1 / 28

HACK. these are a few of my favourite respiratory infections

HACK. these are a few of my favourite respiratory infections. Brendan Munn Emergency Residents’ Academic Day August 13 2009. CALGARY EMERGENCY MEDICINE TEACHING ROUNDS. Objectives. review common respiratory infections myths and just enough EBM provide an approach to the above

liliha
Download Presentation

HACK. these are a few of my favourite respiratory infections

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HACK. these are a few of my favourite respiratory infections Brendan Munn Emergency Residents’ Academic Day August 13 2009 CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  2. Objectives • review common respiratory infections • myths and just enough EBM • provide an approach to the above • discuss some cases • minimize powerpoint CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  3. Respiratory Tract Infections CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  4. Respiratory Tract Infections CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  5. Approach • is this pneumonia? • what tests should i order? • is this pneumonia special? • what f*ing antibiotic(s?) should i start? • should this patient be admitted? CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  6. case 1 HPI : 64F with cough, fever x 1 week O/E : febrile, RR 32 CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  7. CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  8. “Does this patient have Community Acquired Pneumonia? Diagnosing Pneumonia by History and Physical Examination” Metlay JP, Kapoor WN, Fine MJ. JAMA. 1997 Nov 5;278(17):1440-5. NO specific symptoms for dx pneumonia NO fever, tachypnea, tachycardia is Sn CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  9. Special Populations CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  10. Special Populations CAP VAP HAP HCAP HIV TB ASPIRATION AECOPD CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  11. case 2 HPI : 64F with cough, fever x 1 week O/E : febrile, RR 32, LLL crackles PMHx : nil CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  12. Sputum Cultures - Evidence • only 20% yield • no correlation C&S with gram or with BC • misses atypicals • nosocomial risk • does not change antibiotics or outcome • ATS07 guidelines : for all “complicated” Roson B, Clin Infect Dis 2000 CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  13. CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  14. Disposition - Evidence • Pneumonia Severity Index (PSI) online calculators available • limitations - 20 factors, CAP Fine, MJ. NEJM, 1997 Jan CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  15. CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  16. curb 65 • C Confusion • U Uremia >7mmol/L • R Respiratory Rate > 30 • B BP > 90 (S) or >60 (D) • Age >65 Lim, WS. Thorax, 2003 May CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  17. case 3 HPI : 64F with L THA O/E : febrile, RR 32, LLL crackles CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  18. Blood Cultures - Evidence • <10% yield in CAP • 50% false positive in ED • only 2% positive once antibiotics • limited data for inpatient if immune N • ATS07 guidelines : for all “complicated” Corbo J, BMJ 2004 CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  19. case 4 HPI : 64F diabetic receiving daily foot wound care at home with cough, fever x1 week O/E : febrile, RR 32, LLL crackles CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  20. HCAP RF hospitalization >2d in preceding 90 days long-term care facilit resident home infusion or wound care therapy chronic dialysis family member with drug resistant bug CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  21. MDR RF Antibiotics within the preceding 90 days Current hospitalization of ≥ 5 days High frequency of antibiotic resistance in the community or in the specific hospital unit Immunosuppressive disease and/or therapy Presence of risk factors for HCAP CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  22. case 5 HPI : 28M with cough x 6 weeks, worsening SOB O/E : febrile, RR 32 CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  23. CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  24. case 7 HPI : 64F alcoholic w cough, fever x 1 week O/E : febrile, RR 32, RLL opacity CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  25. case 8 CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  26. Review • is this pneumonia? • hx/phys poor, gestalt and a monkey, CXR • what tests should i order? • good empiric abx > sputum and blood cx • is this pneumonia special? • know your categories and risk factors • if VAP/HCAP/HAP evaluate MDR risk • always consider HIV, TB CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  27. Review • what f*ing antibiotic(s?) should i start? empiric coverage of common organisms • should this patient be admitted? use the PSI or at worst use CURB65 and feces CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

  28. References Tintinalli Up To Date EMRAP ATS CAP and HAP Guidelines 2007 CALGARY EMERGENCY MEDICINE TEACHING ROUNDS

More Related