00:00
So just to summarize the main
learning points
of this lecture, lung infections are terribly
common, and they are defined by the anatomical
site, upper respiratory tract infections,
lower respiratory tract infections divided
into trachea and bronchial infections, tracheobronchitis
or a pneumonia and alveolar infection.
00:20
So if you have infection, evidence of an infection,
plus evidence of consolidation, clinically
crackles, chest-ray findings with consolidation
visible in chest X ray that means the patient
has pneumonia. And pneumonia is classified
according to where the patient is when they
develop it and their background state. So
community acquired which is the dominant one,
the most important one, then there is the
hospital acquired, ventilator acquired that
we discussed, the diseases acquired whilst
you're in the hospital, and pneumonia affecting
immonocompromised patients, severely immunocompromised
patients. And because these different types
of pneumonia have different microbial causes,
they require a different antibiotic regimens.
01:00
The important thing here is the common causes
of community acquired pneumonia is pneumococcus,
mycoplasma, chlamydia, and influenza, and
whatever agent you use to treat patients,
you need to cover those bacteria. So how do
we manage patient with community
acquired pneumonia? We assess the severity
using the Curb65 score plus clinical judgment
just to make sure we are not missing people
whose Curb65 score is low for some reason
but actually are severely unwell. Investigations,
we need to confirm the presence of consolidation
using a chest X ray, we need to assess how
severe the hypoxia might be using blood gases,
and we can try and identify the infecting
organisms using blood sputum cultures and
urine antigen tests that we discussed earlier.
Treatment is very simple oxygen, oxygen, oxygen.
01:44
You must correct the oxygen level plus antibiotics.
01:48
Intravenous fluid replacement is important to correct
the dehydration and the potential chance of
hypotension and acute kidney injury. And you
need to work out whether the patient is responding
to therapy and that requires monitoring the
temperature, the respiratory rate, the oxygen
saturations, and it can be reinforced by remeasuring
the C-reactive protein level which should
fall as the inflammation settles and the patient
improves. Thank you for listening.