalized with pneumonia Average length of stay days Nursing home 33,700 residents with pneumonia or 2.3 % in 2004 More than 50,000 deaths in 2010 CDC How do we defend against pneumonia? Nose Coughing & sneezing reflexes Mucus Blanket Cilia (mucociliary escalator) Macrophages Leukocytes Etiology Most pneumonias are caused by microaspiration or inhalation of bacteria or viruses into the lung. Usually the body s defenses will prevent infection, but at times of low resistance pathogenic organisms may overwhelm the usual protective mechanisms. Commonly days after an upper respiratory infection (URI). 3
4 Who is at risk for developing pneumonia? Elderly Dormitory or Barrack Conditions Hospitalized Exposure to Smoke and Chemicals Genetics Drug & Alcohol Users Chronic Lung Conditions Compromised Immunity Asthmatics Newborns Risk Factors Continued Age Stroke Neuromuscular disease Sedatives & Alcohol Poor Nutrition Prior Infections Anatomic Changes Tumor Granulocytopenia Community Acquired Pneumonia Microbial diagnosis made in only 7.6 % of cases in 2009 Bacterial > Viral 4
5 CAP: Definition CAP occurs outside the hospital or within 24 hours of admission to a hospital or LTC facility. By definition, the person must NOT have been in a LTC facility within 90 days prior to onset of symptoms Common Bacterium Streptococcus pneumoniae (65%) Mycoplasma pneumoniae historically children & adolescents increasing high rates in adults especially elderly adults Chlamydophilia pneumoniae (previously named Chlamydia) (0-20%) Legionella (2-9%) classically contaminated water sources in hospitals & hotels resistant to all beta-lactams Common Bacterium Haemophilus influenzae Neisseria meningitidis Moraxella catarrhalis Klebsiella pneumoniae Staphylococcus aureus - infrequent pulmonary pathogen watch for patients with recent influenza (MRSA only 2 % of infections were pneumonia) 5
6 Common Viruses Influenza virus Respiratory syncytial virus (RSV) Adenovirus Parainfluenza virus Human metapneumovirus Middle East respiratory syndrome coronavirus patients from Saudi Arabia or other Middle East countries Etiology of Viral Pneumonias Most common causative organisms are Respiratory Syncytial Virus (RSV), influenza, parainfluenza, adenoviruses, measles, and chicken pox. Symptoms usually milder than bacterial pneumonia. Initially fever, dry cough, headache, muscle pain and weakness. In hours dyspnea occurs, fever increases, and cough produces a scant sputum. Viral Pneumonia An acute infection of the pulmonary parenchyma with viral origin Perhaps accounts for half of all pneumonia cases. Symptoms subside in 2-5 days. 6
7 Examples of Exposure-Specific Infections Chlamydia psittaci (psittacosis) Coxiella burnetii (Q Fever) Francisella tularensis (Tularemia) Endemic Fungi (blastomyces, coccidioides, histoplasma) Sin Nombre virus (hantavirus pulmonary syndrome) Yersinia pestis (pneumonic plague) Pleural Effusion If a pleural effusion is evident on the chest x-ray, the patient should be referred for evaluation promptly Failure to recognize an early empyema may mean therapy involves thoracotomy rather than simpler procedures such as thoracentesis or chest tube placement Clinical Pearl The chest x-ray should normalize in 8 weeks in normals, 12 weeks in those with underlying lung disease (COPD) You must show resolution of the pneumonia on chest x-ray in this time frame If the pneumonia does not resolve on chest x-ray, refer to specialist 7
8 Symptoms of Community-Acquired Pneumonia Fever (80 %) Cough Mucopurulent bacterial Scant/watery - atypical Dyspnea Pleuritic Chest Pain (30 %) Hypoxia Tachypnea (45-70 %) Tachycardia Chills (40-50 %) Sweats &/or Rigors (15 %) Crackles &/or Rhonchi Hemoptysis Fatigue Myalgias GI symptoms (nausea, vomiting, diarrhea) Mental status changes Typical Presentation TYPICAL PNEUMONIA: Sudden onset of fever Cough productive of purulent sputum Chest pain Shaking chills Headache Dullness with bronchial signs of lung consolidation Typical Pneumonia Localized X-ray findings Leukocytosis 15,000 30,000 per mm 3 Bacterial 8
9 Atypical Pneumonia Gradual onset Dry cough Headache Myalgia Fatigue Sore throat Nausea, vomiting Diarrhea Physical findings minimal Leukocyte count <15,000 Examples: Viral Mycoplasma pneumoniae Chlamydophila pneumoniae Elderly Ø Elderly patients may have fewer symptoms than younger patients or no symptoms at all Ø If an elderly person has a minor cough and weakness for 1 day, they need to be evaluated Ø Some exhibit only confusion, lethargy, and general disorientation Elderly Presentation Mental status change Falls Incontinence Failure to thrive Metabolic changes Fever - frequently absent 9
