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PNEUMONIA

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Title: PNEUMONIA


1
PNEUMONIA
  • Captain of the men of death
  • William Osler

2
  • "Pneumonia is an infectious disease characterized
    by inflammation of the lungs and constitutional
    disturbances of varying intensity. The fever
    terminates abruptly by crisis. Secondary
    infective processes are common. Diplococcus
    pneumoniae, which is now known as Streptococcus
    pneumoniae, is invariably found in the diseased
    lung. Pneumonia is a self-limited disease and
    runs its course uninfluenced by medicine."
  • - William Osler - 1892

3
History of Pneumonia
  • Described as early as 400 BC by a Greek Physician
    named Hippocrates.
  • Edwin Klebs was the first to see bacterial
    infection from a person who died from pneumonia.
  • Described by Sir William Osler over 100 years ago
    linking the infection to a bacterial cause.
  • Pneumonia killed a majority of the 50-100 million
    people that died from the Spanish flu in 1918.

4
Statistics From CDC
  • Cause of death (based on the International
    Classification Death Percent
  • Rank 1 of Diseases , Tenth Revision , 1992)
    Number rate 2005 2004 change
  • ... All causes 2,447,910 825.9 798.8 800.8
    -0.2
  • 1 Diseases of heart (I00I09,I11,I13,I20I51)
    649,399 219.1 210.3 217.0 -3.1
  • 2 Malignant neoplasms (C00C97) 559,300 188.7
    183.8 185.8 -1.1
  • 3 Cerebrovascular diseases (I60I69) 143,497
    48.4 46.6 50.0 -6.8
  • 4 Chronic lower respiratory diseases (J40J47)
    130,957 44.2 43.2 41.1 5.1
  • 5 Accidents (unintentional injuries)
    (V01X59,Y85Y86) 114,876 38.8 38.1 37.7 1.1
  • 6 Diabetes mellitus (E10E14) 74,817 25.2
    24.5 24.5 0.0
  • 7 Alzheimer's disease (G30) 71,696 24.2 22.9
    21.8 5.0
  • 8 Influenza and pneumonia (J10J18) 62,804
    21.2 20.3 19.8 2.5
  • 9 Nephritis, nephrotic syndrome and nephrosis
    (N00N07,N17N19,N25N27) 43,679 14.7 14.3
    14.2 0.7
  • 10 Septicemia (A40A41) 34,142 11.5 11.2
    11.2 0.0
  • 11 Intentional self-harm (suicide)
    (U03,X60X84,Y87.0) 31,769 10.7 10.6 10.9
    -2.8
  • 12 Chronic liver disease and cirrhosis
    (K70,K73K74) 27,393 9.2 8.9 9.0 -1.1
  • 13 Essential (primary) hypertension and
    hypertensive renal disease (I10,I12) 24,865 8.4
    8.0 7.7 3.9
  • 14 Parkinson's disease (G20G21) 19,547 6.6
    6.4 6.1 4.9
  • 15 Assault (homicide) (U01U02,X85Y09,Y87.1)
    17,694 6.0 5.9 5.9 0.0

5
What is Pneumonia?
  • It is the infection of one or both of the lungs.
    Occurs from bacteria, virus, or fungus that is
    inhaled or gets into the blood stream.
  • http//www.youtube.com/watch?v_JUEVEENE4Mfeature
    related

6
5 Main Causes of Pneumonia
  • Bacteria
  • Viruses
  • Mycoplasmas (Bacteria without a cell wall)
  • Fungi including Pneumocystis
  • Various Chemicals

7
Types of Pneumonia
  • Bacterial Pneumonia
  • Viral Pneumonia
  • Fungal Pneumonia
  • Parasitic Pneumonia
  • Atypical Pneumonia
  • Community-Acquired Pneumonia
  • Hospital-Acquired Pneumonia
  • Healthcare-Associated Pneumonia
  • Ventilator-Associated Pneumonia
  • Aspiration Pneumonia
  • Eosinophilic pneumonia
  • Bronchiolitis obliterans organizing pneumonia

8
Bacterial Pneumonia
  • Infection by Bacteria
  • Most commonly Streptococcus pneumoniae
  • Gram Positive (Gram Stain)
  • Staphylococcus aureus
  • Gram negative, Haemophilus influenzae
  • Contracted through inhalation or through the
    blood stream.
  • Treated with Antibiotics

9
Viral Pneumonia
  • Caused by Influenza, parainfluenza, adenovirus,
    rhinovirus, herpes simplex virus along with
    several other kinds of viruses.
  • Antibiotics are not effective in treating viral
    pneumonia.
  • It is often treated with antiviral medications
    along with plenty of fluid and rest
  • Individuals with suppressed immune systems are
    most at risk for acquiring this form of pneumonia

10
Fungal Pneumonia
  • Primarily caused by Histoplasma capsulatum,
    Coccidioides immitis, Blastomyces dermatitidis .
  • Most of the time no symptoms are noticed after
    inhaling the fungus.
  • Can progress and yield flu like symptoms.

11
Parasitic Pneumonia
  • Not common in industrialized nations.
  • Infection occurs by ingesting parasite
    contaminated food or other products.
  • A common one that occurs primarily in children is
    toxocariasis.
  • Infection caused by larvae of the roundworm

12
Atypical Pneumonia
  • Characterized by a more drawn out course of
    symptoms, unlike other forms of pneumonia which
    have more sudden and severe onsets.
  • Also known as walking pneumonia
  • Almost impossible to differentiate in the
    emergent setting typical pneumonia from atypical.
  • Treat what you see.

