Influenza B

predominiately a pediatric disease ; size and shape of subglottic airway; cricoid cartilage is tha narrowest portion of the trachea

May be acute or subacute

Prodrome: URI, may become secondary to purulent membrane or mucosal sloughing

Et: S. aureus; S. pyogenes; M. catarrhalis; H influenza

Stridor with inspiration and expir; hoarseness; croupy, no particular position of discomfort, resp distress in severe.

Lab exams: often elevated WBC; blood cultures, gram stain of sputuum-tracheal secretions

1. Diagnostic procedure of bacterial tracheitis

2. And Management

1. Laryngoyracheobronchochoscopy

2. Maintain airway, IV antibx, may need tracheostomy

Inflammatory process, which may be caused by infection

cough with purulent sputum production, which may be caused by infection

may also have rhinorrhea, nasal congestion, fever malaise

Lower respiratory tract infection in person with symptoms of acute infection, with or without infiltrate on chest radiograph, results in abnormal pulm funx

Infection of the alveoli, distal airways (especially repiratory bronchioles) and interstitium

++gas exchange is effected

1. community acquired pneumonia

-outpatient (walking pne) and inpatient

2. nosocomial acquired pneumonia

-non-ventilator dependent and ventilator dependent

PORT scoring "patient outcomes research team"

1. comorbidities with pneumonia

2. demographics

3. physical examination findings

1. neoplasm, liver disease, CHF, CVD, CKD

2. men, NH  res.

3. altered MN, RR >30/min, SBP<90mmHG, temp, P>125

I Age<50 and co-existing illness or vital sign abnormallity -treat at home

II 70 pts -treat at home

III 71-90 pts -trial outpatient tx

IV 91-130 pts

V 131 pts or higher

Temp >100.4

-rigors, sweats

-cough

-dyspnea

-fatigue

-myalgias

-pleuritic chest pain

-usually abnormal physical exam

1. Typical pnuemonia

2. Atypical Pneumonia

1. Streptococcus pneumoniae

2. Mycoplasma pneumoniae, chlamydophilia pneumonia, legionella pneumophila, influenza virus, adenovirus, and others- more common in young adults

Physical exam findings:

Laboratory findings:

crackles, rales, rhonchi, coarse nreath sounds

-brinchial breath sounds (hallow)

-tactile fremitus

-egophony

-tachypnea

cyanosis

Labs: WBC, blood cult, sputum gram, urine antigens, PCR, titers, cold agglutinins

Cxr helps identify complications

-consider CT scan for CXR (-) whose diagnoses is questionabl

macrolides

fluroquinilones (levaquin)

doxycycline

alternative: amoxicillin, beta-lactam

-Macrolide plus and IV beta-lactam

-fluroquinilone (alone)

Abnormal, pathologic dilation of the medium sized airways (segmented and sub-segmentedal >2mm in diameter) caused by destruction of componeents in the walls of the airways (elastic and muscular)--dilation becomes reservoirs for colonization of pathoges

-Cycle of damage- chronic inflammation, abnormal vascularity

-Inflammation usually caused by: infection - inflammatory mediators released by neutrophils damage epithelium

1.aspiration

2.cystic fibrosis

3. obstruction of bronchial tree

4. auto immune

5. alpha-1 antitrypsin defiency

6. CT disease (Marfans)

7. primary ciliary dyskineisa

Adenovirus and Influenza virus

bacteria: S.aureus, klebsiella spp. anaerobes, prevotella, fusobacterium

coarse breath sounds, rhonic, rales, wheezing

advanced diseases: hypoxia, Cor Pulmonale, right vent failure, and clubbing

HRCT -high resolution has replaces bronchoscopy

cxr should be obtained

PFT's- most commonly show obstruction

1. smoking cessation and second hand smoke

2. current flu and pneumonia vac, confirm titers

3. adequate fluid and nutrition intake

-broad spectrum anbx used

- rotation of anbx and come in every mo for tx and monitoring

Brinchiectasis:

1. maximize pulmonary toilet

2. bronchodilators

3. Anti-inflammatory medications

4. surgery

1. postural drainage and percussion,  fluids

2. beta-agonists and anti-cholinergics

3. Corticosteroids, NSAIDS, leukotriene inhibs

4. Focal disease to reduce infections, putum, massive hemoptysis

Subacute infection

lung parenchyma

most common after aspiration- not noticed until 1-2wks

more common in elderly

++often polymicrobial

oral flora common

++common in right lung posterior upper lobe and superior lower lobe

1. anerobic necrotizing pneumonia causes these nectrotic areas

2. secondary abscess-from comorbid disease

3. amebic lung abscess: often with live abscess

oral cavity disease

altered level of consiousness

GERD-esophageal disease

bronchial obstruction

immunocomprimises

TX of lung abscess

CXR- can bee cavitary lesion with an air-fluid level

medical treatment - clynamycin

surgery not definitive

parapneumonic purulent effusion

MC complication of pneumonia

can be caused by trauma, placement of chest tube also streptococcus spp. staphlococci, enterobacteria, enterococcus

Diagnosing empyema:

TX

imagaing-to define effusion

AnBX therapy

Evaculation of suppurative pleural fluid

fibrinolytics

Surgical removal-Late stage