The vast majority of children diagnosed with pneumonia in the outpatient setting are treated with oral antibiotics. High-dose amoxicillin is used as a first-line agent for children with uncomplicated community-acquired pneumonia, which provides coverage for S pneumoniae.

1. Mukesh sah, MD,JI
Virgen Milagrosa University Foundation

2. Pediatric community
Acquired Pneumonia
Prepared by: Mukesh sah
Case presentation

3. HJ
1 year old
Female
Filipino
Roman catholic
Bugallon
1st time admission
09-10-2018 at 6:58AM
Identifying Data

4. Chief
compaints
cough
Source and reliability
Source Mother
Reliability Good (90%

5. History of Present Illness
12 hours PTA
Cough No Medication and consultation
Colds
Vomiting 1 time
7 hours PTA Self Medicated
Difficulty of breathing Ambraxol 1TSP
Irritated Oregano 1TSP
LBM no relief

6. 3 hours PTA
Consultation in LDH due to difficult of Breathing
Salbutamol Neb given 1 Neb q20min 2 doses
Oxygenation inhalation via Nasal canula
Not improved
Referred to R1MC for further assessment

7. Maternal History
Mother : 22 years old
G1P1(1001)
Prenatal check up: regular
Maternal innless: None
Exposure to radiation: None
Multivitamins: compliant
Folic acid: complaint
Ferrous sulfate: compliant

8. Birth history
Birth history
Full term; NSD
Lying in PICU
Birth date: July 8, 2017
BW 3.5kg
BL: 50cm

9. Immunization History
Vaccine 1st dose 2nd dose
BCG 12 days
Hep B Birth 2 mos 3 mos
DPT 2 mos 3 mos
OPV 2 mos 3 mos 4 mos
Hib 2 mos
Measles 9 mos
MMR 1 year

10. Nutritional formula
Nutritional formula
Breast fed : birth until 6 months
Milk formula: 6 months onward
Solid: 6 months onward
Currrent diet: milk
formula milk
Multivitamins: regular

11. Past medical history
• No previous hospitalizations
• With history of Fall at 6 months of life
• No history of Measles, chicken pox
• Not complete innumization

12. Family Medical History
Family Medical History
Positive : Asthma Mother
Positive: Hypotension father
heart diseases (Grand father)
Negative:
Mental/psychiatric disorder
TB
DM
Thyroid diseases

13. Personal and social history
Personal and social history
Parents not married
Lives with mother
first child in the family
Father: 34 years old
college Graduate
Delivery Man in online shop, TB
Mother:
22 years old
high school Graduate
Healthy

14. Home:
Concrete house, Near the Road
With 3 bed rooms
Water: Mineral water
Garbage: collected daily
Pet animal: Dog
With exposure to 2nd hand smoke (Father)
exposed to TB (father)

15. Review of symptoms
General: No weight loss
Skin no jaundice
Bruising in the legs
HEENT No head Injury
no ear discharge
No nasal Discharge, Epistaxix
No mouth sores
No mass
Neurologic: No Seizure
No loss of consciousness
Respiratory: No colds
No hemoptysis
Cardiovascular: No cyanosis

16. Gastrointestinal vomiting
LBM
Musculoskeletal No swelling
No arthralgia
No myalgia
No limitation of Movement
Genitourinary No hematuria
No dysuria
no foul smelling vaginal discharge

17. Physical Examination
Physical Examination
General Survey: awake, Conscious, Weak looking
carried by mother
Vital signs: HR: 154 bpm
RR:40 cpm
temp 37.8
O2 sat 98%
Anthropometrics: weight : 11kg (z-score +1; normal)
height : 89cm (z score +1: Normal)
BMI: 17.5 kg/m2 (z score +1: Normal)

18. Physical Examinations
Skin: warm; no lesion; good skin turgor
HEENT: Normocephalic, Anicteric slreae, Pink palpebral conjunctiva
no haemorrhage, no exudates, no discharges
no dry lips, no oral lesions, no lymphadenopathies
Respiratory: shallow retractions, symmetrical chest
crackes, wheezing sound, rales of all lung fields
Cardiovascualr: adynamic precordium, no heaves and no thrills
regular heart rhythm
distinct heart sounds, no murmurs

19. Gatrointestinal flat, no surgical scars, normoactive
bowel sounds
no bruits, no tympanitic abdomen,
no organomegaly, no tenderness
Extremities CRT <2 sec, no gross deformity
no edema, full and equal pulses
Genitalia labia majora covers labia Minora
no vaginal discaharge, no lesions

20. Neurological GCS 15
Cerebellar Not done
Cranial nerves
CN I able to smell
CNII intact papillary and consensual light reflexex (+ROR)
CNIII, IV, VI full EOMS
CNV intact, no sensory deficits
CNVIII intact gross hearing
CN IX, X intact gag reflex, uvula midline
CN XI SCM and trapezius muscle symmetric with muscle strength 5
CN XII tongue midline

21. Salient features
Salient features
General Data 1 year old
CC: Cough
HPI: productive cough
vomiting
PE:Weak looking
shallow retractions
hyperactive airways
rales of all lung fields
tachypnea
afebrile

22. Course in the ward
In the ER
CR 130 RR 68
T- 37.2
Alar flaring
Tachypneic
Irritable
SCE
Wheezing Rales on both lung fields
Retractions
A: PCAP-C with Hyperactive airways
Plan- admitted in PICU for assessment

23. Day 1
Day 1 7AM
Therapeutics
D5LR 1L 57-58 cc/hr for 6 hours then reassessment
Hook to Oxygen Inhalation
Salbutamol+Ipatropium 1Neb q20min 3 doses
Hydrocortisone 50mg IVP now then q6 hours
Ampicillin 550mg IVP q6 hours
8 30 Am
S/0 No fever, retractions, No alar flaring, Crackles
Occassional Wheezes, good air entry
A: PCAP-C with Hyperactive airways
P: Salbutamol Nebule q1 3 doses then reassess

24. 9 30 AM
Nebulize with salbutamol continue
Start Budesmide 1 neb q12 hours
Continue Hydrocortisone 66mg IVP q6 hours
Day 2
12 AM Asleep, comfortable
Wheezes occasional, no retractions
Continue salbutamol 1 neb q2 hours 3 doses
Transfer to orange II ward
5AM
Asleep, comfortable
SCE, No retractions, wheezes +,
Increase salbutamol 1 neb q 1 hour 4 doses

25. Laboratory Findings
Complete Blood Count
HEMATOLOGY
WBC 28.70 (increased)
Lymp 62.7
Mon 6.0
Eos 1.4
Bas 0.4
RBC 4.31
HGB 107 (Low)
HCT 33.8% (low)
MCV 78.5
MCH 24.8
MCHC 316
RDW-CV 12.9
RDW-SD 41.1
PLT 575
MPV 7.9
PDW 15.8
PCT 0.45%

26. Chest AP and Lateral
Apparent streaky densities are seen in both inner lung zones to consider interstitial
pneumonia.
Nodular densities are seen in lateral view to consider enlarged lymph nodes
Underlying primary Koch’s diseases has been ruled out.
Heart is not enlarged
Aorta is not unusual
Diaphragm and both costophrenic sulci are unremarkable
Visulaized osseus structures are intact

27. Admitting diagnosis
PCAP-C; Hyperactive airways

28. Thank you