10 Subjective Data Recent URI Cough: ranges from hacking, non-productive (mycoplasma, viral) to productive with rusty or yellow sputum (bacterial) Fever, chills Myalgia, pleuritic pain, dyspnea Malaise, headache, loss of appetite Nausea, vomiting Occasional sore throat Objective Data Physical exam may be normal in early stages Increased temperature, pulse Nasal flaring, tachypnea Lungs: dullness to percussion and auscultation over site of consolidation, diffuse crackles and wheezes, rhonchi Physical Examination Auscultation Crackles or rhonchi Bronchial breath sounds Consolidation Percussion Palpation Feel Tactile Fremitus Signs of consolidation: Bronchophony Exaggerated vocal resonance over consolidated area Egophony (E to A) Whispered pectoriloquy Increased resonance 10
11 Diagnosis & Initial Assessment of CAP Chest X-Ray gold standard not helpful with identifying pathogen Screening pulse oximetry Routine diagnostic testing is optional Initial assessment of severity Differential Diagnosis Chronic pulmonary disease: asthma, COPD, chronic bronchitis Atelectasis Damage from physical agents: near drowning, smoke inhalation CHF Neoplasms Lung abscess Tuberculosis Pulmonary embolism Severity of Illness Scoring CURB-65 Confusion of new onset Urea greater than 7 mmol/l (19 mg/dl)* Respiratory rate of 30 breaths/minute Blood pressure < 90 mmhg systolic or diastolic 60 mm Hg 65 or older * May omit if unavailable in office setting 11
12 CURB-65 Scoring 0 to 1 treat as out-patient 2 short hospital 3 to 5 hospital with probable ICU admission Severity of Illness Scoring Pneumonia Severity Index (PSI) Need more laboratory values More complicated Calculator Risk classes I - V Categorizing Severity to Assess for Hospitalization Need (PSI) Class I Class II Class III Class IV Class V Low Risk Low Risk Low Risk Mod. Risk High Risk Outpatient Outpatient Inpatient brief Inpatient Inpatient 12
13 Outpatient Versus Hospitalization Cost of inpatient versus outpatient management is up to 25 times greater! Outpatients resume normal activity sooner. 80 % prefer outpatient therapy. Hospitalization increases thromboembolic events & superinfection by more-virulent or resistant hospital bacteria. Criteria for Hospitalization ~ 10 % of hospitalized patients with CAP requires ICU admission One of most important determinants for ICU care is presence of chronic comorbid conditions 1/3 of patients with severe CAP were previously healthy Antibiotics of Choice: Outpatient Therapy Previously healthy & no risk factors for drugresistant S. pneumoniae infection: Macrolide (azithromycin, clarithromycin or erythromycin) Doxycycline Comorbidities or use of antimicrobials within previous 3 months: Respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin 750 mg) Β-lactam PLUS a macrolide (high-dose amoxicillin or amoxicillin-clavulanate) Alternatives ceftriaxone, cefpodoxime & cefuroxime, doxycycline 13
14 Antibiotic Choice in the Elderly Use macrolide for those 65 and older Proven to increase survival Antibiotic Stewardship Avoid use of respiratory quinolones if not indicated. Save quinolones for patients who really need these medications! No new antibiotics in the near future. Limit duration of therapy to recommended time periods. Probiotics probably help limit development of C. diff, decreasing use of subsequent antibiotics Ancillary Therapies Increased fluids, good nutrition Expectorants (marginal utility) Cough suppressants with care, usually just at bedtime Analgesics, acetaminophen for high fever If likely diagnosis influenza pneumonia, consider Tamiflu Tobacco cessation 14
15 Prevention Good Lifestyle Habits Hygiene Diet Low Stress Influenza Vaccine Pneumococcal Vaccine Prevention Continued - Influenza Vaccine 70% - 100% effective in healthy adults 30% - 60% effective in the elderly & children with a poor match, but is effective for flu complications (pneumonia, CVA, MI, all cause mortality) Vaccinated adults have lower hospitalization rates and death Prevention Continued - Influenza Vaccine Annual vaccination in ~ October all persons age 6 months and older Contraindicated with significant egg allergy - hives Killed, inactivated - IM injection Live attenuated intranasal only for < 50 who are healthy 15
16 Prevention Continued Pneumovax Vaccine PPSV23: Those 65 and older Chronic comorbidities All cigarette smokers Asthmatics Booster - one after age 65 PCV13: Immunocompromised or children Now approved for adults Hospitalization Diagnosis for Hospitalized Patients Chest X-Ray gold standard WBC (leukocytosis or leukopenia) Blood Cultures Sputum Gram stain & Culture Urine Antigens for Legionella & pneumococcus CT scan (rarely) PPD (R/O TB) 16
