呼吸系統(tǒng)疾病(英文)共82張課件

時(shí)間反復(fù)無(wú)常，鼓著翅膀飛逝呼吸系統(tǒng)疾病(英文)呼吸系統(tǒng)疾病(英文)時(shí)間反復(fù)無(wú)常，鼓著翅膀飛逝呼吸系統(tǒng)疾病(英文)TopicsRespiratorydisordersRespiratoryinfectionsPneumoniaRespiratoryDisorders50%ofconsultationwithgeneralpractitionersoracuteillnessinyoungchildrenandathirdofconsultationsinolderchildren20-35%ofacutepediatricadmissionstohospital,someofwhicharelife-threateningAsthmaisthemostcommonchronicillnessofchildhoodCysticfibrosisisthemostcommoninheriteddisorderinCaucasianscausingchronicdisease文本解讀，簡(jiǎn)單來(lái)說(shuō)就是對(duì)文人創(chuàng)作的作品進(jìn)行探究，體會(huì)其包含的內(nèi)容及其所表達(dá)的意義。高中語(yǔ)文教學(xué)中，文本解讀就是指教師和學(xué)生對(duì)文本進(jìn)行感知、理解并從中獲得其內(nèi)涵、意義的實(shí)踐過(guò)程。文本解讀對(duì)于啟發(fā)學(xué)生思維、發(fā)揮他們的想象力和創(chuàng)造力具有重要作用。一、高中語(yǔ)文文本解讀存在的問(wèn)題1.答案統(tǒng)一，缺乏獨(dú)到的見(jiàn)解在高中語(yǔ)文教學(xué)活動(dòng)中，很多教師對(duì)于文本解讀缺乏獨(dú)到的見(jiàn)解，沒(méi)有真正的對(duì)其探討，而是單純的依靠參考書(shū)及網(wǎng)絡(luò)搜集的簡(jiǎn)析，缺乏創(chuàng)造性。教師沒(méi)有潛心研究文本的思想內(nèi)涵以及所表達(dá)的現(xiàn)實(shí)意義，而是按照參考書(shū)的簡(jiǎn)析進(jìn)行教學(xué)，這不僅不能提高自身的文化修養(yǎng)，對(duì)學(xué)生也起不到很好的引導(dǎo)作用。學(xué)生在應(yīng)試教育下，缺乏創(chuàng)新和主動(dòng)性，得到的都是千篇一律的答案。這種統(tǒng)一的“標(biāo)準(zhǔn)答案”嚴(yán)重制約了學(xué)生的“天馬行空”，忽略學(xué)生的想象力和創(chuàng)造力。2.文本解讀過(guò)于簡(jiǎn)單高中語(yǔ)文教學(xué)中，文本解讀是非常重要的內(nèi)容，在文本解讀過(guò)程中，教師應(yīng)帶領(lǐng)學(xué)生共同完成。由教師的感悟喚醒學(xué)生的解讀感悟。因此，對(duì)于文本的研究，教師應(yīng)做到細(xì)致、準(zhǔn)確。只有自己完全理解了文中所表達(dá)的各項(xiàng)基本內(nèi)容及其深刻含義才能很好的引導(dǎo)學(xué)生發(fā)揮他們的想象力，分析課文所體現(xiàn)的思想感情等。讓學(xué)生主動(dòng)探求對(duì)文本的理解和感悟。但是，在高中語(yǔ)文教學(xué)中，很多教師對(duì)于文本的解讀過(guò)于簡(jiǎn)單，也沒(méi)有花費(fèi)較多的時(shí)間來(lái)詳細(xì)分析課文。而卻將過(guò)多的時(shí)間用在搜集資料，問(wèn)題設(shè)計(jì)以及研究教學(xué)方法上，忽略了文本解讀的重要性。比如在《雷雨》這篇文章中，參考書(shū)對(duì)于該篇文章的情節(jié)內(nèi)容、周魯兩個(gè)家庭的命運(yùn)以及人物形象都有了詳細(xì)的解讀。但是除了表面的解析，還要更近一步挖掘其人性的復(fù)雜以及其表達(dá)懺悔救贖的主體思想。