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Pneumonia, Empyema, and TB Meira Louis Margriet Greidanus
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Format for Today Group work x 30 minutes (3 groups) Cases as a large group – Case I: Community Acquired Pneumonia – Case II: Health Care Associated Pneumonia – Case III: Para-pneumonic effusion – Case IV: TB Questions
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Pneumonia
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Case I 43 year old male, previously healthy -Cough x 6 days, productive of green sputum -Febrile x 4 days -Now feeling progressively more SOB -No home meds, no allergies 38.011518130/7594% ORA
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In-patient vs Out-Patient?
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PORT score
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http://www.mdcalc.com/
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CURB-65
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Do they work?
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What tests?
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Which bugs?
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Which drugs? outpatient
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Which drugs? inpatient
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Which drugs? ICU
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Drugs and special populations
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So, when do I worry about the extra coverage?
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Time to antibiotics
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Length of antibiotics?
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Other things to think about...
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Case II 63 yo male, history of COPD, DM, HTN, CHF -Cough x 3 days, productive of yellow sputum -Febrile x 4 days -Now feeling progressively more SOB -Meds: Lasix, ASA, ramipril, insulin -Hospitalized x 5 days for COPD (6 weeks ago) 38.28326105/6493% ORA
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VS
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What’s different about HCAP?
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What makes a patient riskier?
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An antipseudomonal cephalosporin or β-lactam (cefepime, ceftazidime, pip-tazo) Plus a fluoroquinolone (ciprofloxacin, levofloxacin) Plus an agent active against MRSA (linezolid or vancomycin) Empiric Antibiotics for HCAP? = fluoroquinolone or azithromycin
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Para-Pneumonic Effusions
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Case III 45yo female, mild HTN, hyperlipidemia -Unwell x few weeks, episodic fevers, cough -Sent in by GP to r/o PE as completed full course of Azithromycin with no improvement. -Progressive SOB and chest pain 36.510520145/8291% ORA
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What is it?
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When should it be suspected?
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How to image?
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To treat or not to treat?
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So, I poked it, does that help?
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When does the pH lie?
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If I need to drain, does tube size matter?
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TB
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Case IV 29yo male, previously healthy -Recently returned from India after 6 month visit (immigrated several years ago) -Unwell x few weeks, episodic fevers, weight loss -Completed course of Levofloxacin, no change 37.511522120/8292% ORA
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Primary TB vs Reactivated TB
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So, what am I looking for?
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Complications of TB
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Extra Pulmonary Complications Neuro GU MSKCardiacRenal GI
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Where is the money? CXR!
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Primary TB Ranke Ghon Tuburculoma Milliary
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Post Primary TB
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All that cavitates...
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Treatment!
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Questions?
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