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Pneumonia in the elderly - Dr. Kiefer

11/14/2013

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Picture
Why this matters!
  • 30 day mortality for 75-84 yrs old  = 11%, for those >84 yrs = 24%
  • 50-70% of nursing home residents are exposed to antibiotics over any one year; increasing MDR in this population
  • Risk fx: Alcoholism RR 9, COPD RR 4.2, immunosupp R 3.1, Heart disease RR 1.9, institutionalized RR 1.8
  • Elderly may present atypically for pneumonia.  Latent, without chills, ill defined physical signs. 
  • 50% of fever absent in elderly, and mortality is higher in this population

How about a Score?
  • PORT score.  30 day mortality in >age 18. Exclude HIV, hospitalization in prior 7 days
    Step 1.  Identify low risk.  Age <50. No Hx Cancer, CHF, CVD, Renal disease, Liver disease. 
                 On exam AMS, HR>125, RR>30, SBP <90, Temp <35 or >40
    Step 2. Use MD Calc Check boxes.  

    Simple rule: With no high risk findings and women under 80, dischcarge and men under 70. 
  • CURB65.  Useful for sicker patients, 37% of pts greater than 75 yo.
    C:Confusion
    Urea >20
    RR >30
    Blood Pressure - SBP <90, DBP <60
    Age >65

    More of these is higher mortality in 30 days


Blood Cx
?


  • IDSA Guidelines: ICU Admission, Cavitary infiltrates, Leukopenia, active alcoholism, severe liver dz, severe COPD, Asplenia, pleural effusion.
  • If you get blood cultures, you need to a have reason

HCAP
  • Don't necessarily need to treat everyone with healthcare exposure for HCAP
  • Treat if risk of MDR.  Look up the criteria
  • Common pathogens: Increased rated of gram negative bacilli, MRSA
  • Treatment: Should reference IDSA guidelines, but in general need MRSA coverage + either 1 or 2 drug antipseudomonal therapy depending on risk

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Prospective Visiting Students
    • UNC/Wake Forest Students
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction