Post on 13-Jan-2016
Morning ReportJuly 3, 2012
Good Morning!
Symptoms
Acute /subacute Chronic
Localized Diffuse
Single Multiple
Static Progressive
Constant Intermittent
Single Episode Recurrent
Abrupt Gradual
Severe Mild
Painful Nonpainful
Bilious Nonbilious
Sharp/Stabbing Dull/Vague
Problem Characteristics
Ill-appearing/Toxic
Well-appearing/Non-toxic
Localized problem
Systemic problem
Acquired Congenital
New problem Recurrence of old problem
Semantic Qualifiers
Illness Script
Predisposing Conditions Age, gender, preceding events
(trauma, viral illness, etc), medication use, past medical history (diagnoses, surgeries, etc)
Pathophysiological Insult What is physically happening in
the body, organisms involved, etc.
Clinical Manifestations Signs and symptoms Labs and imaging
CXR #1
Predisposing Conditions
35-40/1000 incidence in <5yo
7/1000 incidence in adolescents
colder monthslower socioeconomic
statussmoke exposureboys> girls
Medical historySickle cellBPDGERDCystic FibrosisHeart diseaseImmunodeficiency
Increased aspirationNeuromuscular d/oSeizure d/o
Pathophysiology
Spread by droplets Typically follows URIMechanism
Colonization of nasopharynx with further inhalation of
microorganisms, leading to a pulmonary focus of infection Less commonly…bacteremia results from the initial
upper airway colonization with subsequent seeding of
lungsOrganisms
Streptococcus pneumonia = MOST COMMON Others: S. aureus, Group A Strep, GNR (<3mo),
anaerobes
Clinical Manifestations
Abrupt onsetHigh feverCough
Sometimes productiveToxic appearanceRespiratory distress
Tachypnea (most sensitive/specific) Retractions Nasal Flaring Grunting Hypoxia
Chest pain
Clinical Manifestations
Focal findings on lung exam Crackles Diminished breath
sounds Bronchial breath
sounds Egophany
Unilateral focal infiltrate on CXR
Organisms**
Treatment**
Outpatient therapy (7-10days total) First line: High dose Amoxicillin at
80-100mg/kg/day Penicillin allergy: Cephalosporin (non-type 1); Clinda/Azithro (type 1 allergy) Atypical organisms: Azithromycin x 5 days
Inpatient therapy (duration varies) Ceftriaxone or Ampicillin More extensive disease/failed treatment
Vancomycin Clindamycin
Azithromycin (adjunctive coverage sometime given)
Admission**
Criteria for admission <3 months Respiratory distress Hypoxemia Dehydrated Highly febrile/toxic
Underlying diseaseTesting
CBC Blood culture CXR +/- Sputum culture
Complications**
Lung abscess Thick-walled cavity with air/fluid level TB should be considered Needle aspiration for culture
Necrotizing pneumonia Rare complication of bact PNA Liquefaction/necrosis caused by toxins of virulent organisms VERY ill IV abx for at least 4 weeks
Complications**
Sterile para-pneumonic effusionPurulent effusions with resultant empyema
Persistent fever, ill-appearing, tachypnea, increased WOB,
chest pain and splinting Dullness to percussion/decreased air entry
CXR with decubitus, US, CT
CXR #2
Thanks!!
Almost every content spec “Pneumonia.” Pediatrics in Review. 2008, volume
29, 147
Noon conference = YOGA (12:15)