Lung Consolidation 2018-01-30T16:38:20+00:00

Relevant physical signs

  • General
    • Productive cough
    • May not look well
    • Signs of respiratory distress
    • May be warm if vasodilated and having a fever
    • Sinus tachycardia or atrial fibrillation secondary to sepsis
    • Mucous membranes may be dry in hypovolaemic states
  • Chest
    • Decreased chest expansion on the affected side
    • Dull percussion note
    • Bronchial breathing on the affected side
    • May have coarse crepitations
    • Increased vocal resonance on the affected side

Differential diagnosis

  • Consolidation
  • Underlying malignancy
  • Bronchiectasis
  • Pulmonary fibrosis (would expect crepitations to be fine_
  • Pulmonary oedema (if bilateral)

Investigations

  • Arterial blood gas, full blood count, renal function
  • Chest radiograph to look for consolidation
  • Sputum culture and Gram stain
    • CAP: S. pneumoniae, H. influenzae, S. aureus, Klebsiella
    • Atypical CAP: Legionella, mycoplasma, Chlamydia, Coxiella
    • HAP: Klebsiella, E. coli, Pseudomonas, Acinetobacter, S. aureus, fungi

Management

  • Basic resuscitative measures: oxygen supplementation, fluid resuscitation
  • Early institution of broad-spectrum antibiotics: Augmentin/ceftriaxone + azithromycin for CAP
  • Tazocin for HAP
  • Consider invasive ventilation if deteriorating clinically

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