PNEUMONIA IS MAJOR CAUSE OF MORTALITY IN UNDER 5 YR OF AGE, IN THIS PPT I TRIED TO COVER ALL IMPORTANT FACTOR ABOUT PNEUMONIA, FOLLOW WHO PLAN FOR MANAGEMENT GOD WILL DO REST FOR BETTERMENT OF YOUR PT.
Kolkata Call Girls Shobhabazar 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Gir...
New microsoft power point presentation
1. PNEUMONIA
D R M A H T A B
M B B S , D C H , D N B
H A M D A R D U N I V E R S I T Y
N E W D E L H I , I N D I A
2. INTRODUCTION
PNEUMONIA DEFINED AS INFLAMMATION OF LUNG PARENCHYMA
BIGGEST KILLER WORLDWIDE OF CHILDREN < 5 YR OF AGE
MORTALITY HAS REDUCED FROM 4 MILLION(1981) TO JUST OVER 1 MILLION IN 2013
PNEUMONIA STILL ACCOUTS ONE –FIFTHS OF CHILDHOOD DEATH WORLDWIDE
3. INTRODUCTION
Childhood pneumonia is an important cause of morbidity in the developed world, and
morbidity and mortality in the developing world.
Incidence — The World Health Organization (WHO) estimates there are 156 million cases of
pneumonia each year in children younger than five years, with as many as 20 million cases
severe enough to require hospital admission.
Mortality — The mortality rate in developed countries is low (<1 per 1000 per year). In
developing countries, respiratory tract infections are not only more prevalent but more severe.
Immunizations have had a great impact on incidence of pneumonia caused by pertussis,
diphtheria, measles, Hib, and S.pneumonia.
Where used, BCG for TB has also had a significant impact.
4. ETIOLOGY
Infectious agents: Bacteria, viruses
Non-infectious agents : aspiration of food/gastric acid,
foreign bodies, hydrocarbons, hypersensitivity reactions,
drug or radiation – induced pneumonitis.
5. ETIOLOGY
NEONATES <3WK GROUP B STREPTOCOOCUS,E.COLI,OTHERS GRAM –VE
BACTERIA,STREPTOCOCCUS,HEMOPHILUS INFLUENZA
3WK-3M RSV OTHER RESPIRATORY VIRUS (RHINOVIRUS,PARAINFLUENZA
VIRUS,INFLUENZA,ADENOVIRUS,S.PNEUMONIA,H.INFLUENZA
4M-4YR RSV, OTHER RESPIRATORY VIRUS(RHINOVIRUS,PARAINFLENZA
VIRUS,INFLUENZA,MYCOPLASMA
_>5YR M.PNEUMONIA,S.PNEUMONIAE,CHLAMYDIA
PNEUMONIA,H.INFLUENZA,INFLUENZA,ADENOVIRUS
6. ETIOLOGY
Infectious agents causing community acquired pneumonia vary by age
. Most common cause in infants is RSV Respiratory viruses
(RSV, para-influenza and influenza, adenovirus) in children younger
than 5 yrs old.
S.pneumonia and M.pneumonia is children older than 5 years.
M. Pneumonia and C.pneumonia are principal causes of atypical
pneumonia.
Additional agents occasionally or rarely cause pneumonia as hospital
acquired or zoonotic infections, in endemic areas or in
immunocompromised individuals.
7. Causes of pneumonia in the
immunocompromised
Gram negative enteric bacteria
M.avium complex
Fungi (aspergillosis, histoplasmosis)
CMV
Pneumocystis jirovecii
Pneumonia in patients with cystic fibrosis usually caused by:
Staph. Aureus in infancy
P.aeruginosa or Burkholderia cepacia in older children
8. TYPE OF PNEUMONIA
Lobar Pneumonia – Involvement of a single lobe or segment of a lobe (classic pattern of S.
pneumoniae pneumonia).
Bronchopneumonia – refers to inflammation of the lung that is centered in the bronchioles and
leads to production of mucopurulent exudate that obstructs some of these small airways and
causes patchy consolidation of the adjacent lobules.