這就要求語(yǔ)文教師具備一定扎實(shí)的功底，獨(dú)到的見(jiàn)解，帶領(lǐng)學(xué)生進(jìn)行一場(chǎng)別開(kāi)生面的“視聽(tīng)盛宴”，讓學(xué)生真正掌握作者想要表達(dá)的內(nèi)容，想要渲染的氛圍。3.文本解讀缺乏適度性隨著素質(zhì)教育的不斷提倡，對(duì)于各大學(xué)科的教學(xué)也有了新的標(biāo)準(zhǔn)和要求。文本解讀作為高中語(yǔ)文的重要內(nèi)容也越來(lái)越得到重視。但是，很多學(xué)校和教師卻歪曲了提倡文本解讀的最初意義。文本解讀過(guò)于細(xì)化，缺乏適度性，這不但不能起到很好的教學(xué)效果，反而加重了學(xué)生的學(xué)習(xí)負(fù)擔(dān)。很多教師還會(huì)把文本解讀的內(nèi)容引向考綱和考點(diǎn)的內(nèi)容，讓學(xué)生理解文章的內(nèi)容、體會(huì)作者思想感情的美感蕩然無(wú)存。因此，高中語(yǔ)文教師在進(jìn)行文本解讀時(shí)，要把握分寸，抓住重點(diǎn)。4.樹(shù)立正確的文本解讀觀在當(dāng)前的語(yǔ)文教學(xué)中，高中語(yǔ)文教師必須樹(shù)立正確的文本解讀觀，尊重作者的創(chuàng)作意圖，尊重客觀事實(shí)，細(xì)致深入的進(jìn)行文本解讀。作者創(chuàng)作的作品都帶有一定的意圖，同時(shí)也包含著自己的內(nèi)心情感。教師在進(jìn)行文本解讀時(shí)，要尊重客觀事實(shí)，不能歪曲作者的本意，要充分挖掘作者想表達(dá)的思想感情。比如在解讀《故都的秋》一文時(shí)，不僅要考慮作者寫(xiě)文章時(shí)的心情，還要考慮作者當(dāng)時(shí)所處的環(huán)境及其身世遭遇等。這樣，才能完整的展現(xiàn)文章所表達(dá)的內(nèi)容及其思想感情。二、掌握良好的文本解讀方法1.變換視角，整體感知新課標(biāo)理念要求教師在文本解讀過(guò)程中必須要重視培養(yǎng)學(xué)生的整體把握能力，因此，教師在解讀文本時(shí)應(yīng)變換視角，整體感知課文。從整體上把握課文的內(nèi)涵，從不同的角度探究課文體現(xiàn)的意義。首先，從讀者的角度感知文章，以平和的心態(tài)掌握作者的創(chuàng)作意圖及其表達(dá)的美感和內(nèi)涵。其次，從編者的角度分析文章，分析編者為何將其編入教材中，體會(huì)其意圖，避免分析文本的盲目性。然后，要從教師的角度解讀文本，找出文中的重點(diǎn)及引申含義。最后，還要從學(xué)生的角度解讀文本。讓學(xué)生自我推敲、自我分析，教師再加以指導(dǎo)，提高他們學(xué)習(xí)的積極性和主動(dòng)性。2.立足文本，具體理解3.由此及彼，解讀深悟深入探究是教師對(duì)文本理解的重要過(guò)程，也是考察教師基本功的關(guān)鍵環(huán)節(jié)。深入探究文章的中心思想及其隱含的重要意義是教師進(jìn)行文本解讀的最高層次。因此，教師也應(yīng)不斷的提高自身的文化修養(yǎng)，由淺入深，通過(guò)比較、參讀等方式很好的去解讀作品，去參悟內(nèi)涵。三、高中語(yǔ)文教材處理探究要想更好的解析作品，對(duì)于語(yǔ)文教材的處理也要做到以下幾點(diǎn)：1.點(diǎn)與面相結(jié)合所謂的“點(diǎn)”指的是教學(xué)重點(diǎn)，“面”則是文章的基本內(nèi)容。在高中語(yǔ)文教材中，尤其對(duì)于小說(shuō)、戲劇等作品的分析，做到點(diǎn)面結(jié)合，更容易讓學(xué)生掌握其基本意義及其重點(diǎn)內(nèi)容。首先要讓學(xué)生對(duì)文章的情節(jié)有一定的了解，然后再對(duì)精彩語(yǔ)段以及關(guān)鍵內(nèi)容重點(diǎn)講解。比如《紅樓夢(mèng)》是一篇情節(jié)內(nèi)涵復(fù)雜的長(zhǎng)篇小說(shuō)，對(duì)于該篇小說(shuō)，教師在進(jìn)行講解時(shí)，首先要讓學(xué)生了解文章的基本情節(jié)，然后在捋順各種人物之間的關(guān)系。在通過(guò)重點(diