How do you get the diagnosis of pneumonia?:
The diagnosis of pneumonia is mainly clinical radiological type certification. In this sense, the main laboratory test is the chest radiograph in 2 positions, anteroposterior and lateral, which confirms the location of suspected pneumonia by physical examination, to quantify the size and the presence of complications such as pleural effusion .. .. Other tests are only for support and help us as secondary to try to guide us in the possible etiologies (viral, bacterial), in which studies have respiratory virus (Test Pack for respiratory syncytial virus, Adenovirus IF) , serologic titers (Mycoplasma pneumoniae), complete blood count, speed sedimentation (unspecified), C-reactive protein or CRP.
CLINICAL IN CHILDREN.
The clinical manifestations of bacterial pneumonia vary primarily according to the child's age, the most dangerous in children under three months. Require a high degree of suspicion because the classic signs are replaced by nonspecific manifestations of infection or hypothermia cooling trend, periods of apnea, in general conditions, food rejection, impaired consciousness and diarrhea. The lung test does not usually give higher marks. Hence the importance of taking X-ray chest to every child under three months of this cough in progress.
During the lactation period, ie up to two years of age, signs and symptoms are more clear and counselors of lung involvement. The doctor usually finds signs of high suspicion when listening to both lungs:
The clinical manifestations of bacterial pneumonia vary primarily according to the child's age, the most dangerous in children under three months. Require a high degree of suspicion because the classic signs are replaced by nonspecific manifestations of infection or hypothermia cooling trend, periods of apnea, in general conditions, food rejection, impaired consciousness and diarrhea. The lung test does not usually give higher marks. Hence the importance of taking X-ray chest to every child under three months of this cough in progress.
During the lactation period, ie up to two years of age, signs and symptoms are more clear and counselors of lung involvement. The doctor usually finds signs of high suspicion when listening to both lungs:
- General signs: Highlights by fever, irritability, pallor, and in general conditions. - specific signs: difficulty breathing, grunting, increased respiratory rate and cough.
Finally, in the preschool and school children more likely to find all the classic symptoms known to all: Fever, malaise, pain, side stitch type, abdominal symptoms added as pain, vomiting and bloating. The doctor when listening to it is easier to find the pathology condensing.
CLINICAL IN ADULTS.
The diagnosis of pneumonia in the elderly was established based on the following clinical signs: cough, sputum, green, greenish-white or white-bloody, fever or hypothermia, dehydration, malaise, impaired consciousness (drowsiness , disorientation, drowsiness, stupor, coma).
This evaluation was performed because some older adults admitted for consciousness disturbance and is difficult to diagnose pneumonia in community in these clinical conditions.
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signs: respiratory distress, or fine crackles, tachypnea, tachycardia, hypotension, air bronchogram or chest radiograph show pneumonic infiltrate, condensation zone or pleural effusion.
in older adults the diagnosis of bacterial agent causing community-acquired pneumonia takes less than 50% of patients due to low production of sputum for evaluation, or that the samples are contaminated with microbes usually colonize the oropharynx. Despite these problems, through some research has been possible to conclude that the most common bacteria are Streptococcus pneumoniae, Haemophilus influenzae, enteric gram-negative bacilli, Staphylococcus aureus, anaerobes, viruses and other less common as Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella pneumophila.
NAC diagnosis must be based on compatible clinical features with specific radiological findings, which requires, above suspicion, practice a chest radiograph. Classically, we describe two clinical syndromes and radiological:
- typical syndrome, characterized by high fever, chills, productive cough and pleuritic chest pain. In the chest radiograph usually shows a well defined homogeneous condensation.
- atypical syndrome: characterized by a clinic subacute with fever without chills, headache, myalgia, arthralgia and cough. Radiographic findings are variable, prone to multifocal involvement: multiple infiltrates or interstitial pattern images.
In emergency, once the diagnosis is made, we must discern which patients are tributaries of home treatment, admission to the ICU or hospital admission. The decision is complex and depends mainly on the severity of pneumonia and the patient's circumstances.
