Pulmonary aspiration complicates between 1 in
900 to 1 in 10 000 general anaesthetics,1 dependent
on risk factors. All novice anaesthetists
in the UK are taught to consider the risk of aspiration
and to modify their anaesthetic technique
accordingly. The prevention of aspiration
remains a cornerstone of anaesthetic practice.
The recent Royal College of Anaesthetists
4th National Audit Project2 (NAP4) collected
data on the incidence and causes of major
airway complications in the UK. Over 50%
of airway-related deaths in anaesthesia were
as a consequence of aspiration, outweighing
the much feared can’t intubate can’t ventilate
(CICV) scenario. In addition, 23% of all cases
reported to NAP4 involved aspiration as either
the primary or secondary event. Cases not resulting
in death commonly resulted in significant
morbidity and prolonged stay on intensive care.
Despite the awareness among anaesthetists of
the need to minimize the risks of aspiration and
advances in anaesthetic practices, NAP4 provided
evidence that aspiration often occurred as
a consequence of incomplete assessment of aspiration
risk or a failure to modify anaesthetic
technique. This review aims to highlight the key
findings from NAP4 with regard to aspiration
and evaluates the literature on aspiration risk assessment
and decision-making.
Definition
Pulmonary aspiration is defined by the inhalation
of oro-pharyngeal or gastric contents into the
larynx and the respiratory tract. Mendelson3
described the potential consequences of abolished
airway reflexes under anaesthesia and
the subsequent aspiration of gastric contents,
which became synonymous with Mendelson’s
syndrome.
Aspiration of solid matter can cause hypoxia
by physical obstruction, whereas aspiration of
acidic gastric fluid can cause a pneumonitis with
the syndrome of progressive dyspnoea, hypoxia,
bronchial wheeze and patchy collapse, consolidation
on chest X-ray or all. The risk of mortality
and serious morbidity increases with bronchial
exposure to greater volumes and acidity of aspirated
material.
This document summarizes a study examining the prevalence of pulmonary fungal infection in chronic obstructive pulmonary disease (COPD) patients both with and without comorbidities. The study found that COPD patients with comorbidities had a significantly higher prevalence of pulmonary fungal infection (77.8%) compared to COPD patients without comorbidities (53.1%). Major risk factors for fungal infection in COPD patients with comorbidities included mechanical ventilation, corticosteroid therapy, ICU admission, and older age. COPD patients with comorbidities also had a higher mortality rate (12.3%) than COPD patients without comorbidities (3.1%).
Aspiration pneumonia occurs when gastric contents are aspirated into the lungs, causing infection. It can range from mild to life-threatening. Historically, anaerobic bacteria were most common causes, but recently aerobic bacteria like streptococcus pneumoniae and hospital-acquired gram-negative rods have emerged as primary pathogens. Risk factors include impaired swallowing or consciousness. Diagnosis is based on clinical presentation and chest imaging. Treatment involves antibiotics selected according to likely causative organisms and infection severity and source. Preventive measures focus on managing risk factors in high-risk patients.
This 67-year-old woman with mild Alzheimer's disease presents with community-acquired pneumonia based on symptoms of productive cough, fever, confusion and exam findings of crackles in both lower lung fields and CXR infiltrates. She meets 3 CURB-65 criteria (confusion, RR≥30, age≥65) and 4 IDSA-ATS minor criteria (RR≥30, confusion, BUN>20, PaO2/FiO2<250) warranting consideration of ICU admission given risk of deterioration. Based on her nursing home residence and recent hospitalization, she also meets criteria for possible healthcare-associated pneumonia and should receive broad-spectrum antibiotics with MRSA and Pseudomonas coverage along with diagnostic
This document summarizes guidelines for managing exacerbations of chronic obstructive pulmonary disease (COPD). It defines a COPD exacerbation and classifies exacerbations by severity. The initial evaluation should include symptoms, oxygen levels, and chest imaging. Indications for hospitalization include respiratory distress and risk of distress. Treatment includes increased bronchodilators, corticosteroids, antibiotics for purulent sputum or treatment failure, oxygen supplementation, and mechanical ventilation for severe cases. Antibiotics may reduce treatment failure and mortality rates.
This document discusses community-acquired pneumonia (CAP) in both children and adults. It provides information on the definition, most common causes, symptoms, physical exam findings, diagnostic testing, treatment recommendations, and management of CAP. Specifically, it notes that CAP is a significant cause of morbidity and mortality in children and the elderly. It recommends physical exams, labs, chest x-rays, and severity scores to evaluate patients and determine treatment approach. First-line antibiotic treatment depends on patient factors but usually includes macrolides or doxycycline. Hospitalization is advised if severity criteria are met.
This document provides guidelines for the diagnosis and management of community-acquired pneumonia (CAP) from the Joint Indian Chest Society/National College of Chest Physicians of India. It includes recommendations on the role of chest radiographs, microbiological investigations, risk stratification of patients, antibiotic therapy for both outpatient and inpatient settings, use of adjunctive therapies, and prevention of CAP through immunization and smoking cessation. The guidelines are meant to aid clinicians in properly diagnosing and treating CAP.
1) Aspiration pneumonitis is a chemical injury caused by inhalation of gastric contents, while aspiration pneumonia is an infectious process caused by inhalation of oropharyngeal secretions colonized by pathogens.
2) Risk factors for aspiration pneumonia include neurological dysphagia, GERD, poor oral hygiene, and silent aspiration common in stroke patients.
3) Management of aspiration pneumonitis includes airway protection and antibiotics only if symptoms do not resolve within 48 hours, while aspiration pneumonia requires broad-spectrum antibiotics targeting likely gram-negative organisms in the given setting.
