Today we reviewed the issue of tachypnoea in adults and looked at the USS protocol for lungs to help diagnose the cause of tachypnoea.
Key resources to review include Rosens chapter on Dyspnoea and an uss online atlas to help with lung USS such as radiopedia.
Key dichotomy in tachypnoea is respiratory vs non respiratory causes.
non lung causes include :
cns - ich
cvs - heart failure
toxicological -salicylates eg
metabolic - acidosis / DKA
LUNG USS key points
A profile - means lung is aerated - asthma and cold and pe still possible
A' profile - A lines but no lung sliding - pneumothorax, pleurodesis or fibrosis with loss of volume are main dd.
B profile - fluid in interstitial space - usually pulmonary oedema
A/B profile - focal areas with fluid accumulated suggests pneumonia
C profile - fluid in alveolus - consolidated lung - usually pneumonia
Check out the webinar online / to stream to review in detail
We completed a thorough review of the CXR interpretation in pneumonia and highlighted the following key points for ED practice:
ED Physicians will usually not know the cause of the pneumonia during acute assessment and subsequent admission.
Epidemiological risk stratification is therefore vital to guide empiric antibiotic choice.
Imaging, CT, lab tests usually will not identify the type of organism causing the illness.
Severity assessment is important to predict need for ICU care and guide initial abs choice.
CAP in immunocompetent patients with no other significant comorbidities is likely to be caused by viruses including rev and influenza. The key bacterial causes include
strep / haemophilus / moraxella / mycoplasma / chlamydia trachomatis
alcoholic / diabetic patients - add klebsiella
immunodeficient / hiv patients - staph / p jerovecii / tb
cohorts near water sources - legionella
AIDS or cell mediated immunity deficient - viral pneumonia herpes and cmv
PSI / smart cop / curb 65 - know the components of scoring and what the scores identify
A good review of subject in Rosens and also UpToDate.