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Symptoms |
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Cough |
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Initially dry |
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Later becoming productive |
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May contain blood (rust colour, or frank blood) |
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Pleuritic chest pain |
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Fever - rigors, night sweats |
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Malaise |
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Anorexia |
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Headache |
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Signs |
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General |
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Pyrexia |
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Tachypnoea |
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Tachycardia |
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Hypoxaemia |
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Hypotension |
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Confusion / Irritability / Drowsiness |
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Respiratory |
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Reduced chest wall movement |
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Dull percussion note |
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Bronchial breath sounds |
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Fine crepitations |
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Risk Factors |
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Smoking |
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Corticosteroid use |
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Pre existing lung condition |
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Recent Upper Respiratory Tract Infection (URTI) |
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Advanced age |
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Alcohol |
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Contact with birds |
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Investigations |
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CXR - Lobar consolidation |
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Oxygen saturation (pulse oximetry) |
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ABG |
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Sputum - MCS |
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MCS |
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Gram stain |
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Ziehl Neelson (ZN) stain |
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Consider induced by physiotherapy if poor specimen |
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Blood - MCS |
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Serology - antibody titres to atypical pneumonias |
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Bronchoalveolar lavage - Bronchial washings - MCS |
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Treatment |
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Sitting up |
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Oxygen therapy |
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Consider CPAP ventilation if severely hypoxic |
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Fluid management |
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Analgesia - NSAIDs, or Opiates (eg. Pethidine or Morphine), however, be cautious of respiratory depression with opiates |
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Empiric antibiotic therapy - according to current therapeutic guidelines (see below) |
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Specific antibiotic therapy - tailored to specific organism |
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