INFECTIOUS DISEASE
PNEUMONIA
All a repeat of resp but important so left it here too!
PromptCXR description
ResponseBe a boss at this: some cool catchphrases
Location of any pathology!!
Cavitating lesion
Air bronchograms
Effusions
Fluid in horizontal fissure
Location of any pathology!!
Cavitating lesion
Air bronchograms
Effusions
Fluid in horizontal fissure
PromptCXR Consolidation causes
ResponseInfectious
Strep. Pneumoniae
S. Aureus
Gram negatives - Klebsiella, legionella, pseudomonas, e. Coli, proteus, H. Influenzae)
Mycoplasma
TB
Anaerobes (Fusobacterium, other weird ones)
Fungal - aspergilliosis, cryptococcus, canditisi
Parasites - echinococcus, PJP
Non-infectious
Malignancy - primary/mets/lymphoma
Vascular - pulmoarny infarct, thromboembolic
Granuloma - RA, Sarcoid, Wegeners
bronchiectasis
Weir/wonderful - Pneumoconiosis, lucite plombage
Congenital/cyst
Strep. Pneumoniae
S. Aureus
Gram negatives - Klebsiella, legionella, pseudomonas, e. Coli, proteus, H. Influenzae)
Mycoplasma
TB
Anaerobes (Fusobacterium, other weird ones)
Fungal - aspergilliosis, cryptococcus, canditisi
Parasites - echinococcus, PJP
Non-infectious
Malignancy - primary/mets/lymphoma
Vascular - pulmoarny infarct, thromboembolic
Granuloma - RA, Sarcoid, Wegeners
bronchiectasis
Weir/wonderful - Pneumoconiosis, lucite plombage
Congenital/cyst
PromptInvestigation in cavitating lesion
ResponseSputum MCS + AFB ?TB
CT chest - detect cavitation or infarct, other lesions not seen on CXR
Blood cultures - rationalise ABx
Echo ? IE in IVDU (IVDU in stem)
CT chest - detect cavitation or infarct, other lesions not seen on CXR
Blood cultures - rationalise ABx
Echo ? IE in IVDU (IVDU in stem)
PromptManagement of cavitation lesion
ResponseBroad spectrum IV antibiotics
Oxygen >94%, invasive respiratory support if deterioration
IV fluid resuscitation 30 mL/kg
Inotropes for MAP >65
Disposition ICU with resp admission
Oxygen >94%, invasive respiratory support if deterioration
IV fluid resuscitation 30 mL/kg
Inotropes for MAP >65
Disposition ICU with resp admission
PromptPneumonia antibiotic cover
ResponseCeftriaxone - severe CAP (principally pneumococcus)
Azithromycin 500 mg daily - Atypical CAP (mycoplasma and legionella)
Vancomycin - MRSA cover
Oseltamivir 75 mg BD - If influenza suspected
Meropenem 1g TDS - Melioidosis if in northern australia
Azithromycin 500 mg daily - Atypical CAP (mycoplasma and legionella)
Vancomycin - MRSA cover
Oseltamivir 75 mg BD - If influenza suspected
Meropenem 1g TDS - Melioidosis if in northern australia
PromptNon respiratory causes of ARDS
ResponseTrauma/lung contusion
Burns
Pancreatitis
Aspiration
Massive transfusion
Fat embolus
Drowning
Non respiratory sepsis
Burns
Pancreatitis
Aspiration
Massive transfusion
Fat embolus
Drowning
Non respiratory sepsis
PromptOxygenation approach in CAP
ResponseBronchodilators + hydrocortisone (esp. If respiratory history)
Stepwise increase in supplemental oxygenation - NRB 15L >> HFNP 50L@100%
NIV (Bipap) - PS 12, EPAP 6, FiO2 100%
Intubation
Stepwise increase in supplemental oxygenation - NRB 15L >> HFNP 50L@100%
NIV (Bipap) - PS 12, EPAP 6, FiO2 100%
Intubation
- experienced operator, large tube to facilitate bronchoscopy
- ARDS approach (TV 4-6 mL/kg, plateau pressure <30, permissive hypercapnoea)