Approach to a patient with respiratory infectionSrikant Mohta
This document provides an overview of acute respiratory infections including etiology, classification, clinical presentation, diagnostic evaluation and treatment approaches. It discusses the major syndromes of community-acquired pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia. Evaluation involves history, examination, hematological and microbiological testing. Severity is assessed using CURB-65 or Pneumonia Severity Index to determine site of care. Treatment selection is based on syndrome, severity and likely pathogens.
This document summarizes a study examining the prevalence of pulmonary fungal infection in chronic obstructive pulmonary disease (COPD) patients both with and without comorbidities. The study found that COPD patients with comorbidities had a significantly higher prevalence of pulmonary fungal infection (77.8%) compared to COPD patients without comorbidities (53.1%). Major risk factors for fungal infection in COPD patients with comorbidities included mechanical ventilation, corticosteroid therapy, ICU admission, and older age. COPD patients with comorbidities also had a higher mortality rate (12.3%) than COPD patients without comorbidities (3.1%).
Aspiration pneumonia occurs when gastric contents are aspirated into the lungs, causing infection. It can range from mild to life-threatening. Historically, anaerobic bacteria were most common causes, but recently aerobic bacteria like streptococcus pneumoniae and hospital-acquired gram-negative rods have emerged as primary pathogens. Risk factors include impaired swallowing or consciousness. Diagnosis is based on clinical presentation and chest imaging. Treatment involves antibiotics selected according to likely causative organisms and infection severity and source. Preventive measures focus on managing risk factors in high-risk patients.
This 67-year-old woman with mild Alzheimer's disease presents with community-acquired pneumonia based on symptoms of productive cough, fever, confusion and exam findings of crackles in both lower lung fields and CXR infiltrates. She meets 3 CURB-65 criteria (confusion, RR≥30, age≥65) and 4 IDSA-ATS minor criteria (RR≥30, confusion, BUN>20, PaO2/FiO2<250) warranting consideration of ICU admission given risk of deterioration. Based on her nursing home residence and recent hospitalization, she also meets criteria for possible healthcare-associated pneumonia and should receive broad-spectrum antibiotics with MRSA and Pseudomonas coverage along with diagnostic
This document summarizes guidelines for managing exacerbations of chronic obstructive pulmonary disease (COPD). It defines a COPD exacerbation and classifies exacerbations by severity. The initial evaluation should include symptoms, oxygen levels, and chest imaging. Indications for hospitalization include respiratory distress and risk of distress. Treatment includes increased bronchodilators, corticosteroids, antibiotics for purulent sputum or treatment failure, oxygen supplementation, and mechanical ventilation for severe cases. Antibiotics may reduce treatment failure and mortality rates.
This document discusses community-acquired pneumonia (CAP) in both children and adults. It provides information on the definition, most common causes, symptoms, physical exam findings, diagnostic testing, treatment recommendations, and management of CAP. Specifically, it notes that CAP is a significant cause of morbidity and mortality in children and the elderly. It recommends physical exams, labs, chest x-rays, and severity scores to evaluate patients and determine treatment approach. First-line antibiotic treatment depends on patient factors but usually includes macrolides or doxycycline. Hospitalization is advised if severity criteria are met.
This document provides guidelines for the diagnosis and management of community-acquired pneumonia (CAP) from the Joint Indian Chest Society/National College of Chest Physicians of India. It includes recommendations on the role of chest radiographs, microbiological investigations, risk stratification of patients, antibiotic therapy for both outpatient and inpatient settings, use of adjunctive therapies, and prevention of CAP through immunization and smoking cessation. The guidelines are meant to aid clinicians in properly diagnosing and treating CAP.
1) Aspiration pneumonitis is a chemical injury caused by inhalation of gastric contents, while aspiration pneumonia is an infectious process caused by inhalation of oropharyngeal secretions colonized by pathogens.
2) Risk factors for aspiration pneumonia include neurological dysphagia, GERD, poor oral hygiene, and silent aspiration common in stroke patients.
3) Management of aspiration pneumonitis includes airway protection and antibiotics only if symptoms do not resolve within 48 hours, while aspiration pneumonia requires broad-spectrum antibiotics targeting likely gram-negative organisms in the given setting.
Approach to a patient with respiratory infectionSrikant Mohta
This document provides an overview of acute respiratory infections including etiology, classification, clinical presentation, diagnostic evaluation and treatment approaches. It discusses the major syndromes of community-acquired pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia. Evaluation involves history, examination, hematological and microbiological testing. Severity is assessed using CURB-65 or Pneumonia Severity Index to determine site of care. Treatment selection is based on syndrome, severity and likely pathogens.
This summary provides an overview of a clinical case study presentation about a 68-year old female patient with a history of smoking, obesity, multiple gastric surgeries, achalasia, chronic malnutrition, and recurrent aspiration pneumonia. The presentation traces the progression of the patient's diseases and treatments, highlights the nutrition care process and interventions, and explores the connections between the patient's achalasia and history of bulimia. The patient was recently admitted for acute respiratory failure from aspiration pneumonia and declined further interventions, passing away after 9 days in the hospital.
This document provides information on community-acquired pneumonia (CAP), including its definition, guidelines, incidence, causes, risk factors, evaluation, diagnosis, severity scoring, and laboratory tests. Some key points:
- CAP is defined as an acute lung infection associated with symptoms and radiographic findings outside of a hospital or care facility.
- Guidelines for CAP management have been published by organizations like ATS and IDSA.
- The overall incidence is 3-40 per 1000 people per year, with higher rates among young children and older adults. Mortality can be as high as 10%.
- Common causes include Streptococcus pneumoniae, Haemophilus influenzae, and Legionella species.
COPD patients have increased nasal inflammation compared to controls. There is a correlation between the degree of inflammation in the upper and lower airways of COPD patients. Bacterial colonization in the lower airway is associated with higher nasal bacterial loads. This is the first study to report a correlation between upper and lower airway inflammation in COPD.
