PNEUMONIA

“Captain of the men of death”

– William Osler

• "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

History of PneumoniaHistory 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.

Statistics From CDCStatistics 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 (I00–I09,I11,I13,I20–I51) 649,399 219.1 210.3 217.0 -3.1

• 2 Malignant neoplasms (C00–C97) 559,300 188.7 183.8 185.8 -1.1 • 3 Cerebrovascular diseases (I60–I69) 143,497 48.4 46.6 50.0 -6.8

• 4 Chronic lower respiratory diseases (J40–J47) 130,957 44.2 43.2 41.1 5.1

• 5 Accidents (unintentional injuries) (V01–X59,Y85–Y86) 114,876 38.8 38.1 37.7 1.1

• 6 Diabetes mellitus (E10–E14) 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 (J10–J18) 62,804 21.2 20.3 19.8 2.5

• 9 Nephritis, nephrotic syndrome and nephrosis (N00–N07,N17–N19,N25–N27) 43,679 14.7 14.3 14.2 0.7

• 10 Septicemia (A40–A41) 34,142 11.5 11.2 11.2 0.0 • 11 Intentional self-harm (suicide) (*U03,X60–X84,Y87.0) 31,769 10.7 10.6 10.9

-2.8 • 12 Chronic liver disease and cirrhosis (K70,K73–K74) 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 (G20–G21) 19,547 6.6 6.4 6.1 4.9 • 15 Assault (homicide) (*U01–*U02,X85–Y09,Y87.1) 17,694 6.0 5.9 5.9 0.0

• ... All other causes (residual) 441,475 148.9

What is Pneumonia?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=_JUEVEENE4M&feature=related

5 Main Causes of 5 Main Causes of PneumoniaPneumonia

• Bacteria• Viruses• Mycoplasmas (Bacteria

without a cell wall)

• Fungi including Pneumocystis

• Various Chemicals

Types of PneumoniaTypes 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

Bacterial PneumoniaBacterial 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

Viral PneumoniaViral 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

Fungal PneumoniaFungal 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.

Parasitic PneumoniaParasitic 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

Atypical PneumoniaAtypical 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.

Community-Acquired Community-Acquired PneumoniaPneumonia

• 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

Hospital-Acquired Hospital-Acquired PneumoniaPneumonia

• 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.

Ventilator-Associated Ventilator-Associated PneumoniaPneumonia

• 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.

Aspiration PneumoniaAspiration 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

S/SS/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

TreatmentTreatment

• Diagnosed on basis of physical examination, X-Ray findings, and laboratory cultures.

• Primary Treatment are antibiotics

• Supportive Treatment

The Pre-Hospital SettingThe Pre-Hospital Setting• Place patient in position of

comfort• High-flow Oxygen• Severe Cases may require

endotracheal intubation• IV, base fluid resuscitation on

patient’s 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

SourcesSources

• 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-

pneumonia• http://www.merck.com/mmhe/sec04/ch042/

ch042d.html• http://human-infections.suite101.com/article.cfm/

fungal_pneumonia_endemic• http://www.merck.com/mmhe/sec17/ch196/

ch196a.html• http://www.nlm.nih.gov/medlineplus/ency/article/

000079.htm• http://www.merck.com/mmhe/sec04/ch042/

ch042b.html• http://en.wikipedia.org/wiki/Community-

acquired_pneumonia• http://www.clevelandclinicmeded.com/

medicalpubs/diseasemanagement/pulmonary/hospital_pneumonia/hospital_pneumonia.htm

• http://www.cdc.gov/ncidod/eid/vol7no2/mayhall.htm• http://www.kolbio.com/Combicath-main.asp• http://www.commonwealthfund.org/

snapshotscharts/snapshotscharts_show.htm?doc_id=394481

• http://www.cdc.gov/ncidod/eid/vol7no2/mayhall.htm• http://www.emedicine.com/emerg/topic464.htm• http://www.emedicine.com/med/TOPIC3162.HTM