17 Diagnosis for Hospitalized Patients Procalcitonin peptide precursor of calcitonin released by parenchymal cells in response to bacterial toxins elevated serum levels with bacterial infections <0.1 mcg/l = too low to treat with antibiotics >0.25 mcg/l = treat with antibiotics Distinguish between bacterial versus viral pneumonia Reduce antibacterial use Predict survival Hospital Management (Class III-V) Antibiotic treatment is based on the organism identified Anywhere from days Start IV then switch to PO Clinical stability: Temp <100 Pulse <100 Resp <24 SBP >90 Pulse Oximeter 90 % Ability to maintain oral intake Normal mental status References Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. ATS/IDSA Guidelines. (2005). American Journal of Respiratory & Critical Care Medicine, vol 171, Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the management of community-acquired pneumonia in adults. (2007). Clinical Infectious Diseases. 44, S
18 References Rello, J. & Chastre, J. (2013). Update in pulmonary infections American Journal of Respiratory & Critical Care Medicine. Vol. 187, Thank you! 18
Community Acquired Pneumonia. Abdullah Alharbi, MD, FCCP
Community Acquired Pneumonia Abdullah Alharbi, MD, FCCP A 68 y/ male presented to the ED with SOB and productive coughing for 2 days. Reports poor oral intake since onset due to nausea and intermittent
More informationPULMONARY EMERGENCIES
EMERGENCIES I. Pneumonia A. Bacterial Pneumonia (most common cause of a focal infiltrate) 1. Epidemiology a. Accounts for up to 10% of hospital admissions in the U.S. b. Most pneumonias are the result
More informationPneumonia. Dr. Rami M Adil Al-Hayali Assistant professor in medicine
Pneumonia Dr. Rami M Adil Al-Hayali Assistant professor in medicine Definition Pneumonia is an acute respiratory illness caused by an infection of the lung parenchyma, associated with recently developed
More informationCharles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center
Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center Kathy Peters is a 63 y.o. patient that presents to your urgent care office today with a history
More informationPneumonia Community-Acquired Healthcare-Associated
Pneumonia Community-Acquired Healthcare-Associated Edwin Yu Clin Infect Dis 2007;44(S2):27-72 Am J Respir Crit Care Med 2005; 171:388-416 IDSA / ATS Guidelines Microbiology Principles and Practice of Infectious
More informationan inflammation of the bronchial tubes
BRONCHITIS DEFINITION Bronchitis is an inflammation of the bronchial tubes (or bronchi), which are the air passages that extend from the trachea into the small airways and alveoli. Triggers may be infectious
More informationRespiratory Infections
Respiratory Infections NISHANT PRASAD, MD THE DR. JAMES J. RAHAL, JR. DIVISION OF INFECTIOUS DISEASES NEWYORK-PRESBYTERIAN QUEENS Disclosures Stockholder: Contrafect Corp., Bristol-Myers Squibb Co Research
More informationCommunity Acquired Pneumonia-Adults Clinical Practice Guideline MedStar Health
Community Acquired Pneumonia-Adults Clinical Practice Guideline MedStar Health These guidelines are provided to assist physicians and other clinicians in making decisions regarding the care of their patients.
More informationThe McMaster at night Pediatric Curriculum
The McMaster at night Pediatric Curriculum Community Acquired Pneumonia Based on CPS Practice Point Pneumonia in healthy Canadian children and youth and the British Thoracic Society Guidelines on CAP Objectives
More informationPNEUMONIA. I. Background 6 th most common cause of death in U.S. Most common cause of infection related mortality
Page 1 of 8 September 4, 2001 Donald P. Levine, M.D. University Health Center Suite 5C Office: 577-0348 dlevine@intmed.wayne.edu Assigned reading: pages 153-160; 553-563 PNEUMONIA the most widespread and
More informationOutpatient Management of Patients With Community Acquired Pneumonia Clinical Practice Guideline September 2013
Clinical Practice Guideline September 2013 General Principles: Community Acquired Pneumonia (CAP), together with influenza, remains the seventh leading cause of death in the United States. According to
More informationPneumonia: The Forgotten Killer
Pneumonia: The Forgotten Killer David Glenn Weismiller, MD, ScM, FAAFP Department of Family and Community Medicine University of Nevada, Las Vegas School of Medicine Disclosure Statement It is the policy
More informationKAISER PERMANENTE OHIO COMMUNITY ACQUIRED PNEUMONIA
KAISER PERMANENTE OHIO COMMUNITY ACQUIRED PNEUMONIA Methodology: Expert opinion Issue Date: 8-97 Champion: Pulmonary Medicine Most Recent Update: 6-08, 7-10, 7-12 Key Stakeholders: Pulmonary Medicine,
