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Pulmonary Infections Guide
- 1. Pulmonary Infections Pneumonia and Tuberculosis http://www.youtube.com/watch?v=h6z7Af-ssxw http://www.youtube.com/watch?v=2vGuCK_HOLQ https://www.youtube.com/watch?v=SEhAFmtaOCY https://www.youtube.com/watch?v=lhMCFGPqvJg http://videocast.nih.gov/Summary.asp?File=15873&bhcp=1
- 4. Pneumonia and tbc From most prevalent to least.
- 5. Pneumonia and tbc http://www.medscape.com/viewarticle/850138?nlid=88129_801&src=wnl_edit_medp_infd&uac=53576BK&spo n=3&impID=817799&faf=1 Does this change everything? …or is it just a bad study?
- 6. Pneumonia and tbc http://www.medscape.com/viewarticle/825416?nlid=58208_801&src=wnl_edit_medp_infd&uac=53576BK&spon=3 New Diagnostics + New Vaccines = New Way of Thinking?
- 16. Pneumonia and tbc Seen most often in HAP and HCAP
- 17. Pneumonia and tbc Treat the stain, modify when sensitivity results are available
- 18. Pneumonia and tbc Typical with aspiration. Treat the stain regardless of the culture results!
- 19. Pneumonia and tbc http://videocast.nih.gov/Summary.asp?File=15873&bhcp=1 Aspiration is probably the major cause of VAP
- 20. Pneumonia and tbc What is Ventilator Associated Pneumonia? …it’s where drug resistant organisms have their holidays!
- 21. Pneumonia and tbc Severe pneumonia + pre-existing severe illness + drug resistant pathogen = poor prognosis
- 22. Pneumonia and tbc Is VAP as preventable as catheter associated UTIs and central line infections?
- 23. Pneumonia and tbc The risk of aspiration increases with age.
- 24. Pneumonia and tbc Streptococcus pneumoniae and aspiration cause at least half of the pneumonia cases in the elderly.
- 26. Pneumonia and tbc Much of the damage in viral pneumonia is due to the host response.
- 35. Pneumonia and tbc Bacteremic staphylococcal pneumonia typically has multiple, diffuse, cavitating, round lesions.
- 37. Pneumonia and tbc Pleural fluid can be demonstrated on a lateral decubitus film
- 43. Pneumonia and tbc Summary of Testing Guidelines
- 44. Pneumonia and tbc CURB-65 and PSSI Help Guide Treatment Decisions
- 45. Pneumonia and tbc Treatment Summary
- 46. Pneumonia and tbc Age is the most significant risk factor for pneumonia
- 48. Pneumonia and tbc The problem of pneumonia in the elderly is as old as medicine.
- 49. Pneumonia and tbc So what can we do?
- 50. Pneumonia and tbc ww.medpagetoday.com/InfectiousDisease/Pneumonia/53017?xid=nl_mpt_special_reports_2015-09-08&eun=g519 …and a meta-analysis supports steroid use.
- 51. Pneumonia and tbc So what can we do...?
- 52. Pneumonia and tbc Pneumococcal vaccine decreases pneumococci in children.
- 53. Pneumonia and tbc ...even in non-immunized children!
- 54. Pneumonia and tbc Less carriage by kids means less disease in kids...
- 55. Pneumonia and tbc ...and in the elderly!
- 56. Pneumonia and tbc In fact, the effect may be most dramatic for pneumonia in the elderly!
- 57. Pneumonia and tbc There is little evidence that pneumococcal vaccine given to the elderly has any value.
- 58. Pneumonia and tbc The best way to prevent pneumonia in adults may be to vaccinate kids against strep pneumoniae and influenza!
- 59. Pneumonia and tbc http://health.usnews.com/health-news/articles/2015/09/10/other-peoples-flu-vaccines-help-shield-seniors-too-study Influenza vaccination of non-elderly adults limits influenza in the elderly.
- 61. Pneumonia and tbc If tuberculosis is suspected-get Infectious Diseases involved immediately. The public health and infection control implications are gigantic!Insist on performing tuberculosis stains as early as possible, the cost and bother are always justifiable. A day or two of excessive respiratory isolation is far preferable to unnecessary exposure of scores of people to tuberculosis. http://en.wikipedia.org/wiki/Tuberculosis_management
Editor's Notes
- Productive mucoid cough and fever. Elderly often do not present with fever> bad immune response. Congestive heart failure and kidney failure patients also do no present with fever. Elderly are a high risk group for pneumonia. Pleuritic chest pain> one sided. Pleura rubs against each other> need surfactant. “hurts when I breathe” Pneumonia> productive cough. Mycoplasma> fever and infiltrated dry cough. Common in people between 15 and 40. To dx pneumonia: need to see infiltrates on CXR. Pneumonia might be present for a couple weeks before infiltrates are seen on X-ray. (Atypical pneumonia)
- Atypical pneumonia: mycoplasma is most common (late appearance of infiltrates)
- Lists are from most common infectious agent to least. Children most often get viral pneumonia. Adults: streptococcus is typical. Everything else is atypical. Adenovirus causes colds. Some strains are potent and can cause viral pneumonia. Occurs in “mini outbreaks” within dorms, military barracks etc.
- Smokers typically get hemophilus influenzae CAP