CCBB Del Aparato Respiratori O: Neumología
CCBB Del Aparato Respiratori O: Neumología
CCBB Del Aparato Respiratori O: Neumología
APARATO
RESPIRATORI
O
IRA HIPERCAPNICA:
GRADIENTE NORMAL (EXTRAPULMONAR)
• Depresion centro respiratorio (fármacos, patología
SNC).
• Enfermedad neuromuscular: botulismo, ELA,
polimiositis, Guillian Barre, miastenia gravis, tetanos,
metabólicas severas, difteria, poliomielitis, medular,
bloqueadores ganglionares.
• Obstruccion aérea: cuerpo extraño, patología faríngea o
laríngea, angioedema.
GRADIENTE ELEVADA:
• campos claros=obstrucción via aerea difusa.
• Infiltrados=mixta, fatiga muscular.
SEVERIDAD
CURB-65
PNEUMONIA SEVERITY INDEX (PSI)
CRITERIOS DE INGRESO A UCI
COMPLICACIONES
Abnormality Days
• ATELECTASIA
Tachycardia and hypotension 2
• DERRAME PARANEUMÓNICO
Fever, tachypnea, and hypoxia 3 • EMPIEMA
Cough 14 • ABSCESO PULMONAR
Fatigue 14 • BRONQUIECTASIA
Infiltrates on chest radiograph 30
TRATAMIENTO
Organism Preferred antimicrobial(s) Alternative antimicrobial(s)
Outpatient treatment
Streptococcus pneumoniae
1. healthy and no use of antimicrobials within the previous 3 months:
Penicillin Macrolide, cephalosporins, clindamycin, doxycyline,
A macrolide OR Doxycyline* Penicillin G, amoxicillin
nonresistant; MIC <2 respiratory fluoroquinolone*
2. Presence of comorbidities; or use of ATB within the previous 3 months: Basis of susceptibility, including
Penicillin resistant; Vancomycin, linezolid, high-dose amoxicillin (3 g/day
A respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin cefotaxime, ceftriaxone,
MIC ≥2 with penicillin MIC ≤4 microgram/mL)
[750 mg]) OR A beta-lactam (first-line agents: high-dose amoxicillin, fluoroquinolone
amoxicillin-clavulanate; alternative agents: ceftriaxone, cefpodoxime, or Haemophilus influenzae
cefuroxime) PLUS a macrolide (azithromycin, clarithromycin, or Non-beta-lactamase Amoxicillin Fluoroquinolone, doxycycline, azithromycin,
erythromycin)* Beta-lactamase
2-3RA cephalosporin, amoxiclav Fluoroquinolone, doxycycline, azithromycin,
Inpatients, non-ICU treatment producing
M. pneumoniae/C. Macrolide, a tetracycline Fluoroquinolone
A respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin
pneumoniae
[750 mg]) OR An antipneumococcal beta-lactam (preferred agents:
cefotaxime, ceftriaxone, or ampicillin-sulbactam; or ertapenem for Legionella species Fluoroquinolone, azithromycin Doxycyline
selected patients)• PLUS a macrolide (azithromycin, clarithromycin, or Chlamydophila
A tetracycline Macrolide
erythromycin)*Δ psittaci
Coxiella burnetii A tetracycline Macrolide
Inpatients, ICU treatment
Francisella tularensis Doxycycline Gentamicin, streptomycin
An antipneumococcal beta-lactam PLUS azithromycin OR An Yersinia pestis Streptomycin, gentamicin Doxycyline, fluoroquinolone
antipneumococcal beta-lactam PLUS a respiratory fluoroquinolone OR For Ciprofloxacin, levofloxacin,
Bacillus anthracis
penicillin-allergic patients, a respiratory fluoroquinolone (moxifloxacin, doxycycline (usually with second Other fluoroquinolones; beta-lactam, if susceptible;