More informationCommunity Acquired Pneumonia in Adults Clinical Practice Guideline Antibiotic Stewardship
Community Acquired Pneumonia in Adults Clinical Practice Guideline Antibiotic Stewardship These guidelines are provided to assist physicians and other clinicians in making decisions regarding the care
More informationCommunity-Acquired Pneumonia OBSOLETE 2
Community-Acquired Pneumonia OBSOLETE 2 Clinical practice guidelines serve as an educational reference, and do not supersede the clinical judgment of the treating physician with respect to appropriate
More informationCommunity Acquired Pneumonia - Pediatric Clinical Practice Guideline MedStar Health Antibiotic Stewardship
Community Acquired Pneumonia - Pediatric Clinical Practice Guideline MedStar Health Antibiotic Stewardship These guidelines are provided to assist physicians and other clinicians in making decisions regarding
More informationUpper...and Lower Respiratory Tract Infections
Upper...and Lower Respiratory Tract Infections Robin Jump, MD, PhD Cleveland Geriatric Research Education and Clinical Center (GRECC) Louis Stokes Cleveland VA Medical Center Case Western Reserve University
More informationRespiratory Diseases and Disorders
Chapter 9 Respiratory Diseases and Disorders Anatomy and Physiology Chest, lungs, and conducting airways Two parts: Upper respiratory system consists of nose, mouth, sinuses, pharynx, and larynx Lower
More informationCommunity Acquired Pneumonia
April 2014 References: 1. Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL Mace SE, McCracken Jr. GH, Moor MR, St. Peter SD, Stockwell JA, and Swanson JT. The Management of
More informationAntimicrobial Stewardship in Community Acquired Pneumonia
Antimicrobial Stewardship in Community Acquired Pneumonia Medicine Review Course 2018 Dr Lee Tau Hong Consultant Department of Infectious Diseases National Centre for Infectious Diseases Scope 1. Diagnosis
More informationObjectives. Pneumonia. Pneumonia. Epidemiology. Prevalence 1/7/2012. Community-Acquired Pneumonia in infants and children
Objectives Community-Acquired in infants and children Review of Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America - 2011 Sabah Charania,
More informationCommunity Acquired Pneumonia Pediatric Ages 3 month to 18 years Clinical Practice Guideline MedStar Health Antibiotic Stewardship
Community Acquired Pneumonia Pediatric Ages 3 month to 18 years Clinical Practice Guideline MedStar Health Antibiotic Stewardship These guidelines are provided to assist physicians and other clinicians
More informationCritical Care Nursing Theory. Pneumonia. - Pneumonia is an acute infection of the pulmonary parenchyma
- is an acute infection of the pulmonary parenchyma - is a common infection encountered by critical care nurses when it complicates the course of a serious illness or leads to acute respiratory distress.
More informationChapter 22. Pulmonary Infections
Chapter 22 Pulmonary Infections Objectives State the incidence of pneumonia in the United States and its economic impact. Discuss the current classification scheme for pneumonia and be able to define hospital-acquired
More informationPNEUMONIA IN CHILDREN. IAP UG Teaching slides
PNEUMONIA IN CHILDREN 1 INTRODUCTION 156 million new episodes / yr. worldwide 151 million episodes developing world 95% in developing countries 19% of all deaths in children
More informationPOLICY FOR TREATMENT OF LOWER RESPIRATORY TRACT INFECTIONS
POLICY F TREATMENT OF LOWER RESPIRATY TRACT INFECTIONS Written by: Dr M Milupi, Consultant Microbiologist Date: June 2018 Approved by: The Drugs & Therapeutics Committee Date: July 2018 Implementation
More informationSputum. PNEUMONIA: Variations and Interventions Always a Challenge CURE Activity February 9, William Guest, MD, FCCP Pneumonia Statistics
PNEUMONIA: Variations and Interventions Always a Challenge CURE Activity February 9, 2010 William Guest, MD, FCCP Assistant Dean of Curriculum School of Medicine SW Campus Medical College of Georgia Definition/Diagnosis
More informationUnit II Problem 2 Pathology: Pneumonia
Unit II Problem 2 Pathology: Pneumonia - Definition: pneumonia is the infection of lung parenchyma which occurs especially when normal defenses are impaired such as: Cough reflex. Damage of cilia in respiratory
More informationBATES VISUAL GUIDE TO PHYSICAL EXAMINATION. OSCE 5: Cough
BATES VISUAL GUIDE TO PHYSICAL EXAMINATION OSCE 5: Cough This video format is designed to help you prepare for objective structured clinical examinations, or OSCEs. So Ms. Chen, tell me what is your average
More informationPNEUMONIA. Patient Case: Chief Complaint: I have been short of breath and have been coughing up rust-colored phlegm for the past 3 days.
PNEUMONIA Relevant Guidelines: 2008 IDSA CAP guidelines: http://www.idsociety.org/guidelines/patient_care/idsa_practice_guidelines/infections_by_org an_system/lower/upper_respiratory/community-acquired_pneumonia_(cap)/
More informationBrice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine
Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine Discuss advances in predicting prognosis Understand dwhat we know (and don t know) about the Microbiology Recognize important
More informationNosocomial Pneumonia. <5 Days: Non-Multidrug-Resistant Bacteria
Nosocomial Pneumonia Meredith Deutscher, MD Troy Schaffernocker, MD Ohio State University Burden of Hospital-Acquired Pneumonia Second most common nosocomial infection in the U.S. 5-10 episodes per 1000
More informationLecture Notes. Chapter 16: Bacterial Pneumonia
Lecture Notes Chapter 16: Bacterial Pneumonia Objectives Explain the epidemiology Identify the common causes Explain the pathological changes in the lung Identify clinical features Explain the treatment
More informationInfections of the head, neck, and lower respiratory tract
Infections of the head, neck, and lower respiratory tract Infections of the upper respiratory tract Common 25% bacteria antibiotics 75% viruses Diagnosis on clinical grounds Nonspecific infections of the
More informationChapter 10 Respiratory System J00-J99. Presented by: Jesicca Andrews
Chapter 10 Respiratory System J00-J99 Presented by: Jesicca Andrews 1 Respiratory System 2 Respiratory Infections A respiratory infection cannot be assumed from a laboratory report alone; physician concurrence
More informationPneumonia. Definition of pneumonia Infection of the lung parenchyma Usually bacterial
Pneumonia Definition of pneumonia Infection of the lung parenchyma Usually bacterial Epidemiology of pneumonia Commonest infectious cause of death in the UK and USA Incidence - 5-11 per 1000 per year Worse
More informationTurkish Thoracic Society
Türk Toraks Derneği Turkish Thoracic Society Pocket Books Series Diagnosis and Treatment of Community Acquired Pneumonia in Children Short Version (Handbook) in English www.toraks.org.tr This report was
More informationWORKSHOP. The Multiple Facets of CAP. Community acquired pneumonia (CAP) continues. Jennifer s Situation
Practical Pointers pointers For for Your your Practice practice The Multiple Facets of CAP Dr. George Fox, MD, MSc, FRCPC, FCCP Community acquired pneumonia (CAP) continues to be a significant health burden
More information11/19/2012. The spectrum of pulmonary diseases in HIV-infected persons is broad.
The spectrum of pulmonary diseases in HIV-infected persons is broad. HIV-associated Opportunistic infections Neoplasms Miscellaneous conditions Non HIV-associated Antiretroviral therapy (ART)-associated
More informationGOALS AND INSTRUCTIONAL OBJECTIVES
October 4-7, 2004 Respiratory GOALS: GOALS AND INSTRUCTIONAL OBJECTIVES By the end of the week, the first quarter student will have an in-depth understanding of the diagnoses listed under Primary Diagnoses
More informationViruses, bacteria, fungus, parasites (in rare cases) or other organisms can cause pneumonia.
1 Pneumonia Pneumonia is an infection which inflames the air sacs either in one or both of the lungs. The air sacs are generally filled with fluid or pus, causing cough along with phlegm or pus, fever,
More informationURIs and Pneumonia. Elena Bissell, MD 10/16/2013
URIs and Pneumonia Elena Bissell, MD 10/16/2013 Objectives Recognize and treat community acquired PNA in children/adults Discern between inpatient and outpatient treatment of PNA Recognize special populations/cases
More informationCAP, HCAP, HAP, VAP. 1. In 1898, William Osler described community-acquired pneumonia as:
1. In 1898, William Osler described community-acquired pneumonia as: Brad Sharpe, M.D. Professor of Clinical Medicine Department of Medicine UCSF sharpeb@medicine.ucsf.edu I have no relevant financial
More informationGuidelines/Guidance/CAP/ Hospitalized Child. PHM Boot Camp 2014 Jay Tureen, MD June 19, 2014
Guidelines/Guidance/CAP/ Hospitalized Child PHM Boot Camp 2014 Jay Tureen, MD June 19, 2014 CAP in Children: Epi Greatest cause of death in children worldwide Estimated > 2 M deaths in children In developed
More informationThe Old Man s Friend (And the Ire of Many an ED QI Director) Objectives. Terminology 10/22/2009
Pneumonia Management & Chris Fee, MD Assistant Clinical Professor UCSF Department of Emergency Medicine The Old Man s Friend (And the Ire of Many an ED QI Director) 7th leading cause of death in US 915,000
More informationDisclosures. Case 1. Acute Bronchitis. Acute Bronchitis. Community-Acquired Pneumonia and other Respiratory Tract Infections. What do you recommend?
Community-Acquired Pneumonia and other Respiratory Tract Infections none Disclosures Joel T. Katz, M.D. Associate Professor of Medicine Division of Infectious Diseases Brigham and Women s Hospital Case
More informationPatient information: Pneumonia in adults (Beyond the Basics)
Page 1 of 8 Official reprint from UpToDate www.uptodate.com 2014 UpToDate Patient information: Pneumonia in adults (Beyond the Basics) Authors Thomas J Marrie, MD Thomas M File, Jr, MD Section Editor John
More informationHospital-acquired Pneumonia
Hospital-acquired Pneumonia Hospital-acquired pneumonia (HAP) Pneumonia that occurs at least 2 days after hospital admission. The second most common and the leading cause of death due to hospital-acquired
More informationDiffusion: Oxygen in the alveoli move into capillaries to go to the body, and carbon
1 2 Oxygenation and Perfusion Alina Ruiz, MSN-Ed., RN Anatomy and Physiology of Oxygenation What does the respiratory system do? 3 4 5 6 7 Lungs: Ventilation vs Respiration vs Perfusion Ventilation is
More informationMedStar Health Ambulatory Clinical Practice Guideline
Title: Antimicrobial Stewardship Community Acquired Pneumonia MedStar Health Ambulatory Clinical Practice Guideline Clinical Policy: New X Revised Reviewed Purpose: Ambulatory Management of Patients in
More informationRESPIRATORY TRACT INFECTIONS. CLS 212: Medical Microbiology
RESPIRATORY TRACT INFECTIONS CLS 212: Medical Microbiology Anatomy of the Respiratory System Respiratory Infections Respiratory tract can be divided into: Upper Respiratory Tract (URT): Sinuses Nasopharynx,.
More informationRespiratory Tract Infec1ons Long Term Care. Dr Karsten Hammond Infec1ous Diseases 28 March 2015
Respiratory Tract Infec1ons Long Term Care Dr Karsten Hammond Infec1ous Diseases 28 March 2015 Disclosures I have no financial rela1onships to disclose 82 yo Female In LTC for two years, total care from
More informationChoosing an appropriate antimicrobial agent. 3) the spectrum of potential pathogens
Choosing an appropriate antimicrobial agent Consider: 1) the host 2) the site of infection 3) the spectrum of potential pathogens 4) the likelihood that these pathogens are resistant to antimicrobial agents
More informationPneumonia Aetiology Why is it so difficult to distinguish pathogens from innocent bystanders?
Pneumonia Aetiology Why is it so difficult to distinguish pathogens from innocent bystanders? David Murdoch Department of Pathology University of Otago, Christchurch Outline Background Diagnostic challenges
More informationWright, Respiratory Infections in the Challenging Patient. Disclosures. Objectives
Respiratory Infections in the Challenging Patient Wendy L. Wright, MS, APRN, BC, FAANP, FAAN Adult / Family Nurse Practitioner Owner - Wright & Associates Family Healthcare Amherst, New Hampshire Owner
More informationAdult CAP. How to approach for diagnosis. Natpatou Sanguanwongse, MD. Bureau of Emerging Infectious Disease July Sunday, July 8, 12
Adult CAP How to approach for diagnosis Natpatou Sanguanwongse, MD. Bureau of Emerging Infectious Disease July 2012 Community-acquired pneumonia (CAP) one of several disease in which individuals (who have
More informationRESPIRATORY TRACT INFECTIONS. CLS 212: Medical Microbiology Zeina Alkudmani
RESPIRATORY TRACT INFECTIONS CLS 212: Medical Microbiology Zeina Alkudmani Lower Respiratory Tract Upper Respiratory Tract Anatomy of the Respiratory System Nasopharynx Oropharynx Respiratory Tract Infections
More informationManagement of Common Respiratory Disorders in Children. Whitney Pressler, MD Pediatric Brown Bag Series Webinar June 14, 2016
Management of Common Respiratory Disorders in Children Whitney Pressler, MD Pediatric Brown Bag Series Webinar June 14, 2016 Disclosures I have no financial relationships to disclose I will not be discussing
More informationManagement of Common Respiratory Disorders in Children. Disclosures. Roadmap 6/10/2016
Management of Common Respiratory Disorders in Children Whitney Pressler, MD Pediatric Brown Bag Series Webinar June 14, 2016 Disclosures I have no financial relationships to disclose I will not be discussing
More informationCommunity acquired pneumonia
Community acquired pneumonia definition Symptoms of an acute LRTI New focal signs on chest examination At least one systemic feature New radiographic shadow Defination{Crofton} IT IS A SYNDROME CAUSED
More informationCOPD exacerbation. Dr. med. Frank Rassouli
Definition according to GOLD report: - «An acute event - characterized by a worsening of the patients respiratory symptoms - that is beyond normal day-to-day variations - and leads to a change in medication»
More informationBronchitis/Pneumonia Core Content Keith Conover, M.D., FACEP /15/02 Clinical Spectrum Chest pain, shoulder pain, neck pain, abdominal pain,
Bronchitis/Pneumonia Core Content Keith Conover, M.D., FACEP 1.0 10/15/02 Clinical Spectrum Chest pain, shoulder pain, neck pain, abdominal pain, headache Links with smoking, pollen count, FH of asthma
More informationPediatric Respiratory Infections
Pediatric Respiratory Infections Brenda Kelly PharmD BCPS Residency Program Director Virginia Mason Memorial, Yakima, Washington brendakelly@yvmh.org Disclosure The presenter has no actual or potential
More informationPNEUMONIA. Dr. A.Torossian, M.D., Ph. D. Department of Respiratory Diseases
PNEUMONIA Dr. A.Torossian, M.D., Ph. D. Department of Respiratory Diseases Definition Pneumonia is an infection of the lungs caused by bacteria, viruses, fungi and other microorganisms. Classifications
More informationPneumonia. Trachea , The Patient Education Institute, Inc. id Last reviewed: 11/11/2017 1
Pneumonia Introduction Pneumonia is an inflammation and infection of the lungs. Pneumonia causes millions of deaths every year. It can affect anybody, but is more dangerous to older adults, babies and
More informationPathology of Pneumonia
Pathology of Pneumonia Dr. Atif Ali Bashir Assistant Professor of Pathology College of Medicine Majma ah University Introduction: 5000 sq meters of area.! (olympic track) Filters >10,000 L of air / day!