EYE! The clinical diagnosis of pneumonia without radiographic evidence lacks specificity because the clinical (history and physical examination) did not allow to differentiate the patient with pneumonia and other acute respiratory conditions .. required for diagnosis: a clinically compatible ( at least two of the following symptoms: fever, chills, a cough or worsening of chronic coughing and an increase or change in color of sputum, pleuritic pain, dyspnea) and acute radiation injury can not be explained by other causes (infections of the upper airway, bronchitis, influenza)
But accurate diagnosis is made when confirming the presence of pulmonary infiltrates on chest radiograph.
DIAGNOSIS MANAGEMENT.
should be based on the existence of a compatible clinical symptoms, accompanying certain radiological findings, which necessarily involves the practice of chest radiography (CXR). The clinical findings and chest radiography can not predict with certainty the etiology of pulmonary infection. The chest radiograph to confirm the clinical diagnosis, establish the location, extent and severity, in addition to differentiate between pneumonia and other diseases, to detect possible complications, and may be useful in monitoring patients at high risk. The diagnosis is clinical and radiographic pneumonia: the history and physical examination that the election is considered an appropriate antimicrobial regimen greatly influences the prognosis of the patient, as it has devoted much of its length consensus documents produced by the scientific societies.
The aim was to evaluate the evolution of a group of CAP caused by atypical pathogens in terms of empirical therapy had been scheduled to determine whether the use of antibiotics directed at this group of pathogens influenced the course of the infection process and the predecessor of Influenza A.
Patients with NAC were performed in the emergency department a complete medical history and physical examination, laboratory tests.
SUMMARIZING: NAC is an acute infection of the lung parenchyma. Its diagnosis requires a compatible clinical picture (at least two of the following symptoms: fever, chills, a cough or worsening of chronic coughing and an increase or change in color of sputum, pleuritic pain, dyspnea) and acute radiation injury can not be explained by other causes.
Older adults often have co morbidities such as congestive heart failure, diabetes mellitus, chronic renal failure and chronic obstructive pulmonary disease (COPD), whose symptoms more difficult the investigation of classical clinical signs of pneumonia.
Pneumonia is the only acute respiratory infection in a delay in the initiation of antibiotic therapy has been associated with an increased risk of complications and death.
IMPORTANT! There atypical pneumonia presentation make diagnosis difficult and delay the onset of treatment, adversely affecting the prognosis of patients. These patients often do not present the classic respiratory symptoms and / or fever, consult by nonspecific symptoms such as malaise, anorexia, altered mental status, or decompensation of chronic diseases. DRA
ESTER Matzkin.
RECOVERY OF PATIENTS WITH NAC IN THE EMERGENCY SERVICES.
NAC diagnosis must be based on compatible clinical features with specific radiological findings, which requires, above suspicion, practice a chest radiograph. Classically, we describe two clinical syndromes and radiological: - typical syndrome, characterized by high fever, chills, productive cough and pleuritic chest pain. In the chest radiograph usually shows a well defined homogeneous condensation.
- atypical syndrome: characterized by a clinic subacute with fever without chills, headache, myalgia, arthralgia and cough. Radiographic findings are variable, prone to multifocal involvement: multiple infiltrates or interstitial pattern images.
In emergency, once the diagnosis is made, we must discern which patients are tributaries of home treatment, admission to the ICU or hospital admission. The decision is complex and depends mainly on the severity of pneumonia and the patient's circumstances.
When making decisions, it must establish a balance between the physician's clinical trial and systematization given by the different protocols or guidelines distributed among professionals. !!!!¡¡ Initial treatment of CAP is usually empirical, antimicrobial selection should be based on outbreaks and microbiological studies and clinical trials!
The severity of the pneumonia can be very variable: hemodynamic instability, disorientation, or stupor, breathing work important (FR> 30 res / min), multilobar involvement, significant pleural effusion, respiratory failure, acute renal failure, severe leukopenia or leukocytosis, Anemia Hypoalbuminemia, bacteremia or metastatic.
OWN EXPERIENCE IN THE FLU EPIDEMIC N1H1 IN ARGENTINA.
