Pneumonia

1 yr old presents with fever cough and Breathlessness of 3 days duration.  He receivd antibiotics prior to admission

He had a furuncle 2 wk ago

He is immunized for age

He weighs 7.8kg and length of 72 cm

No h/o foreign body aspiration

He has lethargy seizures or vomiting

No failure to thrive ,recurrent respiratory infections

Rr 59/Mt,retraction lower chest,spo2 94%

Grunt+ already nasi prominent

Apex 4th ics,liver 2 cm below costal margin

What is likely possibility?

Fever cough and Breathlessness makes a respiratory infection likely

Tachypnea ,retractions andngrunt suggest along parenchymal disease

No general danger signs ,no malnutrition

So pneumonia

What is the severity?

List 4 d/d

Bronchiolitis

Younger child  infancy,h/o auri,tachypnea,mild fever,chest hyperinflation,b/l wheeze,family member with viral infection 😅

Foreign body

children when start mouthing can have fb aspiration. Fsudden onset Breathlessness is a feature .lack of fever auri support it. Investigations like xraty are relevant with this d/d

Congenital heart disease

Left to right shunts can present with pneumonia. Failure to thrive recurrent infections. They may have abnormal pulse ,precordium or Apex with abnormal heart sounds and murmur

Pleural effusion pneumothorax

They may start with similar symptoms but progress aggressively (staph) or fail to resolve (pulmonary tb). So ask for contact with TB  or  big pustules or scabies or measles like 🤒illness in the child

Severely malnourished  child with pneumonia could well be pneumocystis jiroveci infections

which points in history are important?

Onset

associated auri

Progression

Age

Preexisting illness gerd cerebral palsy

Similar illness

Contact tb

tobacco smoke exposure

h/o asthma

immunosuppressive therapy

What are the findings and justification?

tachypnea

lower chest retractions

grunt

alae nasi prominent

Accessory muscle like scalenes sternocleidomastoid

sub costal retractions

Dull percussion note

Chest  bronchial breath sounds may be heard

Crackles

harsh breath sounds

diminished breath sounds

What is the initial treatment?

Baby does not respond after 48 hours

What you do?

Check for complication like wmyema,localized effusion

What is the 2nd line 🤔?

After having ruled out complications 3rd generation cephalosporin like ceftriaxone to be started

When will you suspect staph pneumonia?

How do you classify pneumonia now?

How do you treat staph pneumonia?