Transcript pneumonia - faculty at Chemeketa

PNEUMONIA
“Captain of the men of death”
– William Osler
• "Pneumonia is an infectious disease characterized by
inflammation of the lungs and constitutional disturbances
of varying intensity. The fever terminates abruptly by
crisis. Secondary infective processes are common.
Diplococcus pneumoniae, which is now known as
Streptococcus pneumoniae, is invariably found in the
diseased lung. Pneumonia is a self-limited disease and runs
its course uninfluenced by medicine."
- William Osler - 1892
History of Pneumonia
• Described as early as 400 BC
by a Greek Physician named
Hippocrates.
• Edwin Klebs was the first to
see bacterial infection from a
person who died from
pneumonia.
• Described by Sir William Osler
over 100 years ago linking the
infection to a bacterial cause.
• Pneumonia killed a majority of
the 50-100 million people that
died from the Spanish flu in
1918.
Statistics From CDC
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Cause of death (based on the International Classification
Rank 1
of Diseases , Tenth Revision , 1992)
Death
Number
Percent
rate
2005
2004
change
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1
All causes
2,447,910
825.9
Diseases of heart (I00–I09,I11,I13,I20–I51)
798.8
649,399
800.8
219.1
-0.2
210.3
217.0
-3.1
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2
3
Malignant neoplasms (C00–C97) 559,300
Cerebrovascular diseases (I60–I69)
188.7
143,497
183.8
48.4
185.8
46.6
-1.1
50.0
-6.8
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4
Chronic lower respiratory diseases (J40–J47)
130,957
44.2
43.2
41.1
5.1
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5
114,876
38.8
38.1
37.7
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6
7
Accidents (unintentional injuries) (V01–X59,Y85–Y86)
1.1
Diabetes mellitus (E10–E14)
74,817
25.2
Alzheimer's disease (G30)
71,696
24.2
24.5
22.9
24.5
21.8
0.0
5.0
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8
Influenza and pneumonia (J10–J18)
21.2
20.3
19.8
2.5
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9
43,679
14.7
14.3
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10
11
11.2
10.7
0.0
10.6
10.9
•
12
9.2
8.9
9.0
•
13
24,865
8.4
8.0
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14
15
Nephritis, nephrotic syndrome and nephrosis (N00–N07,N17–N19,N25–N27)
14.2
0.7
Septicemia (A40–A41)
34,142
11.5
11.2
Intentional self-harm (suicide) (*U03,X60–X84,Y87.0)
31,769
-2.8
Chronic liver disease and cirrhosis (K70,K73–K74)
27,393
-1.1
Essential (primary) hypertension and hypertensive renal disease (I10,I12)
7.7
3.9
Parkinson's disease (G20–G21) 19,547
6.6
6.4
Assault (homicide) (*U01–*U02,X85–Y09,Y87.1)
17,694
6.0
6.1
5.9
4.9
5.9
0.0
•
...
All other causes (residual)
441,475
62,804
148.9
What is Pneumonia?
• It is the infection of one or both of the
lungs. Occurs from bacteria, virus, or
fungus that is inhaled or gets into the
blood stream.
• http://www.youtube.com/watch?v=_JUEVE
ENE4M&feature=related
5 Main Causes of Pneumonia
• Bacteria
• Viruses
• Mycoplasmas (Bacteria
without a cell wall)
• Fungi including
Pneumocystis
• Various Chemicals
Types of Pneumonia
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Bacterial Pneumonia
Viral Pneumonia
Fungal Pneumonia
Parasitic Pneumonia
Atypical Pneumonia
Community-Acquired Pneumonia
Hospital-Acquired Pneumonia
Healthcare-Associated Pneumonia
Ventilator-Associated Pneumonia
Aspiration Pneumonia
Eosinophilic pneumonia
Bronchiolitis obliterans organizing pneumonia
Bacterial Pneumonia
• Infection by Bacteria
• Most commonly
Streptococcus
pneumoniae
• Gram Positive (Gram
Stain)
• Staphylococcus aureus
• Gram negative,
Haemophilus influenzae
• Contracted through
inhalation or through the
blood stream.
• Treated with Antibiotics
Viral Pneumonia
• Caused by Influenza,
parainfluenza, adenovirus,
rhinovirus, herpes simplex
virus along with several other
kinds of viruses.
• Antibiotics are not effective in
treating viral pneumonia.
• It is often treated with antiviral
medications along with plenty
of fluid and rest
• Individuals with suppressed
immune systems are most at
risk for acquiring this form of
pneumonia
Fungal Pneumonia
• Primarily caused by
Histoplasma capsulatum,
Coccidioides immitis,
Blastomyces dermatitidis .
• Most of the time no
symptoms are noticed
after inhaling the fungus.
• Can progress and yield flu
like symptoms.
Parasitic Pneumonia
• Not common in
industrialized nations.
• Infection occurs by
ingesting parasite
contaminated food or
other products.
• A common one that
occurs primarily in
children is toxocariasis.
