X Ray can be normal in Pneumonia
A Chest X-ray can be normal in the first 24 hours of pneumonia, said Padma Shri & Dr. B C Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.
By: HEART CARE FOUNDATION OF INDIA
Pneumonia can be community-acquired or hospital-acquired. Community acquired pneumonia is pneumonia that is acquired in the community in a person without a history of contact with a patient or a health care worker and can be treated by simple antibiotics.
But if a person develops pneumonia in 48 hours after getting admitted to hospital or after 48 hours of endotracheal intubation it is called hospital acquired pneumonia. This pneumonia needs treatment with combination of costly antibiotics.
HCAP is healthcare-associated pneumonia that occurs in a non hospitalized patient but with extensive healthcare contact. Public must avoid visits to the hospitals to avoid this as once the pneumonia develops, it requires costly and aggressive antibiotics.
One should suspect HCAP if the patient in the last one month has received any intravenous therapy; has been going to a doctor for a wound care; has received intravenous chemotherapy;
Uncomplicated community-acquired pneumonia (CAP) can be treated in a clinic as it has low mortality but patients with CAP who require admission have 37% mortality.
High-risk community-acquired pneumonia patients can be remembered by the formula CURB 65
C stands for confusion (anoxia)
U stands for Urea more than 20 (pre renal azotemia)
R stands for respiratory rate more than 30 per minute (due to oox oxygen)
B stands for low blood pressure systolic less than 90 and diastolic less than 60 (due to CO2 retention)
Any patient of community-acquired pneumonia who does not respond within 72 hours should be treated as high-risk patient. Pneumonia patients have low mortality if they have received pneumonia/flu vaccination in the past.
For community-acquired pneumonia treatment, one can treat only on the basis of clinical features and a chest X-ray. But in healthcare-associated pneumonia, sputum culture examination is required.
Do not treat X-ray, breathlessness or cough as they may persist for a long period of time after treatment.
Cough in pneumonia may last for a week and X ray may take four weeks to clear in normal individuals and 12 weeks in the elderly.
Repeat X ray after one week of discharge is not necessary. However follow up X ray is required at 8 to 12 weeks to document resolution of pneumonia and to exclude underlying malignancy.
For simple health care associated pneumonia where multi drug resistance is not suspected: Treat with IV 2 g of ceftriaxone or Levofloxacin 750 mg daily or ampicillin sulbactam 3 g intravenous every six hours. The best bet is to give 750 mg Levofloxacin every day.
About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 71933 people since 1st November 2012.
The CPR 10 Mantra is – “Within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”
Dr K K Aggarwal