Management Of Community Acquired PneumoniaAshraf ElAdawy
This document provides information on community-acquired pneumonia (CAP), including its definition, classification, pathogens, pathophysiology, diagnosis, and methods for assessing severity. CAP is defined as an alveolar infection developing outside of a hospital within 48 hours of admission. The most common causative pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and atypical bacteria. Severity must be assessed to determine the appropriate site of care, and several prognostic scoring systems are discussed including the Pneumonia Severity Index (PSI), CURB-65, and CRB-65, which stratify patients into risk groups to guide management decisions.
Community acquired pneumonia by dr md abdullah saleemsaleem051
This document provides information on community-acquired pneumonia (CAP), including epidemiology, risk factors, presentation, diagnosis, treatment recommendations, and prevention strategies. It notes that CAP is one of the most common infectious diseases worldwide, with higher rates among the elderly. Common bacterial causes are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Clinical assessment and chest imaging are important for diagnosis and management. Antibiotic treatment should be based on likely pathogens and severity of illness. Immunization can help prevent CAP in high-risk groups.
Pneumocystis jirovecii is a fungus that causes pneumonia in immunocompromised patients. It is diagnosed through microscopic visualization of the organism in samples obtained through induced sputum or bronchoscopy with bronchoalveolar lavage. Real-time PCR assays have increased sensitivity over conventional staining but may produce false positives. Risk factors include HIV/AIDS with CD4 count <200 cells/uL, use of immunosuppressive drugs, hematologic malignancies, and organ transplantation. Presentation involves fever, cough, and dyspnea. Treatment involves trimethoprim-sulfamethoxazole.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) initially presented with respiratory symptoms like cough and fever but has since been found to involve other organ systems. The document reports 3 cases of gastrointestinal perforation in COVID-19 patients treated at a hospital in India. Case 1 involved a 60-year-old woman with rectal perforation. Case 2 was a 24-year-old postpartum woman with caecal perforation. Case 3, a 21-year-old man, presented with gastric perforation. The document reviews theories for how SARS-CoV-2 may cause gastrointestinal tract perforation, including via ACE2 receptors in the GI tract, coagulation disorders, viral replication in GI cells
Ventilator Associated Pneumonia (VAP) is a common nosocomial infection that develops in patients on mechanical ventilation. VAP increases mortality, length of stay, and medical costs. Risk factors include prolonged intubation and underlying patient health issues. Symptoms include cough, fever, purulent sputum, and new lung infiltrates. Evidence-based strategies to prevent VAP include oral care, silver coated endotracheal tubes, elevating the head of the bed, and using ventilator bundles.
This document discusses community-acquired pneumonia (CAP). It defines CAP and outlines its epidemiology, noting risk factors like increasing age and winter season. Diagnosis involves clinical evaluation, chest imaging, and ruling out other causes if imaging is abnormal but symptoms aren't. Severity is assessed using scores like CURB-65 to determine appropriate treatment setting. Most ambulatory patients receive 5 days of antibiotics while hospitalized patients get broader empiric coverage. Adjunctive steroids may benefit severe cases. Proper follow up and prevention through vaccination and smoking cessation are also discussed.
This document summarizes aspergillosis, including invasive pulmonary aspergillosis (IPA), chronic necrotizing aspergillosis (CNA), and aspergilloma. Aspergillus is a common mold that can cause a variety of pulmonary diseases. IPA predominantly affects immunocompromised patients and presents as pneumonia. Diagnosis involves tissue biopsy, galactomannan testing, and imaging. Voriconazole is recommended treatment. CNA occurs in patients with underlying lung disease and is characterized by slow lung tissue invasion. Itraconazole is effective treatment. Aspergilloma involves a fungus ball in a pre-existing lung cavity.
This document discusses community acquired pneumonia (CAP). It begins by defining CAP and discussing its epidemiology and classification. It then covers the incidence, clinical presentation, radiological manifestations, and typical microbiological findings of CAP. It discusses specific investigations and pathogens involved in severe CAP. Scoring systems for assessing CAP severity, including PSI, CURB-65 and CRB-65, are outlined. Guidelines are provided on treatment based on severity, including empiric antibiotic choice. Risk factors for drug-resistant pathogens and tuberculosis are noted. The document concludes with recommendations for empiric treatment of severe CAP patients admitted to the ICU.
This document discusses interstitial lung disease (ILD), focusing on idiopathic pulmonary fibrosis (IPF). ILD describes a group of lung disorders involving scarring of the lungs. IPF is the most common and severe type of ILD. The document defines ILD and its subtypes. It describes the diagnostic challenges of ILD and importance of investigating each case. Causes of ILD include exposures to irritants like asbestos as well as some autoimmune diseases. IPF is characterized by worsening shortness of breath and cough. It involves scarring of the lung tissue and has a poor prognosis. The document provides details on the prevalence, risk factors, diagnosis, and outcomes of IPF.
This document discusses hospital-acquired pneumonia (HCAP) and the nurse's role in prevention. It describes a case study of a 68-year-old man presenting with symptoms of pneumonia including cough, shortness of breath, and fever. Key risk factors for this patient include age, recent hip fracture, and chronic illnesses like diabetes and hypertension. The document outlines signs and symptoms of HCAP, treatment options including antibiotics and oxygen therapy, and the importance of infection control practices like hand hygiene in prevention.
The document discusses smoking-related interstitial lung diseases. Cigarette smoke can injure lung cells through oxidative stress and inflammation, potentially leading to fibrosis in some smokers. Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) is a rare smoking-related lung condition seen in heavy smokers, with symptoms of cough and wheezing. Physiologic testing may show obstruction, restriction, or normal results. Radiographs often appear normal or show subtle reticulation, especially in lung bases.
- Community acquired pneumonia (CAP) is an infection of the lung parenchyma acquired outside the hospital setting. Diagnosis involves presence of respiratory and systemic symptoms along with new radiological shadows on chest x-ray.
- Severity is classified using CURB-65 criteria to determine if hospital admission is required. Treatment involves antibiotics, with specific regimens depending on risk factors for multidrug-resistant organisms.
- Duration of treatment is typically 5-7 days but may be prolonged for specific cases. Prevention involves smoking cessation, hand washing, vaccination, and controlling underlying conditions like diabetes.
The document discusses Pneumocystis jirovecii, formerly known as Pneumocystis carinii, the fungus that causes Pneumocystis pneumonia. It was renamed in 1999. It describes the morphology of the organism including its trophozoite, precyst, and cyst forms. It also discusses the epidemiology, pathogenesis, clinical presentation, laboratory diagnosis including staining techniques, treatment with trimethoprim-sulfamethoxazole, and prevention with chemoprophylaxis for at-risk patients.
Aspiration Pneumonia General Medicine Rotation 12 15 09Trennette Gilbert
Aspiration pneumonia occurs when gastric or oropharyngeal contents are inhaled into the lungs. It requires both compromise of lung defenses and a large bacterial inoculum. Risk factors include reduced consciousness, neurological impairment, and GI disorders. Diagnosis is based on new infiltrates on chest x-ray along with signs of infection. Treatment involves oxygen, empiric antibiotics targeting likely pathogens, and treating predisposing conditions. Monitoring includes following vitals, labs, imaging and oxygenation to ensure response to therapy. The patient case involved an elderly man with post-op ileus who developed aspiration pneumonia responding well to broad-spectrum IV antibiotics.
Community-acquired pneumonia (CAP) is a common infectious disease worldwide and a major cause of mortality and morbidity. The document discusses definitions, etiology, risk factors, diagnosis, and treatment recommendations for CAP according to guidelines from IDSA/ATS. Key points include common bacterial and atypical pathogens causing typical and atypical CAP; use of severity assessment scores to determine hospitalization and ICU needs; recommendations for empirical antibiotic therapy based on patient factors; and considerations for MRSA coverage and broad-spectrum therapy.
This document discusses ventilator associated pneumonia (VAP), including its definition, causes, risk factors, prevention, and treatment. Some key points:
- VAP is pneumonia that develops in intubated patients and accounts for most ICU infections. It occurs in 10-20% of mechanically ventilated patients and has a high mortality rate.
- Risk factors include underlying illnesses, suppression of immune system, and prolonged ventilation. Common causes are oropharyngeal/GI bacteria and viruses that enter the lungs through the endotracheal tube or around the cuff.
- Prevention strategies include following bundles like elevating the head, oral care with chlorhexidine, and stopping unnecessary devices; as well
- SARS-CoV-2 is the virus that causes COVID-19 and is primarily spread through respiratory droplets. Common symptoms include fever, cough and shortness of breath.
- Diagnosis involves PCR or antigen testing of respiratory samples. Risk factors for severe disease include older age and underlying medical conditions.
- Treatment depends on severity but may include supportive care, remdesivir, dexamethasone and monoclonal antibody therapy. Prevention relies on measures like masking, distancing and infection control practices.
Bronchiolitis is a common respiratory infection in infants caused by viruses like RSV. It involves inflammation in the small airways of the lungs. It mostly affects children under 2 years old. Symptoms include cough, wheezing and difficulty breathing. Treatment focuses on supportive care with oxygen and fluids. Medications are generally not effective. Prevention involves monthly RSV antibody injections for high-risk infants during RSV season.
Ventilación Mecánica en la paciente obstétricaAivan Lima
This document discusses respiratory failure and mechanical ventilation in pregnant patients. It outlines several physiological changes in pregnancy that can promote respiratory failure, including decreased lung capacity and increased oxygen demands of the fetus. Common causes of respiratory failure in pregnancy are discussed, such as pneumonia, pulmonary edema, asthma exacerbations, aspiration, pulmonary embolism, and amniotic fluid embolism. Treatment considerations for mechanically ventilating pregnant patients with respiratory failure are also addressed.
This summary provides an overview of a clinical case study presentation about a 68-year old female patient with a history of smoking, obesity, multiple gastric surgeries, achalasia, chronic malnutrition, and recurrent aspiration pneumonia. The presentation traces the progression of the patient's diseases and treatments, highlights the nutrition care process and interventions, and explores the connections between the patient's achalasia and history of bulimia. The patient was recently admitted for acute respiratory failure from aspiration pneumonia and declined further interventions, passing away after 9 days in the hospital.
This document provides information on community-acquired pneumonia (CAP), including its definition, guidelines, incidence, causes, risk factors, evaluation, diagnosis, severity scoring, and laboratory tests. Some key points:
- CAP is defined as an acute lung infection associated with symptoms and radiographic findings outside of a hospital or care facility.
- Guidelines for CAP management have been published by organizations like ATS and IDSA.
- The overall incidence is 3-40 per 1000 people per year, with higher rates among young children and older adults. Mortality can be as high as 10%.
- Common causes include Streptococcus pneumoniae, Haemophilus influenzae, and Legionella species.
COPD patients have increased nasal inflammation compared to controls. There is a correlation between the degree of inflammation in the upper and lower airways of COPD patients. Bacterial colonization in the lower airway is associated with higher nasal bacterial loads. This is the first study to report a correlation between upper and lower airway inflammation in COPD.
Management Of Community Acquired PneumoniaAshraf ElAdawy
This document provides information on community-acquired pneumonia (CAP), including its definition, classification, pathogens, pathophysiology, diagnosis, and methods for assessing severity. CAP is defined as an alveolar infection developing outside of a hospital within 48 hours of admission. The most common causative pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and atypical bacteria. Severity must be assessed to determine the appropriate site of care, and several prognostic scoring systems are discussed including the Pneumonia Severity Index (PSI), CURB-65, and CRB-65, which stratify patients into risk groups to guide management decisions.