More informationCLAIRE NOWLAN & SAM SEARLE. Pneumonia in the nursing home
CLAIRE NOWLAN & SAM SEARLE Pneumonia in the nursing home No disclosures or conflicts of interest PMHX: A. FIB. GERD MIXED DEMENTIA MMSE 16/30 HTN Mr. Hack 86 years old RAMIPRIL 4 MG OD PARIET 20MG OD DONEPEZIL
More informationBacterial pneumonia with associated pleural empyema pleural effusion
EMPYEMA Synonyms : - Parapneumonic effusion - Empyema thoracis - Bacterial pneumonia - Pleural empyema, pleural effusion - Lung abscess - Complicated parapneumonic effusions (CPE) 1 Bacterial pneumonia
More information10/2/2017. Pneumonia: Are We Missing the Mark? Objectives. Pneumonia
Pneumonia: Are We Missing the Mark? LaDawna Goering, DNP, APN, ANP-BC Nick Van Hise, Pharm. D, BCPS Objectives Diagnose Pneumonia Evaluate severity of illness tools and site of care decisions Review diagnostic
More informationAspiration pneumonia in older people
Aspiration pneumonia in older people Ayman Morish, M.D. Internal medicine, Critical care Medicine and Geriatrics Fellow. Contents Epidemiology Causes of aspiration pneumonia Issues of older age Management
More informationCommunity-acquired pneumonia in adults
Prim Care Clin Office Pract 30 (2003) 155 171 Community-acquired pneumonia in adults Julio A. Ramirez, MD a,b, * a Department of Medicine, University of Louisville School of Medicine, 512 S. Hancock Street,
More information27/11/2012. Parainfuenza 1, 2 3 Rhinovirus Coronavirus Adenovirus Respiratory syncytial virus (RSV) Chlamydophila pneumoniae Mycoplasma pneumonite
8 «Evidence-based Medicine-» 27/11/2012,,,, : :,,,,,,,, (30%-50%) () (5%-10%) (40%-50%) 20% Infuenza A B Parainfuenza 1, 2 3 Rhinovirus Coronavirus Adenovirus Respiratory syncytial virus (RSV) Chlamydophila
More informationPneumonia Severity Scores:
Pneumonia Severity Scores: Are they Accurate Predictors of Mortality? JILL McEWEN, MD FRCPC Clinical Professor Department of Emergency Medicine University of British Columbia Vancouver, BC Canada President,
More information(cilia) that help sweep away fluids and/or particles International Journal of Pharmaceutical Sciences and Research 2055
IJPSR (2014), Vol. 5, Issue 5 (Research Article) Received on 29 November, 2013; received in revised form, 21 February, 2014; accepted, 16 April, 2014; published 01 May, 2014 EVALUATION OF EFFICACY AND
More informationSelf-study course. Pneumonia
Self-study course Pneumonia This brochure is available in alternate formats. Call 1-800-282-8096 (V/TTY) 2 Course objectives: At the end of this course you will be able to: 1) Identify a series of steps
More informationPneumonia in the Hospitalized
Pneumonia in the Hospitalized Patient: Use of Steroids Nicolette Myers, MD Pulmonary/Sleep/Critical Care November 9, 2018 Park Nicollet Clinic Facts About Pneumonia CAP is the 8 th most common cause of
More informationPNEUMONIA. Pneumonia is an inflammation of the lungs caused by bacteria, viruses, fungi, rickettsiae and other microorganisms.
PNEUMONIA Dr. A.Torossian, M.D., Ph. D. Department of Respiratory Diseases Definition Pneumonia is an inflammation of the lungs caused by bacteria, viruses, fungi, rickettsiae and other microorganisms.
