1. AN APPROACH TO A PATIENT OF PNEUMONIA

2. OVERVIEW OF PRESENTATION  DEFINITION  CLASSIFICATION  CLINICAL PRESENTATIONS  INVESTIGATIONS  MANAGEMENT  COMPLICATIONS  PREVENTION  SCENARIO

3. DEFINITION  AN INFLAMMATION OF LUNG SUBSTANCE ASSOCITAED WITH FEVER SYMPTOMS AND SIGNS IN CHEST AND ABNORMAILITIES IN CHESY XRAY

4. EPIDIMIOLOGY  INCIDENCE: 1-3/1000 POPULATION  MORTALITY: 10 % (PATIENTS ADMITTED TO HOSPITAL)

5. CLASSIFICATION 1.COMMUNITY ACQUIRED STREP PNEUMONIAE HAEMOPHILUS INFLUENZAE MYCOPLASMA PNEUMONIAE GRAM NEGATIVE BACILLI 2.HOSPITAL ACQUIRED > 48 HRS AFTER HOSP ADMISSION GRAM NEGATIVE ENTEROBACTERIA PSEUDOMONAS KLEBSIELLA BACTEROIDES 3. ASPIRATION STROKE,MYASTHENIA,BULBAR PALSIES, 4.IMMUNOCOMPROMISED PATIENT GRAM NEG BACILLI PNEUMOCYSTIS CARINII FUNGI,VIRUSES

6. CLASSIFICATION  ATYPICAL PNEUMONIA MYCOPLASMA PNEUMONIAE LEGIONELLA COXIELLA BURNETTI VIRAL  OTHER CAUSES ASPIRATION OF VOMIT ALLERGIC MECHANISM RADIOTHERAPY

7. CLINICAL FEATURES  TYPICAL PNEUMONIA SYMPTOMS A.GENERAL SYMPTOMS FEVER WITH CHILLS AND RIGORS HEADACHE VOMITING CONFUSION B.PULMONARY SYMPTOMS DYSPNOEA COUGH(RUSTY COLORED) HEMOPTYSIS

8. C.PLEURAL SYMPTOMS PLEURITIC CHEST PAIN AGG BY COUGHING, DEEP BREATHING CLINICAL FEATURES

9. SIGNS FEVER CYANOSIS CONFUSION TACHYPNOEA TACHYCARDIA HYPOTENSION SIGNS OF CONSOLIDATION DIMINISHED EXPANSION DULL PERCUSSION INCREASED VOCAL FREMITUS /VOCAL RESONANCE BRONCHIAL BREATHING PLEURAL RUB

10.  ATYPICAL PNEMONIA MYCOPLASMA PNEUMONIAEFLU LIKE SYMPTOMS( HEADACHE MYALGIA ARTHALGIA) FOLLOWED BY DRY COUGH EXTRA PULMONARY FEATURES (SUCH AS RASH, MENINGITIS,ENCEPHALITIS,HEMOLYTIC ANEMIA) LEGIONELLA PNEUMONIAETRANSMITS THRU INFECTED WATERCOLONIZES WATER TANKS FLU LIKE SYMPTOMS,DRY COUH, DYSPNEA EXTRAPULMUNARY FEATEURES INCLUDE ANOREXIA, HEMATURIA,RENAL FAILURE MAY DEVELOP CHLAMYDIA PNEUMONIAEPHARYNGITIS,HOARSENESS,OTITIS,FOLLOWEDBY PNEUMONIA VIRALFLU LIKE SYPTOMS( HEADACHE,MALAISE FEVER DRY COUGH)

11. INVESTIGATIONS BASELINE FBC U&E LFT CRP SPECIFIC CXR LOBAR MULTI LOBAR INFILTRATE,CAVITATION,PLEURAL EFFUSION ORGANISMS X RAY STREP PNEU H INFLUENZAE LOBAR CONSOLIDATION KLEBSIELLA

12. INVESTIGATIONS  STAPH AUREUS PATCHY INFILTRATES  PSEUDOMONAS  E COLI  ANAEROBES  MYCOPLASMA LEGIONELLA EXTENSIVE PATCHY INFILTRATE  ABG  BLOOD, SPUTUM CULTURES,PLEURAL FLUID CULTURE  BRONCHOALVEOLAR LAVAGE, BRONCHOSCOPY IMMUNOCOMPRISED PATIENTS  SEROLOGICAL TEST PNEUMOCOCCAL ANTIGEN TEST