Interstitial pneumonitis (IP) – refers to inflammation of the interstitial, which is composed of the
walls of the alveoli, alveolar sacs and ducts, and the bronchioles. IP is characteristic of viral
infections, but may also be a chronic process.
Necrotizing pneumonia (associated with aspiration pneumonia and pneumonia resulting from S.
pneumoniae, S. pyogenes, and S. aureus
9. RISK FACTOR
LOW BIRTH WEIGHT
MALNUTRITION
VITAMIN A DEFICIENCY
LACK OF BREAST FEEDING
PASSIVE SMOKING
LARGE FAMILY SIZE
F/O BRONCHITIS
OVERCROWDING
AIR POLLUTION (INDOOR IN ALSO IMPORTANT IN DEVELOPING COUNTRY)
10. SYMPTOM
Fever, chills
Tachypnea( MOST CONSISTENT CLINICAL MANIFESTATION)
Cough
Malaise
Pleuritic chest pain
Retractions
Difficulty breathing / SOB
INCREASED WORK OF BREATING ( INTERCOSTAL,SUBCOSTAL,SUPRACOSTAL
RETRACTION,NF,USE OF ACCESSORY MUSCLES)
SEVERE INFECTION MAY HAVE CYANOSIS AND LETHARGY
11. CLINICAL MANIFESTAION
VIRAL PNEUMONIA ; TEMPERATURE IS LOWER THAN BACTERIAL PNEUMONIA
BACTERIAL PNEUMONIA; BEGIN WITH HIGH GRADE FEVER,COUGH AND CHEST PAIN,OTHERS
DROWSINESS AND INTERMITTENT PERIOD OF RESTLESSNESS,SPLINTING ON AFFECTED SIDE TO
MINIMIZE PAIN
Neonates may have fever with only subtle or no physical findings of pneumonia
12. EXAMINATION FINDING
The examination findings vary depending on the site of infection:
Inspiratory crackles (rales, crepitations) – more common in lobar
pneumonia and bronchiolitis/pneumonia
Decreased breath sounds – may be noted in areas of consolidation
Coarse, low-pitched continuous breath sounds (ronchi) – more common
in bronchopneumonia
Expiration wheezes, high-pitched breath sounds – more common in
bronchiolitis and interstitial pneumonitis.
Viral pneumonia are associated more often with cough, wheezing or
stridor; fever is less
13. DIAGNOSIS
BASED ON HISTORY,PHYSICAL EXAMINATION,X RAYS FINDING AND LEUKOCYTOSIS
CXR PA AND LATERAL VIEW SUPPORT DIAGNOSIS AND INDICATE COMPLICATION
EG VIRAL PNEUMONIA; HYPERINFLATION WITH B/L INTERSTITIAL INFILTRATES AND
PERIBRONCHIAL CUFFING
LOBAR CONSOLIDATION TYPICALLY PNEUMOCOCACCAL PNEUMONIA
USG CHEST; LUNG CONSOLIDATION,AIR BRONCHOGRAM AND EFFUSION
14. BLOOD INVESTIGATION
CBC IN VIRAL WBC MAY NORMAL OR ELEVATED BUT NOT MORE THAN 20000/MM3 WITH
LYMPHOCYTOSIS
BACTERIAL PNEUMONIA ELEVATED WBC 15-40K/MM3 WITH PREDOMINENCE OF
GRANULOCYTOSIS
LARGE PLEURAL EFFUSION ,LOBAR CONSOLIDATION AND HIGH FEVER SUGGEST BACTERIAL
ETIOLOGY
15. DEFINITE DIAGNOSIS OF VIRAL INFECTION REST ON ISOLATION OF A VIRUS OR DETECTION OF
VIRAL GENOME OR ANTIGEN IN RESPIRATORY TRACT SECRETION
DEFINITE DIAGNOSIS OF BACTERIAL INFECTION REQUIRE ISOLATION OF ORGANISM BY
BLOOD,PLEURAL FLUID AND LUNG
18. HISTORY
Age
Presence of cough, difficulty breathing, SOB
Chest pain
Fever
Recent URTI
Associated symptoms and duration of symptoms
Immunization status
TB exposure
Maternal chlamydia, GBS during pregnancy
Choking episodes
Previous episodes
Previous antibiotics
20. TREATMENT
SEVERE PNEUMONIA;
DIAGNOSIS;
1. CENTRAL CYANOSIS SPO2<90%
2. SEVERE RESPIRATORY DISTRESS (GRUNTING ,SEVERE CHEST INDRAWING
3. SIGN OF GENERAL DANGER SIGN (INABILITY TO BREAST FEED OR DRINK,LETHARGY OR
UNCONSIOUSNESS,CONVULSION.