Community acquired pneumonia by dr md abdullah saleemsaleem051
This document provides information on community-acquired pneumonia (CAP), including epidemiology, risk factors, presentation, diagnosis, treatment recommendations, and prevention strategies. It notes that CAP is one of the most common infectious diseases worldwide, with higher rates among the elderly. Common bacterial causes are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Clinical assessment and chest imaging are important for diagnosis and management. Antibiotic treatment should be based on likely pathogens and severity of illness. Immunization can help prevent CAP in high-risk groups.
Pneumocystis jirovecii is a fungus that causes pneumonia in immunocompromised patients. It is diagnosed through microscopic visualization of the organism in samples obtained through induced sputum or bronchoscopy with bronchoalveolar lavage. Real-time PCR assays have increased sensitivity over conventional staining but may produce false positives. Risk factors include HIV/AIDS with CD4 count <200 cells/uL, use of immunosuppressive drugs, hematologic malignancies, and organ transplantation. Presentation involves fever, cough, and dyspnea. Treatment involves trimethoprim-sulfamethoxazole.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) initially presented with respiratory symptoms like cough and fever but has since been found to involve other organ systems. The document reports 3 cases of gastrointestinal perforation in COVID-19 patients treated at a hospital in India. Case 1 involved a 60-year-old woman with rectal perforation. Case 2 was a 24-year-old postpartum woman with caecal perforation. Case 3, a 21-year-old man, presented with gastric perforation. The document reviews theories for how SARS-CoV-2 may cause gastrointestinal tract perforation, including via ACE2 receptors in the GI tract, coagulation disorders, viral replication in GI cells
Ventilator Associated Pneumonia (VAP) is a common nosocomial infection that develops in patients on mechanical ventilation. VAP increases mortality, length of stay, and medical costs. Risk factors include prolonged intubation and underlying patient health issues. Symptoms include cough, fever, purulent sputum, and new lung infiltrates. Evidence-based strategies to prevent VAP include oral care, silver coated endotracheal tubes, elevating the head of the bed, and using ventilator bundles.
This document discusses community-acquired pneumonia (CAP). It defines CAP and outlines its epidemiology, noting risk factors like increasing age and winter season. Diagnosis involves clinical evaluation, chest imaging, and ruling out other causes if imaging is abnormal but symptoms aren't. Severity is assessed using scores like CURB-65 to determine appropriate treatment setting. Most ambulatory patients receive 5 days of antibiotics while hospitalized patients get broader empiric coverage. Adjunctive steroids may benefit severe cases. Proper follow up and prevention through vaccination and smoking cessation are also discussed.
This document summarizes aspergillosis, including invasive pulmonary aspergillosis (IPA), chronic necrotizing aspergillosis (CNA), and aspergilloma. Aspergillus is a common mold that can cause a variety of pulmonary diseases. IPA predominantly affects immunocompromised patients and presents as pneumonia. Diagnosis involves tissue biopsy, galactomannan testing, and imaging. Voriconazole is recommended treatment. CNA occurs in patients with underlying lung disease and is characterized by slow lung tissue invasion. Itraconazole is effective treatment. Aspergilloma involves a fungus ball in a pre-existing lung cavity.
This document discusses community acquired pneumonia (CAP). It begins by defining CAP and discussing its epidemiology and classification. It then covers the incidence, clinical presentation, radiological manifestations, and typical microbiological findings of CAP. It discusses specific investigations and pathogens involved in severe CAP. Scoring systems for assessing CAP severity, including PSI, CURB-65 and CRB-65, are outlined. Guidelines are provided on treatment based on severity, including empiric antibiotic choice. Risk factors for drug-resistant pathogens and tuberculosis are noted. The document concludes with recommendations for empiric treatment of severe CAP patients admitted to the ICU.
This document discusses interstitial lung disease (ILD), focusing on idiopathic pulmonary fibrosis (IPF). ILD describes a group of lung disorders involving scarring of the lungs. IPF is the most common and severe type of ILD. The document defines ILD and its subtypes. It describes the diagnostic challenges of ILD and importance of investigating each case. Causes of ILD include exposures to irritants like asbestos as well as some autoimmune diseases. IPF is characterized by worsening shortness of breath and cough. It involves scarring of the lung tissue and has a poor prognosis. The document provides details on the prevalence, risk factors, diagnosis, and outcomes of IPF.
This document discusses hospital-acquired pneumonia (HCAP) and the nurse's role in prevention. It describes a case study of a 68-year-old man presenting with symptoms of pneumonia including cough, shortness of breath, and fever. Key risk factors for this patient include age, recent hip fracture, and chronic illnesses like diabetes and hypertension. The document outlines signs and symptoms of HCAP, treatment options including antibiotics and oxygen therapy, and the importance of infection control practices like hand hygiene in prevention.
The document discusses smoking-related interstitial lung diseases. Cigarette smoke can injure lung cells through oxidative stress and inflammation, potentially leading to fibrosis in some smokers. Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) is a rare smoking-related lung condition seen in heavy smokers, with symptoms of cough and wheezing. Physiologic testing may show obstruction, restriction, or normal results. Radiographs often appear normal or show subtle reticulation, especially in lung bases.
- Community acquired pneumonia (CAP) is an infection of the lung parenchyma acquired outside the hospital setting. Diagnosis involves presence of respiratory and systemic symptoms along with new radiological shadows on chest x-ray.
- Severity is classified using CURB-65 criteria to determine if hospital admission is required. Treatment involves antibiotics, with specific regimens depending on risk factors for multidrug-resistant organisms.
- Duration of treatment is typically 5-7 days but may be prolonged for specific cases. Prevention involves smoking cessation, hand washing, vaccination, and controlling underlying conditions like diabetes.