13. SEVERITY  CONFUSION  UREA>7MMOL/L  RESP RATE>30MIN  BP<90/60mmHG  OTHER FEATURES INC RISK OF DEATH ARE AGE >50YRS CO EXISTING DISEASE BILATERAL/MULTI LOBAR INVOLVEMENT SaO2 < 92%

14. MANAGEMENT  GENERAL MEASURES 1.OXYGEN 2.ANALGESICS 3.IV FLUIDS IF DEHYDRATED  TREAT SHOCK HYPOTENSION  ANTIBIOTICS INTIALLY EMPIRICAL THEN ACCORDING TO SENSITIVITY REPORTS

15. EMPIRICAL TREATMENT CLINICAL SETTINGANTIBIOTICS COMMUNITY ACQUIRED MILD NOT DIAGNOSED PREVIOUSLY AMOXICILIN500mg-I1G/8H OR ERYTHROMYCIN 500mg/6h po mildFloroquinolones IF IV REQUIRED AMPICILLIN 500mg /6hrs+erythromycin 500mg/6hrs ivi severeCo amoxiclav iv or cephalosporin iv and erythromycin

16. EMPIRICAL TREATMENT atypicalClarithromycin 500mg/12h.tetracyclines Hospital acquiredAminoglycoside iv +anti pseudomonal penicillin iv or 3 gen ceph aspirationCefuroxime 1.5g/8h iv +metronidazole 500mg/8h iv NeutropenicAminoglycosides iv +anti pseudo penicillin+3 rd gen ceph iv

17. COMPLICATIONS  RESPIRATORY FAILURE  HYPOTENSION  AF  PLEURAL EFFUSION  EMPYEMA  LUNG ABCESS  SEPTICEMIA  PERICARDITIS MYOCARDITIS  JAUNDICE

18. PREVENTION  PRACTICE GOOD HYGIENE  PNEUMOCCOCCAL VACCINE PREVENTS STREP PNEUMONIAE  PNEUMOVAX.5ML S/C  PREVNAR  FOR CHRONIC HEART AND LUNG CONDITIONS CIRRHOSIS NEPHROSIS DIABETES IMMUNOSUPPRESION  FLU VACCINE PREVENTION AGAINST INFLUENZA VIRUS MUST BE GIVEN YEARLY TO PROTECT AGAINST NEW VIRAL STRAINS  HiB VACCINE PREVENTS PNEUMONIA IN CHILDREN WITH H INFLU TYPE B  PRACTICE GOOD PREVENTING MEASURES BY EATING A PROPER DIET,GETTING REGULAR EXERCISE,PLENTY OF SLEEP  DO NOT SMOKE

19. SCENARIO  A 22 YEAR OLD PRESENTED WITH FEVER LETHARGY AND NECK STIFFNESS 3 DAYS BEFORE SHE HAD BEEN PERFECTLY WELL HER SYPTOMS BEGAN WITH A CORYZAL ILLNESS AND A NON PRODUCTIVE COUGH THE NEXT DAY SHE FELT INTERMITTENTLY HOT AND COLD WITH GENERALIZED MUSCLE ACHE THE DAY BEFORE PRESENTATION SHE COMPLAINED OF A SLIHTLY SORE NECK WHICH BECAME PAINFUL TO MOVE SHE VOMITED AFTER COUGHING ON SEVERAL OCCASIONS HER GENERAL CONDITION DETRIORATED ON DAY OF ADMISION SHE RECENTLY RETURNED FROM A FAMILY HOLIDAY FROM STATES  O/E IRRITABLE  NORMOTENSIVE FEBRILE TACYPNEAC TACHYCARDIA  CVS NORMAL  CHEST GOOD AE NO CRACKLES  DULL PERCUSION NOTE RT UPPER APEX  ABDOMEN NORMAL  CNS KERNING POSITIVE REST NORMAL  ENT NORMAL  INVESTIGATIONS  HB WC PLATELETS ESR GLUCOSE CSF Normal

20.  What important investigation is missing ????????  diagnosis