The community-acquired pneumonia (CAP) is a high prevalence, initial treatment must be empirical. Acquired pneumonia in adults in the community is an acute disease, characterized by worsening general condition, fever, chills, cough, mucopurulent sputum and respiratory distress on physical examination associated with tachycardia, tachypnea, fever and focal signs in pulmonary testing. The probability that a patient with acute respiratory symptoms of pneumonia depends on the prevalence of the disease in the environment where it occurs and clinical features. It is estimated that the prevalence of pneumonia outpatient services is 3-5% of patients with respiratory disease.
The severity of the pneumonia can be very variable: hemodynamic instability, disorientation, or stupor, breathing work important (FR> 30 res / min), multilobar involvement, significant pleural effusion, respiratory failure, acute renal failure, severe leukopenia or leukocytosis, Anemia Hypoalbuminemia, bacteremia or metastatic.
OWN EXPERIENCE IN THE FLU EPIDEMIC N1H1 IN ARGENTINA.
The community-acquired pneumonia (CAP) is a high prevalence, initial treatment must be empirical. Acquired pneumonia in adults in the community is an acute disease, characterized by worsening general condition, fever, chills, cough, mucopurulent sputum and respiratory distress on physical examination associated with tachycardia, tachypnea, fever and focal signs in pulmonary testing. The probability that a patient with acute respiratory symptoms of pneumonia depends on the prevalence of the disease in the environment where it occurs and clinical features. It is estimated that the prevalence of pneumonia outpatient services is 3-5% of patients with respiratory disease.
EYE! The clinical diagnosis of pneumonia without radiographic evidence lacks specificity because the clinical (history and physical examination) did not allow to differentiate the patient with pneumonia and other acute respiratory conditions .. required for diagnosis: a clinically compatible ( at least two of the following symptoms: fever, chills, a cough or worsening of chronic coughing and an increase or change in color of sputum, pleuritic pain, dyspnea) and acute radiation injury can not be explained by other causes (infections of the upper airway, bronchitis, influenza)
But accurate diagnosis is made when confirming the presence of pulmonary infiltrates on chest radiograph.
DIAGNOSIS MANAGEMENT.
should be based on the existence of a compatible clinical symptoms, accompanying certain radiological findings, which necessarily involves the practice of chest radiography (CXR). The clinical findings and chest radiography can not predict with certainty the etiology of pulmonary infection. The chest radiograph to confirm the clinical diagnosis, establish the location, extent and severity, in addition to differentiate between pneumonia and other diseases, to detect possible complications, and may be useful in monitoring patients at high risk. The diagnosis is clinical and radiographic pneumonia: the history and physical examination that the election is considered an appropriate antimicrobial regimen greatly influences the prognosis of the patient, as it has devoted much of its length consensus documents produced by the scientific societies.
The aim was to evaluate the evolution of a group of CAP caused by atypical pathogens in terms of empirical therapy had been scheduled to determine whether the use of antibiotics directed at this group of pathogens influenced the course of the infection process and the predecessor of Influenza A.
Patients with NAC were performed in the emergency department a complete medical history and physical examination, laboratory tests.
SUMMARIZING: NAC is an acute infection of the lung parenchyma. Its diagnosis requires a compatible clinical picture (at least two of the following symptoms: fever, chills, a cough or worsening of chronic coughing and an increase or change in color of sputum, pleuritic pain, dyspnea) and acute radiation injury can not be explained by other causes. Older adults often have co morbidities such as congestive heart failure, diabetes mellitus, chronic renal failure and chronic obstructive pulmonary disease (COPD), whose symptoms more difficult the investigation of classical clinical signs of pneumonia.
Pneumonia is the only acute respiratory infection in a delay in the initiation of antibiotic therapy has been associated with an increased risk of complications and death.
IMPORTANT! There atypical pneumonia presentation make diagnosis difficult and delay the onset of treatment, adversely affecting the prognosis of patients. These patients often do not present the classic respiratory symptoms and / or fever, consult by nonspecific symptoms such as malaise, anorexia, altered mental status, or decompensation of chronic diseases. DRA
ESTER Matzkin.
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