13
Community-Acquired Pneumonia
  • Community Acquired means that an individual has
    not been recently hospitalized and has acquired a
    lung infection
  • Most commonly caused by streptococcus
  • Can also be caused by Haemophilus, influenzae,
    Legionella, mycoplasma, chlamydia, and viruses.
  • Occurs most commonly in the very young and the
    very old
  • Usually starts from an upper respiratory tract
    infection
  • S/S usually are that of a flu along with a
    productive cough with sputum that is rust colored
    from blood.
  • Leads to sepsis
  • Vaccine is available for 23 of the known
    pneumococcus
  • Can be treated with antibiotics
  • Problem with antibiotic resistant strains

14
Hospital-Acquired Pneumonia
  • Defined as pneumonia that is acquired within
    48-72 hours of being admitted to a hospital or
    care facility.
  • Tends to be a more severe strain of pneumonia due
    to the more aggressive organisms that cause it
  • People in the hospital and care facilities tend
    to be more vulnerable making them less able to
    fight the infection.
  • Approximately 300,000 cases annually and carries
    a mortality rate of 30-70
  • Increases hospital stay by 7-9 days on average
  • Some risk factors include Over the age of 70,
    Prolonged hospital stay, and COPD patients
  • Most commonly occurs in patients that require ICU
    care
  • Caused when organisms are delivered to lower
    reparatory through aspiration or contaminated
    respiratory machines.

15
Ventilator-Associated Pneumonia
  • A sub-type of Hospital Acquired Pneumonia
  • Defined as pneumonia that is acquired by someone
    who has be on a ventilator for 48 hours or more
  • The easiest way to reduce risks of ventilator
    associated pneumonia is to use proper sterile
    techniques when performing invasive procedures
    such as intubations.
  • Health care associated infections amount to
    approximately 90,000 deaths and 4.5 billion
    excess health care costs each year.

16
Aspiration Pneumonia
  • Defined as inhalation of either oropharyngeal or
    gastric content into the lower airway.
  • The inhalation of oropharyngeal content is
    usually witnessed and leads to an infection
    process.
  • Occurs often in patients with altered level of
    consciousness, CVA, drug intoxication, or head
    trauma.
  • Approximately 10 of patients hospitalized from
    drug overdoses have aspiration pneumonia
  • High Risk Patients are Elderly Coma
    Anesthesia Excessive alcohol consumption Near
    Drowning accident

17
S/S
  • What we will commonly see and hear in the field
  • Fever
  • Cough
  • Cough will bring up Greenish, Yellowish Mucus and
    possibly hemoptysis
  • Stabbing Chest pain that worsens with deep
    respirations
  • Fatigue
  • Head Ache
  • Loss of Appetite
  • Shortness of Breath
  • Cyanotic, Sweaty, clammy skin
  • Rapid Heart Rate
  • Crackles (Rales)/Wheezing Auscultated
  • Diminished lung sounds in areas filled with
    infection

18
Treatment
  • Diagnosed on basis of physical examination,
    X-Ray findings, and laboratory cultures.
  • Primary Treatment are antibiotics
  • Supportive Treatment

19
The Pre-Hospital Setting
  • Place patient in position of comfort
  • High-flow Oxygen
  • Severe Cases may require endotracheal intubation
  • IV, base fluid resuscitation on patients
    hydration status (Assess for dehydration).
  • Breathing Treatment
  • Antipyretic agents for high fevers
  • Remember to consider Pneumonia in patients
    complaining of chest pain especially if its
    accompanied by fever

20
Sources
  • Paramedic Care Principles and Practice Medical
    Emergencies 2nd Edition
  • CDC
  • Merck
  • Emedicine.com
  • The Common Wealth Fund
  • Cleveland Clinic
  • U.S. National Library of Medicine
  • Healthline.com
  • http//www.flickr.com/photos/heitkamp/408443623/
  • http//www.healthline.com/adamcontent/viral-pneumo
    nia
  • http//www.merck.com/mmhe/sec04/ch042/ch042d.html
  • http//human-infections.suite101.com/article.cfm/f
    ungal_pneumonia_endemic
  • http//www.merck.com/mmhe/sec17/ch196/ch196a.html
  • http//www.nlm.nih.gov/medlineplus/ency/article/00
    0079.htm
  • http//www.merck.com/mmhe/sec04/ch042/ch042b.html
  • http//en.wikipedia.org/wiki/Community-acquired_pn
    eumonia
  • http//www.clevelandclinicmeded.com/medicalpubs/di
    seasemanagement/pulmonary/hospital_pneumonia/hospi
    tal_pneumonia.htm
  • http//www.cdc.gov/ncidod/eid/vol7no2/mayhall.htm
  • http//www.kolbio.com/Combicath-main.asp
  • http//www.commonwealthfund.org/snapshotscharts/sn
    apshotscharts_show.htm?doc_id394481
  • http//www.cdc.gov/ncidod/eid/vol7no2/mayhall.htm
  • http//www.emedicine.com/emerg/topic464.htm
  • http//www.emedicine.com/med/TOPIC3162.HTM
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