The document discusses Pneumocystis jirovecii, formerly known as Pneumocystis carinii, the fungus that causes Pneumocystis pneumonia. It was renamed in 1999. It describes the morphology of the organism including its trophozoite, precyst, and cyst forms. It also discusses the epidemiology, pathogenesis, clinical presentation, laboratory diagnosis including staining techniques, treatment with trimethoprim-sulfamethoxazole, and prevention with chemoprophylaxis for at-risk patients.
Aspiration Pneumonia General Medicine Rotation 12 15 09Trennette Gilbert
Aspiration pneumonia occurs when gastric or oropharyngeal contents are inhaled into the lungs. It requires both compromise of lung defenses and a large bacterial inoculum. Risk factors include reduced consciousness, neurological impairment, and GI disorders. Diagnosis is based on new infiltrates on chest x-ray along with signs of infection. Treatment involves oxygen, empiric antibiotics targeting likely pathogens, and treating predisposing conditions. Monitoring includes following vitals, labs, imaging and oxygenation to ensure response to therapy. The patient case involved an elderly man with post-op ileus who developed aspiration pneumonia responding well to broad-spectrum IV antibiotics.
Community-acquired pneumonia (CAP) is a common infectious disease worldwide and a major cause of mortality and morbidity. The document discusses definitions, etiology, risk factors, diagnosis, and treatment recommendations for CAP according to guidelines from IDSA/ATS. Key points include common bacterial and atypical pathogens causing typical and atypical CAP; use of severity assessment scores to determine hospitalization and ICU needs; recommendations for empirical antibiotic therapy based on patient factors; and considerations for MRSA coverage and broad-spectrum therapy.
This document discusses ventilator associated pneumonia (VAP), including its definition, causes, risk factors, prevention, and treatment. Some key points:
- VAP is pneumonia that develops in intubated patients and accounts for most ICU infections. It occurs in 10-20% of mechanically ventilated patients and has a high mortality rate.
- Risk factors include underlying illnesses, suppression of immune system, and prolonged ventilation. Common causes are oropharyngeal/GI bacteria and viruses that enter the lungs through the endotracheal tube or around the cuff.
- Prevention strategies include following bundles like elevating the head, oral care with chlorhexidine, and stopping unnecessary devices; as well
- SARS-CoV-2 is the virus that causes COVID-19 and is primarily spread through respiratory droplets. Common symptoms include fever, cough and shortness of breath.
- Diagnosis involves PCR or antigen testing of respiratory samples. Risk factors for severe disease include older age and underlying medical conditions.
- Treatment depends on severity but may include supportive care, remdesivir, dexamethasone and monoclonal antibody therapy. Prevention relies on measures like masking, distancing and infection control practices.
Bronchiolitis is a common respiratory infection in infants caused by viruses like RSV. It involves inflammation in the small airways of the lungs. It mostly affects children under 2 years old. Symptoms include cough, wheezing and difficulty breathing. Treatment focuses on supportive care with oxygen and fluids. Medications are generally not effective. Prevention involves monthly RSV antibody injections for high-risk infants during RSV season.
Ventilación Mecánica en la paciente obstétricaAivan Lima
This document discusses respiratory failure and mechanical ventilation in pregnant patients. It outlines several physiological changes in pregnancy that can promote respiratory failure, including decreased lung capacity and increased oxygen demands of the fetus. Common causes of respiratory failure in pregnancy are discussed, such as pneumonia, pulmonary edema, asthma exacerbations, aspiration, pulmonary embolism, and amniotic fluid embolism. Treatment considerations for mechanically ventilating pregnant patients with respiratory failure are also addressed.
This document discusses aspiration during anesthesia. It defines aspiration as the inhalation of oropharyngeal or gastric contents into the respiratory tract. Aspiration can cause hypoxia, pneumonitis, or pneumonia depending on the material aspirated. Risk factors include a full stomach, delayed gastric emptying, pregnancy, and certain medical conditions or medications. Protective mechanisms like the lower esophageal sphincter and airway reflexes are attenuated under anesthesia, increasing risk. Strategies to reduce risk include reducing gastric volume, protecting the airway, positioning, and guidelines for high-risk cases. Aspiration is managed supportively, though antibiotics are only used if pneumonia develops.
1) Aspiration is the inhalation of oropharyngeal or gastric contents into the larynx and respiratory tract. It was first recognized as a cause of anesthetic death in 1848.
2) Risk factors for aspiration include a full stomach, delayed gastric emptying, incompetent lower esophageal sphincter, certain surgical positions, and light anesthesia. Strategies to prevent aspiration focus on reducing gastric volume, protecting the airway, and positioning patients properly.
3) Aspiration can cause pneumonitis, pneumonia, or obstruction. Management involves supportive treatment, antibiotics if pneumonia develops, and mechanical ventilation may be needed to remove clots or secretions from the airway. Steroids are
Bronchiolitis is a common viral infection that causes inflammation in the small airways of the lungs called bronchioles. It mostly affects infants under 2 years old and is usually caused by respiratory syncytial virus. The document discusses the symptoms, diagnosis, risk factors, treatment and prevention of bronchiolitis. Supportive care including oxygen, hydration and suctioning is the primary treatment approach, as medications have limited effectiveness.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
This document discusses a study on the safety and efficacy of tiotropium bromide in patients with bronchial asthma. Tiotropium is a long-acting anticholinergic drug that works by blocking muscarinic receptors in the lungs. The study found that in patients with COPD (n=48), tiotropium significantly improved lung function measures (FEV1, FVC, FEV1/FVC ratio) compared to baseline, with few side effects. The document concludes that tiotropium provides measurable bronchodilation in asthma and is well tolerated, suggesting it may be a treatment option for bronchial asthma.
Aspiration pneumonia occurs when a large volume of oropharyngeal or gastric contents are aspirated into the lungs, depositing a large bacterial inoculum. This can overwhelm normal lung defenses and cause pneumonia. Risk factors include dysphagia, altered mental status, vomiting, enteral feeding, and oropharyngeal colonization with more virulent bacteria. Aspiration is common but often does not cause pneumonia due to protective mechanisms; however, large volume macroaspiration can lead to aspiration pneumonia.
