probability (Pain) = chest pain and respiratory symptoms

Presentation of right middle lobe consolidation ( clinical)

- Dull in area of consolidation

- Tactile vocal fremitus increased in area of consolidation

- Bronchial breathing at area of consolidation

- Pyretic

Symptoms of community acquired pneumonia

Cough

Sputum

Dyspnoea

Chest pain

signs of community acquired pneumonia

Pyrexia

Tachycardia

Raised RR

Low oxygen sats

Percussion dull if consolidation

Bronchial breath sounds in consolidation

Crackles

What is the curb 65 score for

Calculate severity of community acquired pneumonia

What does CURB 65 stand for in calculating community acquired pneumonia severity

Confusion

Urea

RR > 30

BP = systolic <60 or diastolic < 60

65=65 age over 65

Investigations in community acquired pneumonia

FBC

U and E

LFT

CRP

Blood cultures

Chest xray

Sputum sample

CT thorax if CXR already done

Causes of type I respiratory failure

PE and pneumonia

What is type I respiratory failure

Oxygen in blood is low

Without increase in CO2

What is type II respiratory failure

Low level of oxygen in blood AND high level of CO2 in blood

causes of type II respiratory failure

COPD

Oxygen saturation target for type I respiratory failure

92-96%

Commonest cause of community acquired pneumonia

Streptococcus pneumonia

What type of bacteria is streptococcus pneumoniae

Gram positive

Alpha haemolytic

Coccus

That is the most common cause of community acquired pneumonia

Antibiotic for severe community acquired pneumonia

Co-amoxiclav and clarithromycin

- Consider penicillin allergy

What type of bacteria is legionella pneumophilia

Aerobic gram negative bacilli

- Sensitive to clarithromycin

Features of legionella infectioN

Recent abroad travel -- linked to contaminated water

Low sodium --- due to increased ADH secretion

Why is sodium low in legionella infection

Can cause increased inappropriate secretion of ADH

Describe pleuritic pain

Anywhere on chest wall

Sharp or stabbing

Well localised

Exacerbated by taking a deep breath or coughing

Where are the sensory nerve endings involved in pleuritic pain located

Parietal pleura

What oxygen devices are

- More comfortable, easily tolerated, can talk, sleep, eat and drink

- Nasal cannulae

- Nasal prong

What oxygen device is the first choice for severe emergencies or unstable, acutely unwell patients

non rebreather face mask with reservoir

What problems with non rebreather face masks

Dry and irritate nasal mucosa causing epistaxis

What is the delivery of oxygen for simple face oxygen mask

35-50% oxygen conc

For flow rates 5-10L/min

What oxygen device does this

35-50% oxygen conc

For flow rates 5-10L/min

Simple face oxygen mask

What oxygen device

Conc oxygen 60-80%

For flow rates 6-10L/min

Non rebreather face mask with reservoir

What is the delivery of oxygen for non rebreather face mask with reservoir

Conc oxygen 60-80%

For flow rates 6-10L/min

What oxygen device is a fixed performance device providing a consistent inspired oxygen level

Venturi mask

What oxygen devices give a variable performance with oxygen concentration delivered varying on breathing pattern

Nasal cannulae

Nasal prong

Simple face oxygen mask

Non rebreather face mask with reservoir

What oxygen device provides inspired oxygen concentration of 20-40%

Nasal cannulae

Nasal prong

What inspired oxygen conc do nasal cannulae give

20-40%

What patient should be given a venturi oxygen mask

Type II respiratory failure

What correction is seen in respiratory alkalaemia

Decrease in bicarbonate

Clinical presentation of spontaneous R pneumothorax

- Increased RR

- Decreased chest movement and breath sounds on R

- Hyper resonant R chest on percussion

- Tachycardia