Lower Respiratory Infections

(by survivalmedicine)

Pneumonia

 An infection (bacterial, viral, or fungal) within the lung

Pneumonia Symptoms

 Productive cough
 Fever (>100.5 F)
 Chills / sweat
 Pleuritic chest pain (especially when coughing or taking a breath)
 Shortness of breath
 Malaise / fatigue

Pneumonia Exam Findings

 Fever ( >100.5 F) or Hypothermia ( < 95.0 F)

 Increased respiratory rate (normal adult rate is 12-20 bpm)
 Fast heart rate (normal adult rate is < 100 bpm)
 Stethoscope findings can be normal or reveal rales or ranchi

Differential diagnoses

 Bronchitis (upper respiratory infection)

o Cough lasting > 5 days (10-20)
o Cough usually better by day 14
o Cough can be productive (color does not mean bacterial)
o Bronchospasm (wheezing)
o Fever suggests influenza or pneumonia
o 85%-90% are post-viral inflammation
o Treat with cough suppressant, NSAIDs, acetaminophen, albuterol, mucolytics
o If you are given antibiotics, I suggest storing them for the future
(* usually last the course and not heal by antibiotics; save the antibiotics for pneumonia)

Community Acquired Pneumonia (CAP)

 Most common bacteria causing CAP:

o Streptococcus pneumoniae
 o Mycoplasma pneumoniae
o Haemophilus influenzae
o Chlamydophila pneumonia

 Mortality of 10% (weighted on extremes of ages and debilitated patients)

 Can use the Pneumonia Severity Index (AKA PORT Score): http: www.mdcalc.com/psi-port-
score-pneumonia-severity-index-adult-cap
 Antibiotic decisions can be a lot more complicated: atypical organisms, pseudomonas, HIV,
immunosuppressant, fungal, viral, allergic, health care associated infections, MRSA,

Community Acquired Pneumonia (CAP) Treatment

II. Medication Treatment

A. First Line (macrolides) -- adult dosages:

a. - Azithromicine:  500 mg on day 1 as single dose,   then 250 mg daily for 4 additional
days
b. Clarithromicin: 500 mg twice a day for 7-10 days
c. Doxycycline: 100 mg twice a day for 7-10 days

B. Second Line (fluoroquinolones)— adult dosages:

a. Gemiloxacin: 320 mg once a day for 7-10 days
b. Levofloxacin: 750 mg once a day for 7-10 days
c. Moxifloxacin: 400 mg once a day for 7-10 days

III. Steam and Percussion

 Breath steam for several minutes

 Uses a cupped hand and firmly pound on patient’s back (all to loosen the mucus)