More informationGetting Smart About: Upper Respiratory Infections
Getting Smart About: Upper Respiratory Infections Daniel Z. Uslan, MD Assistant Clinical Professor Director, Antimicrobial Stewardship Program UCLA Health System Disclosures None relevant to the topic
More informationChapter 16. Lung Abscess. Mosby items and derived items 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 16 Lung Abscess 1 EDA PM C AFC RB A B Figure 16-1. Lung abscess. A, Cross-sectional view of lung abscess. B, Consolidation and (C) excessive bronchial secretions are common secondary anatomic alterations
More informationCardiovascular and Respiratory Disorders
Cardiovascular and Respiratory Disorders Blood Pressure Normal blood pressure is 120/80 mmhg (millimeters of mercury) Hypertension is when the resting blood pressure is too high Systolic BP is 140 mmhg
More informationEpiglottitis. Bronchitis. Bronchiolitis. Pneumonia. Croup syndrome. Miss. kamlah 2
Miss. kamlah 1 Epiglottitis. Bronchitis. Bronchiolitis. Pneumonia. Croup syndrome. Miss. kamlah 2 Acute Epiglottitis Is an infection of the epiglottis, the long narrow structure that closes off the glottis
More informationUPDATE IN HOSPITAL MEDICINE
UPDATE IN HOSPITAL MEDICINE FLORIDA CHAPTER ACP MEETING 2016 Himangi Kaushal, M.D., F.A.C.P. Program Director Memorial Healthcare System Internal Medicine Residency DISCLOSURES None OBJECTIVES Review some
More informationUpper Respiratory Tract Infections
Upper Respiratory Tract Infections OTITIS MEDIA Otitis media is an inflammation of the middle ear. There are more than 709 million cases of otitis media worldwide each year; half of these cases occur in
More informationBradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF
Maximizing Care for Community- Acquired Pneumonia Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF sharpeb@medicine.ucsf.edu 1. In 1898, William Osler described community-acquired
More informationDELL CHILDREN S MEDICAL CENTER EVIDENCE-BASED OUTCOMES CENTER. Community Acquired Pneumonia
DELL CHILDREN S MEDICAL CENTER Community Acquired Pneumonia LEGAL DISCLAIMER: The information provided by Dell Children s Medical Center of Texas (DCMCT), including but not limited to Clinical Pathways
More informationCommunity-Acquired Pneumonia. Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital. Nothing to disclose.
Community-Acquired Pneumonia Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital Nothing to disclose. Community-Acquired Pneumonia Talk will focus on adults Guideline
More informationINFLUENZA AND OTHER RESPIRATORY VIRUSES
INFLUENZA AND OTHER RESPIRATORY VIRUSES Lung Foundation Australia Patient Seminar 21 st October 2017 Lynette Reid Respiratory Clinical Nurse Specialist, RHH What is influenza (the flu )? Influenza (flu)
More informationWithin the past decade, the number of
CME EARN CATEGORY I CME CREDIT by reading this article and the article beginning on page 48 and successfully completing the posttest on page 53. Successful completion is defined as a cumulative score of
More informationpneumonia The management of community-acquired The prevalence of community-acquired pneumonia
The management of community-acquired pneumonia Pneumonia is a significant cause of mortality in children and older people, particularly among Māori and Pacific Peoples. In New Zealand, Māori are six times
More informationPANEL KEGAWAT DARURATAN SISTEM PERNAPASAN (SERANGAN ASMA AKUT, PNEUMONIA DAN COPD) dan EDEMA PARU
1 PANEL KEGAWAT DARURATAN SISTEM PERNAPASAN (SERANGAN ASMA AKUT, PNEUMONIA DAN COPD) dan EDEMA PARU ASTHMA 2 2 Agonist Bronchodilator Response Anticholinergic Asthma Response Panel A COPD Response Panel
More informationPractice Guidelines for the Management of Community-Acquired Pneumonia in Adults
000 GUIDELINES FROM THE INFECTIOUS DISEASES SOCIETY OF AMERICA Practice Guidelines for the Management of Community-Acquired Pneumonia in Adults John G. Bartlett, 1 Scott F. Dowell, 2 Lionel A. Mandell,
More informationBradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF -- William Osler, M.D.
Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF sharpeb@medicine.ucsf.edu a. An ailment that often leads to suffocation and death. b. A friend of the aged. c. A common
More informationAntibiotics, Expectorants, and Cough Suppressants. Center For Cardiac Fitness Pulmonary Rehab The Miriam Hospital
Antibiotics, Expectorants, and Cough Suppressants Center For Cardiac Fitness Pulmonary Rehab The Miriam Hospital Objectives Review the mechanism of action (MOA), dosing, benefits, and various options for:
More informationMichael S. Niederman, M.D. Clinical Director Pulmonary and Critical Care Medicine New York Presbyterian Hospital Weill Cornell Medical Center
CA-MRSA Pneumonia Michael S. Niederman, M.D. Clinical Director Pulmonary and Critical Care Medicine New York Presbyterian Hospital Weill Cornell Medical Center Professor of Clinical Medicine Weill Cornell
More informationInfection Control. Student Orientation
Infection Control Student Orientation Basic, but important, Principles of Cross Transmission Presence of microorganisms on hands or in environment does not necessarily = cross transmission or infection
More informationUnconscious exchange of air between lungs and the external environment Breathing
Respiration Unconscious exchange of air between lungs and the external environment Breathing Two types External Exchange of carbon dioxide and oxygen between the environment and the organism Internal Exchange
More informationRespiratory tract infections. Krzysztof Buczkowski
Respiratory tract infections Krzysztof Buczkowski Etiology Viruses Rhinoviruses Adenoviruses Coronaviruses Influenza and Parainfluenza Viruses Respiratory Syncitial Viruses Enteroviruses Etiology Bacteria
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Blum CA, Nigro N, Briel M, et al. Adjunct prednisone
More informationand localized ground glass opacities, or bronchiolar focal or multifocal micronodules;
E1 Chest CT scan and Pneumoniae_YE Claessens et al- Supplementary methods Level of CAP probability according to CT scan - definite CAP: systematic alveolar condensation, or alveolar condensation with peripheral
More information