RESPIRATORY
RESPIRATORY
Embedded Files
PNEUMONIA
PNEUMONIA
ABOUT THIS SESSION
ABOUT THIS SESSION
This is a self-directed learning resource designed to be worked through in the clinical environment.
Learning objectives:
Learning objectives:
- Present a short summary of a history and examination of someone with pneumonia
- Present findings on a chest radiograph using a systematic approach
- Prescribe appropriate antibiotics to treat pneumonia based on severity
- Decide whether a patient needs hospital admission for pneumonia and understand how that decision is made
Total time:
60 minNumber of students:
1-2Grade of students:
3rd to 5th year medical studentsCreated by:
Dr Beth BrockbankUploaded:
13th September 2019Last updated:
13th September 2019Resources needed for this session:
Resources needed for this session:
Clerking and/or AMTS proforma, pen, paper, prescription chart
Resources linked to this session:
Resources linked to this session:
None
Activity 1: History Taking and Examination Skills
15 minActivity 1: History Taking and Examination Skills
Take a focused history from a patient presenting with possible pneumonia to include past medical history, drug and allergy history, social history, family history and brief review of systems. Perform a focused respiratory examination.
Activity 2: Presentation Skills and Diagnostic Reasoning
15 minActivity 2: Presentation Skills and Diagnostic Reasoning
Construct a list of three key differentials for the patient you have seen. For each one, suggest two features from the history/examination that make it more or less likely.
Consider the following questions:
- What are the causes of crackles on examination?
- Why is it important to know about recent hospitalisations or if the patient lives in a care home?
- What are common causative organisms of pneumonia? How might these differ if the patient has recently been admitted to hospital or has come from a care home?
- What are the difference between typical and atypical organisms in pneumonia?
Activity 3: Initial Investigations
5 minActivity 3: Initial Investigations
Review the patient’s blood results. If none are available, use the example opposite and highlight the key abnormalities.
Consider:
- Do they fit with the clinical picture? If not, does this change your most likely diagnosis?
- What blood test results abnormalities may point towards certain atypical organisms?
Urea 8.1
Creat 127
CRP 189
ALP 150
WCC 22.5
Hb 145
Plt 24
Activity 4: Basic Imaging
5 minActivity 4: Basic Imaging
Review the chest radiograph of the patient you have seen. If none is available, use the example opposite. Systematically interpret the x-ray using an A to E approach,
- What is the most obvious abnormality?
Activity 6: Complications
5 minActivity 6: Complications
Suggest five possible complications of pneumonia.
Review the radiograph opposite.
Consider:
- What is the main abnormality on the radiograph opposite?
- What is the management of this condition?
Activity 6: Prescribing
5 minActivity 6: Prescribing
Find and complete a sepsis proforma for the patient you have seen.
Using an online calculator, assess the patients prognosis using a validated tool (e.g. the CURB-65). Consider:
- What practical value does this scoring system have?
Find a drug chart. Following the local antimicrobial policies, practice prescribing antibiotics for:
- Mild pneumonia
- Severe pneumonia
- Penicillin allergy (anaphylaxis)
Consider:
- Which antibiotics are used to cover the atypical organisms and why?
- What is the mechanism of action of these antibiotics?
Activity 7: Further Discussion
Activity 7: Further Discussion
Points for further consideration:
- Does your patient need to be admitted to hospital?
- What factors contribute to this decision? Consider medical and social issues.
- Has your patient been screened for sepsis in ED? What does this mean in clinical practice?
Summary and Feedback
5 minSummary and Feedback
Highlight three key things you have learned today. Summarise them on a post-it note and keep it somewhere you will find in a week or two.
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