This document summarizes a case report of tularemia (Francisella tularensis infection) in British Columbia and reviews 16 other cases over 15 years. All cases were acquired rurally and presented most commonly with skin lesions and lymphadenopathy. Two severe cases of sepsis and pulmonary infection were also reported. Physicians and public health workers should be aware of this rare but potentially serious disease endemic to BC, especially for those exposed to wildlife.
1. Pneumonia is an inflammatory process in the lungs that can be caused by infection or other inflammatory conditions. It causes abnormalities in lung ventilation and gas exchange.
2. Congenital pneumonia specifically refers to pneumonia that is present at birth, usually caused by viral or bacterial infections transmitted from the mother. These infections can pose serious challenges to the immature newborn.
3. Pneumonia is a major cause of neonatal mortality worldwide. It requires prompt diagnosis and treatment including antibiotics, respiratory support, and careful management of cardiac and respiratory functions to prevent complications and ensure infant survival.
This document provides an overview of bronchiolitis including pathogenesis, microbiology, risk factors, clinical presentation, diagnosis, and treatment recommendations. Bronchiolitis is typically caused by viral infection, most commonly RSV, and causes inflammation in the small airways. Clinical diagnosis is based on symptoms of fever, cough and respiratory distress. Treatment focuses on supportive care like hydration and supplemental oxygen rather than medications like bronchodilators or steroids which studies have shown are not effective. High flow nasal cannula may help reduce respiratory distress. Prevention involves reducing exposure to tobacco smoke which increases risk and severity.
Updates In Bronchiolitis 23 2 2010 Dr HumaidEM OMSB
This document summarizes recent evidence on the diagnosis and management of bronchiolitis. It defines bronchiolitis and discusses causes such as respiratory syncytial virus (RSV) and human metapneumovirus. Clinical features include fever, cough, wheezing and respiratory distress. Risk factors for severe disease are described. Treatment is generally supportive with oxygen, fluids and respiratory support as needed. Bronchodilators and corticosteroids are not routinely recommended but may be considered in some cases.
Pediatric community acquired pneumoniaSamiaa Sadek
This document discusses pediatric community-acquired pneumonia (CAP). It defines CAP and outlines its key causes and risk factors. Pneumonia is a leading killer of children under 5 globally. While viruses are a common cause, bacteria like Streptococcus pneumoniae and Haemophilus influenzae also frequently cause pediatric CAP. Risk factors include malnutrition, HIV/AIDS, indoor air pollution, and crowding. The document describes presenting signs and symptoms and recommends diagnostic tests. Chest x-rays and testing for respiratory viruses can help determine the cause. Blood tests and cultures are also discussed. Hospitalization is suggested for pediatric CAP cases with hypoxemia, failure to improve after outpatient treatment, underlying conditions, or other complications.
Case Study Of Pneumonia And Chronic Pulmonary DiseaseEvelyn Donaldson
This document discusses a case study of pneumonia and chronic pulmonary disease. It describes how pneumonia inflames the lungs and can range from mild to severe. It identifies both extrinsic and intrinsic risk factors for pneumonia, including exposure to irritants, smoking, alcohol abuse, and underlying medical conditions. It also discusses types of pneumonia, pneumonia severity index scoring, research on hospital-acquired pneumonia, and prevention of ventilator-associated pneumonia.
This document discusses pneumonia in children. It provides definitions, epidemiology, risk factors, classification, etiology, clinical presentation, investigations, treatment and prevention of pneumonia. Some key points:
- Pneumonia is the leading cause of death among children under 5 globally, accounting for 16% of deaths. It occurs most frequently in developing countries.
- Risk factors include malnutrition, low birth weight, lack of breastfeeding, lack of immunization, indoor air pollution, parental smoking, and zinc deficiency.
- Clinical features depend on the causative agent. Bacterial pneumonia presents with high fever and chest pain while viral pneumonia shows low grade fever and respiratory distress.
- Investigations include chest X-ray
Tuberculous Ileal Perforation in Post-Appendicectomy PeriOperative Period: A ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Epidemiology treatment and_outcomes_of_sa_nosocomial_pneumonia_chest_2005-1Christian Wilhelm
This study examined outcomes of nosocomial bacteremic Staphylococcus aureus pneumonia (NBSAP) in 60 patients over 5 years. It found that NBSAP commonly developed late in a patient's hospital stay among critically ill patients on mechanical ventilation. NBSAP was associated with high mortality and infection-related mortality rates of 55.5% and 40%, respectively. While delayed appropriate antibiotic therapy did not predict worse outcomes compared to early therapy, the study was limited by small sample size. The findings suggest a need for new antibiotics with better activity against NBSAP.
1) Aspiration pneumonitis is a chemical injury caused by inhalation of sterile gastric contents, while aspiration pneumonia is an infectious process caused by inhalation of oropharyngeal secretions colonized by bacteria.
2) Risk factors for aspiration pneumonia include neurological dysphagia, gastroesophageal reflux, poor oral hygiene, and silent aspiration which is common in stroke patients.
3) Treatment of aspiration pneumonitis includes suctioning the airway after witnessed aspiration and possible intubation. Antibiotics are not routinely recommended but may be used if infection develops. Corticosteroids are not proven to provide clear benefits.
Repeated Hemoptysis With Progressive Bronchiectasis: A Case Report of Lady Wi...semualkaira
Bronchiectasis is a type of incurable structural lung disease with
clinical manifestations of chronic cough, expectoration or recurrent hemoptysis, which is often given anti-infection and symptomatic treatment. In this study, a patient suffering from bronchiectasis
with repeated hemoptysis caused by nontuberculous mycobacterium (NTM) was discussed. A 54-year-old female immunocompetent patient was admitted to our hospital due to repeated hemoptysis for 5 years. Computed tomography (CT) scan revealed progressive bronchiectasis in the upper and middle lobes of her right lung.
