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Medicine Notes Respiratory Notes

Lower Respiratory Tract Infections Notes

Updated Lower Respiratory Tract Infections Notes

Respiratory Notes

Respiratory

Approximately 35 pages

Complete set of notes covering the respiratory system. Includes pathophysiology, aetiology, presenting symptoms, management and relevant pharmacology. Concise bullet points, colour coded by topic. Includes tables and summary charts. All you need to pass respiratory module at medical school....

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Lower Respiratory Tract Infections

Pneumonia

Infective respiratory tract infection causing radiological shadowing

Classified according to setting in which it is acquired as this influences the likely pathogens and therefore determines best empirical treatment

Community-acquired pneumonia

Pathophysiology

  • Droplet spread

  • Organisms multiply rapidly in lung

  • Local defense mechanisms overcome

  • = Pneumonia

Clinical features

  • Fever

  • Cough

  • Sputum production (yello/green)

  • Chest pain

  • Dyspnoea

  • Systemic features (malaise, anorexia, fatigue)

Likely organisms

  • Strep. Pneumonia

  • H. Influenzae

Investigations

Microbial Non-Microbial

  • Sputum MC+S

  • Blood culture

  • Urine (legionella antigen)

  • Microscopy (gram, acid fast stain for TB)

  • PCR – viral replication

  • Nose and throat swabs

  • NPAs (nasopharyngeal aspirates – viral)

Imaging

  • CXR

Bloods

  • Blood gas (saturation)

  • FBC (WCC, platelets)

  • U+E (Urea + hydration status)

  • CRP

Management

Assess severity

  • CURB 65

General supportive measures

  • Analgesia, O2, IV fluids

Antibiotic therapy

  • Mild cases (amoxicillin)

  • Severe cases (IV macrolide – erythromycin)

Treat complications

  • Effusion, empyema, lobar collapse

Hospital-acquired pneumonia

Pneumonia occurring >48 hours after hospital admission

Causative organisms

  • Staph aureus

  • Gram negative organisms e.g Klebsiella pneumonia

  • Pseudomonas (has a 50% mortality rate in ventilated patients)

Pathophysiology

  • Predisposing factors

    • Aspiration risk

    • Reduced host defenses (ventilator associated pneumonia)

Clinical features and investigation

  • Same as community-acquired pneumonia

  • Severity of illness often greater as a result of underlying disease

Management

  • General supportive treatment

    • O2, fluids, physiotherapy

  • Specific antibiotic treatment

    • Needs to cover gram negative organisms resistant to antibiotics given for community acquired pneumonia

      • Meropenam, tazocin

Pneumonia in the Immunocompromised

‘Pneumonia occurring in patients with deficient cellular or humoral immune mechanisms’

Incidence is increasing due...

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