• Infection caused by larvae
of the roundworm
Atypical Pneumonia
• Characterized by a more drawn out course
of symptoms, unlike other forms of
pneumonia which have more sudden and
severe onsets.
• Also known as walking pneumonia
• Almost impossible to differentiate in the
emergent setting typical pneumonia from
atypical.
• Treat what you see.
Community-Acquired
Pneumonia
• Community Acquired means that an individual has not been recently
hospitalized and has acquired a lung infection
• Most commonly caused by streptococcus
• Can also be caused by Haemophilus, influenzae, Legionella,
mycoplasma, chlamydia, and viruses.
• Occurs most commonly in the very young and the very old
• Usually starts from an upper respiratory tract infection
• S/S usually are that of a flu along with a productive cough with
sputum that is rust colored from blood.
• Leads to sepsis
• Vaccine is available for 23 of the known pneumococcus
• Can be treated with antibiotics
• Problem with antibiotic resistant strains
Hospital-Acquired
Pneumonia
• Defined as pneumonia that is acquired within 48-72 hours of being
admitted to a hospital or care facility.
• Tends to be a more severe strain of pneumonia due to the more
aggressive organisms that cause it
• People in the hospital and care facilities tend to be more vulnerable
making them less able to fight the infection.
• Approximately 300,000 cases annually and carries a mortality rate of
30-70%
• Increases hospital stay by 7-9 days on average
• Some risk factors include: Over the age of 70, Prolonged hospital
stay, and COPD patients
• Most commonly occurs in patients that require ICU care
• Caused when organisms are delivered to lower reparatory through
aspiration or contaminated respiratory machines.
Ventilator-Associated
Pneumonia
• A sub-type of Hospital Acquired
Pneumonia
• Defined as pneumonia that is
acquired by someone who has
be on a ventilator for 48 hours
or more
• The easiest way to reduce risks
of ventilator associated
pneumonia is to use proper
sterile techniques when
performing invasive procedures
such as intubations.
• Health care associated
infections amount to
approximately 90,000 deaths
and 4.5 billion excess health
care costs each year.
Aspiration Pneumonia
• Defined as inhalation of either
oropharyngeal or gastric
content into the lower airway.
• The inhalation of oropharyngeal
content is usually witnessed
and leads to an infection
process.
• Occurs often in patients with
altered level of consciousness,
CVA, drug intoxication, or head
trauma.
• Approximately 10% of patients
hospitalized from drug
overdoses have aspiration
pneumonia
• High Risk Patients are: Elderly;
Coma; Anesthesia; Excessive
alcohol consumption; Near
Drowning accident
S/S
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What we will commonly see and hear in the field
Fever
Cough
Cough will bring up Greenish, Yellowish Mucus and possibly
hemoptysis
Stabbing Chest pain that worsens with deep respirations
Fatigue
Head Ache
Loss of Appetite
Shortness of Breath
Cyanotic, Sweaty, clammy skin
Rapid Heart Rate
Crackles (Rales)/Wheezing Auscultated
Diminished lung sounds in areas filled with infection
Treatment
• Diagnosed on basis of physical
examination, X-Ray findings, and
laboratory cultures.
• Primary Treatment are antibiotics
• Supportive Treatment
The Pre-Hospital Setting
• Place patient in position of
comfort
• High-flow Oxygen
• Severe Cases may require
endotracheal intubation
• IV, base fluid resuscitation on
patient’s hydration status
(Assess for dehydration).
• Breathing Treatment
• Antipyretic agents for high
fevers
• Remember to consider
Pneumonia in patients
complaining of chest pain
especially if its accompanied by
fever
Sources
• Paramedic Care:
Principles and Practice
Medical Emergencies 2nd
Edition
• CDC
• Merck
• Emedicine.com
• The Common Wealth
Fund
• Cleveland Clinic
• U.S. National Library of
Medicine
• Healthline.com
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http://www.flickr.com/photos/heitkamp/408443623/
http://www.healthline.com/adamcontent/viralpneumonia
http://www.merck.com/mmhe/sec04/ch042/ch042d.
html
http://humaninfections.suite101.com/article.cfm/fungal_pneumon
ia_endemic
http://www.merck.com/mmhe/sec17/ch196/ch196a.
html
http://www.nlm.nih.gov/medlineplus/ency/article/000
079.htm
http://www.merck.com/mmhe/sec04/ch042/ch042b.
html
http://en.wikipedia.org/wiki/Communityacquired_pneumonia
http://www.clevelandclinicmeded.com/medicalpubs/
diseasemanagement/pulmonary/hospital_pneumoni
a/hospital_pneumonia.htm
http://www.cdc.gov/ncidod/eid/vol7no2/mayhall.htm
http://www.kolbio.com/Combicath-main.asp
http://www.commonwealthfund.org/snapshotscharts
/snapshotscharts_show.htm?doc_id=394481
http://www.cdc.gov/ncidod/eid/vol7no2/mayhall.htm
http://www.emedicine.com/emerg/topic464.htm
http://www.emedicine.com/med/TOPIC3162.HTM