Description
A clinician's approach to Acute Respiratory Distress Syndrome (ARDS) focuses on early identification, including the assessment of risk factors, clinical signs, and imaging, followed by immediate supportive management with oxygen therapy and mechanical ventilation. Treatment aims to address the underlying cause, minimize ventilator-associated lung injury through strategies like low tidal volume ventilation, and manage complications while closely monitoring for improvements in oxygenation and lung function.
Résumé
- Respiratory infections are a significant cause of hospitalization and mortality. Proper diagnosis requires understanding the patient's specific symptoms, distinguishing between upper and lower respiratory tract infections, and differentiating between viral and bacterial etiologies. Fever grade, sputum production, and WBC count are key indicators.
- The CRB-65 score aids in assessing pneumonia severity. Confusion, respiratory rate exceeding 30, blood pressure below 90/60, and age over 65 are factors indicating the need for hospital admission and IV antibiotics. Blood investigations revealing leukocytosis, leukopenia, or thrombocytopenia suggest severe infection.
- Viral infections often present with lower-grade fevers and sore throats, while bacterial infections tend to be more severe with high-grade fever and increased sputum production. Procalcitonin levels can assist in differentiating between viral and bacterial infections when uncertainty exists. Nasopharyngeal swabs should be performed to test for influenza and COVID-19.
- Antibiotic resistance is a major concern. Guidelines for pneumonia recommend starting with macrolides or beta-lactams. Escalation of antibiotics should be guided by culture and sensitivity results. De-escalation should occur when lower-group antibiotics prove effective based on sensitivity.
- Managing respiratory infections in patients with underlying asthma or COPD requires assessing saturation and respiratory rate. Treatment involves antibiotics, bronchodilators, and possibly steroids. Non-invasive ventilation may be needed if saturation is low.
- Key red flags include breathlessness, high respiratory rate, hemoptysis, and copious purulent sputum. Untreated respiratory infections can lead to respiratory failure, multi-organ involvement, and death.
Exemple de certificat
À propos des intervenants
Dr Rupan Bhadury
Consultant, hôpital superspécialisé Medica, Kolkata
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