She subsequently underwent thoracoscopic lobectomy of the right
middle lobe plus segmentectomy of the anterior segment of the
right upper lobe. Postoperative pathological diagnosis was confirmed to be intracellular mycobacterium. In view of her results,
the patient was concluded to have “Lady Windermere syndrome”
and was clinically cured following 15 months of anti-NTM treatment.
10 Conversion Rate Optimization (CRO) Techniques to Boost Your Website’s Perf...Web Inspire
What is CRO?
Conversion Rate Optimization, or CRO, is the process of enhancing your website to increase the percentage of visitors who take a desired action. This could be anything from purchasing a product to signing up for a newsletter. Essentially, CRO is about making your website more effective in turning visitors into customers.
Why is CRO Important?
CRO is crucial because it directly impacts your bottom line. A higher conversion rate means more customers and revenue without needing to increase your website traffic. Plus, a well-optimized site improves user experience, which can lead to higher customer satisfaction and loyalty.
Securing BGP: Operational Strategies and Best Practices for Network Defenders...APNIC
Md. Zobair Khan,
Network Analyst and Technical Trainer at APNIC, presented 'Securing BGP: Operational Strategies and Best Practices for Network Defenders' at the Phoenix Summit held in Dhaka, Bangladesh from 23 to 24 May 2024.
Decentralized Justice in Gaming and EsportsFederico Ast
Discover how Kleros is transforming the landscape of dispute resolution in the gaming and eSports industry through the power of decentralized justice.
This presentation, delivered by Federico Ast, CEO of Kleros, explores the innovative application of blockchain technology, crowdsourcing, and incentivized mechanisms to create fair and efficient arbitration processes.
Key Highlights:
- Introduction to Decentralized Justice: Learn about the foundational principles of Kleros and how it combines blockchain with crowdsourcing to develop a novel justice system.
- Challenges in Traditional Arbitration: Understand the limitations of conventional arbitration methods, such as high costs and long resolution times, particularly for small claims in the gaming sector.
- How Kleros Works: A step-by-step guide on the functioning of Kleros, from the initiation of a smart contract to the final decision by a jury of peers.
- Case Studies in eSports: Explore real-world scenarios where Kleros has been applied to resolve disputes in eSports, including issues like cheating, governance, player behavior, and contractual disagreements.
- Practical Implementation: Detailed walkthroughs of how disputes are handled in eSports tournaments, emphasizing speed, cost-efficiency, and fairness.
- Enhanced Transparency: The role of blockchain in providing an immutable and transparent record of proceedings, ensuring trust in the resolution process.
- Future Prospects: The potential expansion of decentralized justice mechanisms across various sectors within the gaming industry.
For more information, visit kleros.io or follow Federico Ast and Kleros on social media:
• Twitter: @federicoast
• Twitter: @kleros_io
EASY TUTORIAL OF HOW TO USE CiCi AI BY: FEBLESS HERNANE Febless Hernane
Cici AI simplifies tasks like writing and research with its user-friendly platform. Users sign up, input queries, customize responses, and edit content as needed. It offers efficient saving and exporting options, making it ideal for enhancing productivity through AI assistance.
Honeypots Unveiled: Proactive Defense Tactics for Cyber Security, Phoenix Sum...APNIC
Adli Wahid, Senior Internet Security Specialist at APNIC, delivered a presentation titled 'Honeypots Unveiled: Proactive Defense Tactics for Cyber Security' at the Phoenix Summit held in Dhaka, Bangladesh from 23 to 24 May 2024.
Network Security and Cyber Laws (Complete Notes) for B.Tech/BCA/BSc. ITSarthak Sobti
Network Security and Cyber Laws
Detailed Course Content
Unit 1: Introduction to Network Security
- Introduction to Network Security
- Goals of Network Security
- ISO Security Architecture
- Attacks and Categories of Attacks
- Network Security Services & Mechanisms
- Authentication Applications: Kerberos, X.509 Directory Authentication Service
Unit 2: Application Layer Security
- Security Threats and Countermeasures
- SET Protocol
- Electronic Mail Security
- Pretty Good Privacy (PGP)
- S/MIME
- Transport Layer Security: Secure Socket Layer & Transport Layer Security
- Wireless Transport Layer Security
Unit 3: IP Security and System Security
- Authentication Header
- Encapsulating Security Payloads
- System Security: Intruders, Intrusion Detection System, Viruses
- Firewall Design Principles
- Trusted Systems
- OS Security
- Program Security
Unit 4: Introduction to Cyber Law
- Cyber Crime, Cyber Criminals, Cyber Law
- Object and Scope of the IT Act: Genesis, Object, Scope of the Act
- E-Governance and IT Act 2000
- Legal Recognition of Electronic Records
- Legal Recognition of Digital Signatures
- Use of Electronic Records and Digital Signatures in Government and its Agencies
- IT Act in Detail
- Basics of Network Security: IP Addresses, Port Numbers, and Sockets
- Hiding and Tracing IP Addresses
- Scanning: Traceroute, Ping Sweeping, Port Scanning, ICMP Scanning
- Fingerprinting: Active and Passive Email
Unit 5: Advanced Attacks
- Different Kinds of Buffer Overflow Attacks: Stack Overflows, String Overflows, Heap and Integer Overflows
- Internal Attacks: Emails, Mobile Phones, Instant Messengers, FTP Uploads, Dumpster Diving, Shoulder Surfing
- DOS Attacks: Ping of Death, Teardrop, SYN Flooding, Land Attacks, Smurf Attacks, UDP Flooding
- Hybrid DOS Attacks
- Application-Specific Distributed DOS Attacks