diagnosis of pneumonia dr vinay verma
TRANSCRIPT
Slide 1
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DIAGNOSIS OF PNEUMONIA
Dr VINAY VERMA #512
Slide 2
Clinical Data Obtained at the Patient’s BedsideVital signs Increased respiratory rate Increased heart rate, cardiac output,
blood pressure
Slide 3
Clinical Data Obtained at the Patient’s Bedside Chest pain/decreased chest expansion Cyanosis Cough, sputum production, and hemoptysis Chest assessment findings
Increased tactile and vocal fremitus Dull percussion note Bronchial breath sounds Crackles and rhonchi Pleural friction rub Whispered pectoriloquy
Slide 4
Figure 2-11. Figure 2-11. A short, dull, or flat percussion note is typically produced over areas A short, dull, or flat percussion note is typically produced over areas of alveolar consolidation.of alveolar consolidation.
Slide 5
Figure 2-16. Figure 2-16. Auscultation of bronchial breath sounds over a consolidated lung Auscultation of bronchial breath sounds over a consolidated lung unit.unit.
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Figure 2-19. Figure 2-19. Whispered voice sounds auscultated over a normal lungWhispered voice sounds auscultated over a normal lungare usually faint and unintelligible.are usually faint and unintelligible.
Slide 7Slide 7
Clinical Data Obtained from Laboratory Tests and Special Procedures
Slide 8
Diagnostic MethodsHistory, physical examination
Chest X-Ray
Sputum examination (gram stained)
Sputum , blood cultures
Serological tests
Peripheral blood analysis
Slide 9
Pulmonary Function Study: Expiratory Maneuver Findings
FVC FEVFVC FEVTT FEF FEF25%-75%25%-75% FEF FEF200-1200200-1200
N or N or N or N or N N
PEFRPEFR MVV FEFMVV FEF50% 50% FEVFEV1%1%
N N or N N or N N or N N or
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Pulmonary Function Study Lung Volume and Capacity Findings
VT RV FRC TLC
N or
VC IC ERV RV/TLC%
N
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Arterial Blood GasesArterial Blood Gases
Mild to Moderate PneumoniaMild to Moderate Pneumonia Acute alveolar hyperventilation with Acute alveolar hyperventilation with
hypoxemiahypoxemia
pH PaCO2 HCO3- PaO2
(Slightly)
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Time and Progression of Disease
100
50
30
80
0
PaCO2
10
20
40
Alveolar Hyperventilation
60
70
90 Point at which PaO2 declines enough to stimulate peripheral oxygen receptors
PaO2
Disease OnsetPa
O2 o
r PaC
O2
Figure 4-2. PaO2 and PaCO2 trends during acute alveolar hyperventilation.
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Arterial Blood Gases
Severe PneumoniaSevere Pneumonia Acute ventilatory failure with hypoxemiaAcute ventilatory failure with hypoxemia
pH PaCO2 HCO3- PaO2
(Slightly)
Slide 14Slide 14
Time and Progression of Disease
100
50
30
80
0
PaO2
10
20
40
Alveolar Hyperventilation
60
70
90Point at which PaO2 declines enough to stimulate peripheral oxygen receptors
PaCO 2
Acute Ventilatory FailureDisease Onset
Point at which disease becomes severe and patient begins to become fatigued
Pa0 2
or P
aC0 2
Figure 4-7. PaO2 and PaCO2 trends during acute ventilatory failure.
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Abnormal Laboratory Tests and Procedures
Sputum examination Gram-positive organisms
Streptococcus Staphylococcus
Gram-negative organisms Klebsiella Pseudomonas aeruginosa Haemophilus influenzae Legionella pneumophila
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Radiologic Findings
Chest radiograph Increased density Air bronchograms Pleural effusions
CT scan Consolidation and bronchograms may be seen
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Chest X-Ray Gold standart test for pneumonia
For differencial diagnosis
For grading pneumonia severity
For examining complications
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-First 24 hours-Dehydration -Elderly-Neutropenia-Pneumocystis carinii
Normal Chest X Ray in Pneumonia
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Radiology:
lobar opacities, interstitial images, bronchopneumonic (patchy) opacities, Others (absea, pneumatocele, pleurisy...)
Diagnosis
Slide 20
Figure 15-5. Chest X-ray film of a 20-year-old woman with severe pneumonia of the left lung.
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Figure 15-6. Air bronchogram. The branching linear lucencies within the consolidation in the right lower lobe are particularly well demonstrated in this example of staphylococcal pneumonia. (From
Armstrong P et al: Imaging of diseases of the chest, ed 2, St. Louis, 1995, Mosby.)
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Figure 15-7. Air bronchogram shown by CT in a patient with pneumonia. (From Armstrong P et al: Imaging of diseases of the chest, ed 2, St. Louis, 1995, Mosby.)