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PCAP Report - Mark Reyes
PCAP Report - Mark Reyes
Pneumonia
Mark Nicholas B. Reyes
Medical Intern
Sample Case
• A.S.
• Male
• 5 y.o.
• Chief complaint: cough
Sample Case
History of Present Illness
• Pneumonia (2019)
• Complete immunization at par with age
Sample Case
Family History
• Emotional/Social Milestones
• 12 months: has favorite things and people
• Language/Communication
• 12 months: Responds to simple spoken requests
Sample Case
Developmental History
• Aspiration
• Foreign bodies
• Hypersensitivity reactions
• Drug or radiation induced pneumonitis
What are the defense mechanisms of the lower respiratory
tract against infections?
• Mucociliary clearance
• Macrophages
• Secretory IgA
• Coughing
Pathogenesis
Viral Pneumonia
• Most often occurs when respiratory tract organisms colonize the trachea and
subsequently gain access to the lungs
• May also result from direct seeding of lung tissue after bacteremia
Pathogenesis
S. Pneumonia
• Fever
• Tachypnea
• Cyanosis and fatigue in infants
• Diminished appetite
• Increased worked of breathing
• Crackles and wheezing
Tachypnea
2 months - 11 months
25-40 breaths/min ≥ 50 breaths/min
old
12 months - 59 months
20-30breaths/min ≥ 40 breaths/min
old
≥ 5 years old 15-25 breaths/min ≥30 breaths/min
Who shall be considered as having Community Acquired Pneumonia?
Decreased breath
Age-specific tachypnea
sounds
Chest wall retraction Nasal Flaring
Fever Consolidations as
visualized in lung
Grunting ultrasound
Who will require admission?
Who will require admission?
• Patient
classified as pCAP C may be managed initially as outpatient
provided that all of the following are not present:
• < 2 years old
• Convulsions
• CXR with effusion, lung abscess, air leaks, or multilobar pneumonia
• O2 sat ≤ 95% at room
When is antibiotic recommended?
pCAP A or pCAP B
• Amoxicillin
• 40-50 mg/kg/day TID
• 90mg/kg/day TID
• Azithromycin 10mg/kg/day OD
• Clarithromycin 15mg/kg/day BID
What empiric treatment should be administered ?
Bacterial Etiology - pCAP C
• Stability may be assessed within 24-48 hours after admission if any of the
following parameters has significantly improved or returned to normal:
• Respiratory rate
• O2 sat at room air
• Body temp
• Work of breathing
When can a patient be considered as responding to treatment?
pCAP D
• Necrotizing
• Acute
• Pneumothorax • Lung abscess
pneumonia
respiratory
failure
When can switch therapy be started?
pCAP C
• Vaccine against:
• S. pneumonia
• H. influenzae type B
• Breastfeeding
• Avoid cigarette smoke
References