"A few leeches (six over the liver), or ice application, linseed meal poultices which may be sprinkled with mustard, or hot flannels wrung out of turpentine…"
Definition
Pneumonia is an inflammatory response of lung parenchyma to a variety of infective as well as non-infective agents. 8-% of community acquired pneumonias are pneumococcal in origin. Other aetiologic agents include H. Influenza (in smokers), viruses, and atypical pathogens like Mycoplasma and Chlamydia pneumoniae.
Prognosis
A case of pneumonia is more serious -1) there is background lung disease like COPD, or cystic fibrosis, 2) if complicated by septicaemia and superimposed by ARDS, 3) if result of aspiration in an unconscious patient 4) pneumonia in an alcoholic, 5) elderly patients, and 6) patients who are immuno-compromised. Bacterial pneumonias generally do well with therapy in the immuno-competent, So do mycoplasma pneumonia, though they take longer (1-2 weeks) to recover. Viral pneumonias recover well, but there is considerable post-illness asthenia.
Treatment
If Pain is mild and Air entry is normal,
Tab. PELOX 400mg. bd x 5days (Antibiotic) Tab Oxalgin DP tds x 3 (Analgesic + Antiinflammatory) Tab. WYSOLONE 5mg. 1tds x 3 (short course steroid) Phensedyll 1 tsp tds if cough (Antitussive) Bed Rest at Home
If pain is not relieved in 4-5 days, Ask for x –ray of chest
If patient is severe If patient is breathless or toxic/ If any chest signs are present: Ask for Hb, WBC, ESR and X-ray Chest.
If pleural effusion,
Refer the patient to a physician or 1. Aspirate the fluid. 2. Give full course of anti-TB treatment.
If Lobar Pneumonia,
Refer the patient to a physician
Antibiotic: 1. Inj. CEFANTRAL 1gm I.V. 12 hourly (Use a Broad spectrum Antibiotic or combination covering Gr +ve and Gr –ve organisms. E.g Inj. Ampicillin + Gentamycin, or Penicillin + Gentamycin, or Penicillin + Chloromycetin or Carbenicillin + Gentamycin) 2. Lin codein 1-25 tsp x tds if distressing cough. 3. Tab. Bromhexeine 1tds if excessive secretions. 4. Tab. Proxyvon 1 tds if Pain (Any analgesic) 5. Inj. KETANOV 1ml 6. Inj. Novalgin 3ml IM of severe pain (use analgesics which do not depress respiration). 7. Inj. DERIPHYLLIN 2cc IM or I.V. 8 hours or S.O.S. 8. Inj. BETNESOL 2ml I.V. 6-8 hourly. 9. Oxygen by nasal Cather/ mask. 10. Bed rest till recovery.
Bed rest and adequate nutrition and hydration. Encourage coughing and deep breathing exercises to clear secretions.
Advice to Patient
Nil specific
Follow Up
Daily assessment of patient\'s progress at home. Chest X-ray after 4-6 weeks to assess clearance. If changes persist, rule out any obstructive endobronchial pathology.
Inadequate Response
Consider resistant organism. Ensure proper sputum specimen, even by tracheal suction if required, for gram stain and culture and sensitivities. Rule out any immunity deficiency Rule out any obstructive Endobronchial pathology.
Prevention
Immunization of patients at risk with 1) Influenza A vaccine, 2) Polyvalent pneumococcal vaccine. Avoiding indiscriminate use of antibiotics for minor viral infections. Avoidance of aspiration in patients with impaired sensorium. As gastric acid a good protection against organisms, in patients running a risk of aspiration pneumonia, stress ulceration is to be prevented by sucralfatec, rather than antacids and H2 blockers. Avoid smoking. Proper control of hyperglycemia in diabetics, control of pulmonary congestion in cardiac cases. Effective cough techniques and deep breathing to be taught to patients confined to bed, and to post operative cases.
