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Community acquired pneumonia - Pharmacotherapy

Community acquired pneumonia - Pharmacotherapy

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Community acquired pneumonia - Pharmacotherapy

  1. 1. Areej Abu Hanieh *
  2. 2. *Pneumonia usually developed with the patients who has no contact to a medical facility.
  3. 3. *First , we should determine if patient should be treated outpatient or inpatient . *Outpatient care: able to take oral medications and have adequate outpatient care *º Inpatient care: based on severity-of-illness scores (eg, CURB-65 criteria [confusion, uremia, respiratory rate, low blood pressure, 65 years or older]) or *prognostic models (eg, Pneumonia Severity Index [PSI]) and professional judgment
  4. 4. * Confusion Uremia: BUN>7mmolL (20mgdl) Respiratory rate: greater than or equal to 30/min Low blood pressure: systolic <90 mm Hg; or diastolic ≤60 mm Hg Age 65 years or older CURB-65 vs CRB-65
  5. 5. * *PSI prognostic model: * Assess 20 variables and assign points to each variable, this model classifies patients to 5 classes; *Risk class 1 *Risk class 2: <70 *Risk class 3: 71-90 *Risk class 4: 91-130 *Risk class 5:>130 *The PSI is less practical in a busy emergency-room setting because of the need to assess 20 variables.
  6. 6. *If CURB-65 is from 0-1 , can be treated outpatient . *Patients with CURB-65 score ≥2 require hospitalization or aggressive outpatient care. *If inpatient treatment required, determine if patient should be admitted to ICU or general ward *º ICU admission recommended: 1 major criteria or 3 minor criteria are present , and CURB-65 of 3 and more . *Patient who are admitted to ICU usually require: * vasopressors for septic shock necessitating * or if he has acute respiratory failure requiring intubation and mechanical ventilation.
  7. 7. * Hypothermia (<36°C) • PaO2/FiO2 ratio ≤250 • Leukopenia (WBC <4000 cells/mm³) • Multilobar infiltrates • Confusion/disorientation • Respiratory rate ≥30 breaths/min • Uremia (BUN ≥20mg/dL) • Thrombocytopenia (platelets <100000 cells/mm³) • Hypotension requiring aggressive fluid resuscitation • Other considerations: hypoglycemia, acute alcoholism/alcoholic withdrawal, hyponatremia, unexplained metabolic acidosis, elevated lactate, cirrhosis, asplenia
  8. 8. * • Invasive mechanical ventilation • Septic shock requiring vasopressors
  9. 9. * *Physical exam: *º Crackles or rales, bronchial breath sounds, hypoxemia, tachypnic *º Signs/symptoms of cough, fever, sputum production, pleuritic chest pain *• Chest radiograph: *º Hospitalized for suspected pneumonia but negative chest radiograph: may receive empiric antibiotics with repeat chest radiograph 24−48hrs later
  10. 10. * * Lab tests: *º Pretreatment blood culture and/or expectorated sputum samples for culture and gram stain should be taken if: * ICU admission, outpatient antibiotic therapy failure, cavitary infiltrates, leukopenia, active alcohol abuse, chronic severe liver and lung disease, asplenia, positive Legionella or pneumococcal UAT result, pleural effusion; optional for other indications *º Tests mentioned above are optional in patients without these conditions *Severe CAP: should obtain blood culture, expectorated sputum culture, urinary antigen tests for Legionella pneumophila and S. pneumoniae; endotracheal aspirate sample for intubated patients.
  11. 11. *
  12. 12. * *Duration: minimum 5 days of treatment, should be afebrile 48−72hrs, and no more than 1 CAP associated sign of clinical instability before discontinuing therapy. *• Longer duration of therapy may be warranted in certain circumstances (eg, initial therapy did not target identified pathogen, extrapulmonary infections such as meningitis or endocarditis)
  13. 13. * *Temp ≤37.8°C *º Heart rate ≤100 beats per min *º Respiratory rate ≤24 breaths per min *º Systolic blood pressure ≥90mmHg *º Arterial 02 saturation ≥90% or pO2 ≥60mmHg *º Maintain oral intake and normal mental status *So signs of instability are the opposites of the signs (eg. < , > )
  14. 14. *
  15. 15. *

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