gemifloxacin, or levofloxacin [750 mg]) PLUS aztreonam (inhalation) rifampin; clindamycin; chloramphenicol
agent)
Staphylococcus aureus 3RA cephalosporin, Beta-lactam/beta-lactamase inhibitor◊,
Enterobacteriaceae
Methicillin susceptible Antistaphylococcal penicillin‡ Cefazolin, clindamycin carbapenemΔ fluoroquinolone
Methicillin resistant Vancomycin or linezolid TMP-SMX Antipseudomonal beta-lactam §
Pseudomonas
Bordetella pertussis Macrolide TMP-SMX plus (ciprofloxacin or Aminoglycoside plus (ciprofloxacin or levofloxacin¥)
aeruginosa
Beta-lactam/beta-lactamase levofloxacin¥ or aminoglycoside)
Anaerobe (aspiration) Carbapenem Acinetobacter Cephalosporin-aminoglycoside, ampicillin-sulbactam,
inhibitor◊, clindamycin Carbapenem
species colistin
INFECTOLOGÍA qxmedic.edu@gmail.com www.qxmedic.com
Pathogenic Mechanism Prevention Strategy
NEUMONÍA INTRAHOSPITALARIA
Oropharyngeal colonization with pathogenic bacteria
Abnormal swallowing
Early percutaneous tracheostomya
function
BRONQUIAL Talks in
Alertness
Sentences
May be agitated
Phrases
Usually agitated
Words
Usually agitated Drowsy or confused
Increased Often >30/minute
Guide to rates of breathing in awake children:
Age Normal rate
Respiratory
Increased <2 months <60/minute
rate
2-12 months <50/minute
1-5 years <40/minute
6-8 years <30/minute
Moderate, often Usually loud;
Wheeze only end Loud; throughout exhalation inhalation and Absence of wheeze
expiratory exhalation
100-120 >120
Guide to normal pulse rates in children:
Age Normal rate
Pulse/minute <100 Bradycardia
2-12 months <160/minute
1-2 years <120/minute
2-8 years <110/minute
CLINICA: ESPIROMETRÍA: Pulsus Absent <10 May be present
Often present Absence suggests
>25 mmHg (adult) respiratory muscle
paradoxus mmHg 10-25 mmHg
20-40 mmHg (child) fatigue
• TOS • HIPERSENSIBILIDAD 40-69 percent or
• DISNEA • REVERSIBILIDAD PEF ≥70 percent response lasts <2 <40 percent <25 percent
• SIBILANTES • VARIABILIDAD hours
90-95 percent (test
>95 percent (test not
SaO2 not usually <90 percent
usually necessary)
NEUMOLOGÍA qxmedic.edu@ gmail.com necessary) www.qxmedic.com
CLASIFICACIÓN DE
LA SEVERIDAD DEL
ASMA
Classification of asthma severity (≥12 years of age)
Components of severity Persistent
Intermittent
Mild Moderate Severe
>2 days/week but not
Symptoms ≤2 days/week Daily Throughout the day
dayl
Impairment Nighttime >1x/week but
≤2x/month 3-4x/month Often 7x/week
Normal FEV1/FVC: awakenings not nightly
Interference with
8-19a 85 % None Minor limitation Some limitation Extremely limited
normal activity
20-39a 80 % • Normal FEV1 between
exacerbations • FEV1 ≥80 percent
40-59a 75 %
predicted • FEV1 >60 but <80 • FEV1 <60 percent
Lung function • FEV1 >80
60-80a 70 % percent predicted predicted
percent • FEV1/FVC normal
predicted
FACTORES DE RIESGO
CULTIVO O GRAM
POSITIVO
ASPECTO
PURULENTO
TUBO DE
DRENAJE
GLUCOSA LP
Ph < 7.2
< 50 mg/dl
ENFERMEDADES DE LA PLEURA
Etiology CASOS % CASOS %
• CAUSAS
Nontraumatic 138 (72) 34 (46)
TRAUMA TORACICO
Malignant 87 (45) 13 (18)
METASTASIS
HEMOTORAX