4. OTHER SIGN OF PNEUMONIA EG FAST BREATHING
5. CHEST INDRAWING
6. CHEST AUSCULTATION ( DECREASED BREATH SOUND,BRONCHIAL BREATH
SOUND,CRACKLES,,ABNORMAL VOCAL RESONANCE,PLEURAL RUB
21. INVESTIGATION;
1.MEASURE SPO2
2.CXR TO IDENTIFY (PLEURAL
EFFUSION,EMPYEMA,PNEUMOTHORAX,PNEUMOTACELE,INTERSTITIAL PNEUMONIA)
TREATMENT
1. O2 SUPPLIMENT WHEN SPO2 <90% (NASAL PRONG IS PREFFERED METHOD IF NOT AVALEBLE
THAN NASAL OR NASOPHARENGEAL CATHETOR MAY USED
2. IF PULSE OXIMETER IS NOT AVALIEBLE CONTINUE O2 SUPPLIMENT UNTIL SIGN OF HYPOXIA
(INABILITY TO BF OR RR >70 ARE PRESENT
3. NURSE SHOULD CHECK NASAL PRONG EVERY 3 HR TO CHECK BLOCKAGE AND CORRECT
POSITION
22. ANTIBIOTIC THERAPY ; IV AMPICILLIN/BENZYLPENICILLIN AND GENTAMYCIN
(AMPICILLIN 50MG/KG OR BENZYLPENICILLIN 50000U/KG IM/IV EVERY 6HRLY ATLEAST 5 DAYS
GENTAMYCIN 7.5MG/KG IM/IV OD ATLEAST FR 5 DAYS
IF CHILD DOESN’T SHOW SIGN OF IMPROVEMENT WITHIN 48 HR AND STAPHYLOCOCCAL
PNEUMONIA SUSPECTED SWITCH GENTAMYCIN +CLOXACILLIN 50MG/KG IV/IM 6HRLY
USE CEFTRIAXONE 80MG/KG IM/IV OD IN CASE OF FAILURE OF FIRST LINE TREATMENT
23. Supportive care
1. GENTLE SUCTION OF THICK SECRETION
2.FEVER >38*(102.28F GIVE PARACETAMOL
3 IF WHEEZE GIVE RAPID ACTING BRONCHODILATOR AND STEROID WHEN APPROPRIATE
4 ENSURE CHILD RECEIVE DAILY MAINTENANCE FLUID
5. ENCOURAGE BREAST FEEDING AND ORAL FLUID
5. IF CHILD CANNOT DRINK INSERT NG TUBE GIVE MAINTENANCE FLUID IN SMALL AMOUNT
6. ENCOURAGE CHILD TO EAT FOOD
24. MONITORING
CHILD SHOULD BE CHECK BY NURSE EVERY 3 HRLY AND BY DR TWICE A DAYS
WITHIN 2 DAYS THERE SHOULD BE SIGN OF IMPROVEMENT
IF CHILD DON’T IMPROVE IN 2 DAYS LOOK FOR COMPLICATION AND ALTERNATE DIAGNOSIS
25. DISCHARGE
RD HS RESOLVED
THERE IS NO HYPOXIA
THEY ARE FEEDING WELL
THEY ARE ABLE TO TAKE TAKE ORAL MEDICATION OR COMPLETED A COURSE OF PARENTERAL
ANTIBIOTICS
PARENTS UNDERSTAND SIGN OF PNEUMONIA,RISK FACTORS AND WHEN TO RETURN
FOLLOW-UP GIVE VACCINATION THAT ARE DUE AND ARRANGE FOLLOWUP IN 2 WEEKS
26. PNEUMONIA
COUGH OR DIFFICULT BREATHING PLUS ONE OF FOLLOWING
1.FAST BREATHING
2. LOWER CHEST INDRAWING
IN ADDUTION EITHER CRAKLES OR PLEURAL RUB MAY BE PRESENT ON AUSCULTATION
27. TREATMENT
TREAT AS OUT PATIENT
1. NORMAL FLUID REQUIREMENT +BREAST FEEDING OR FLUID IN FREQUENT SMALL AMOUT
2.ANTIBIOTICS; GIVE FIRST DOSE OF AMOXICILLIN THAN TEACH HOW TO GIVE OTHER DOSE
* SETTING HIGH HIV RATE ORAL AMOXICILLIN 40MG/KG/DOSE TWICE FOR 5 DAYS
++LOW HIV PREVALENCE 40MG/KG/DOSE TWICE A DAYS FR 3 DAYS
3. AVOID UNNECESSARY HARMFUL MEDICATION EG ATROPINE,CODEINE DERIVATIVES OR
ALCOHAL
4. PCM
28. FOLLOWUP IN PNEUMONIA
ENCOURAGE FEEDING
BRING BACK AFTER 3 DAYS
EARLIER IF CHILD BECOME SICKER (REFUAL TO FEED,LETHARGY,SEVERE RD ETC)
29. PROGNOSIS
Overall, the prognosis is good.
Most cases of viral pneumonia resolve without treatment
common bacterial pathogens and atypical organisms respond to antimicrobial.(IMPROVEMENT
IN CLINICAL SYMPTOM GENERALLY 48-96 HR)
Long-term alteration of pulmonary function is rare, even in children with pneumonia that has
been complicated by empyema or lung abscess. Patients placed on a protocol-driven pneumonia
clinical pathway are more likely to have favorable outcomes.
Staphylococcal pneumonia, although rare, can be very serious despite treatment
30. POSSIBILITIES WHEN PT NOT RESPONDING
1. COMPLICATION EG EMPYEMA
2. BACTERIAL RESISTENCE
3. NON BACTERIAL ETIOLOGY EG VIRAL,FUNGAL,ASPIRATION OF FOREIGN BODY
4. PREEXISTING DISEASE EG IMMUNODEFICIENCY,CILIARY DYSKINESIA,CF,PULMONARY
SEQUESTRATION
5. OTHER NON INFECTIOUS ETIOLOGY EG BRONCHIOLITIS OBLITERANCES,HYPERSENSITIVITY
PNEUMONITIS,EOSINOPHILIC PNEUMONIA
37. RECURRENT PNEUMONIA
2 OR MORE IN A SINGLE YEAR OR 3 OR MORE EPISODE EVER WITH RADIOLOGICE CLEARING IN
BETWEEN
UNDERLYING DISORDER FOR RECURRENT PNEUMONIA
HEREDITORY DISORDER; SCD,CF
DISOERDER OF IMMUNITY; HIV/AIDS,BRUTON AGAMMAGLOBUNIMIA,SCID,LAD
DISORDER OF CILIA; KARTAGENER SYNDROME,IMMOTILE CILIA SYNDROME
ANATOMIC DISORDER;PULMONARY SEQUESTRATION,LOBAR EMPHYSEMA,GERD,FOREIGN
BODY,TOF( H TYPE),BRONCHIECTASIS
38. PREVENTION
Immunizations (EG PNEUMOCOCCAL,INFLUENZA)
RSV infections can be reduced in severity using palivizumab
Reduce length of mechanical ventilation and using antibiotic treatment only when necessary
Hand washing before and after every patient and using gloves for invasive procedures
Hospital staff should use masks (especially those with respiratory illnesses)
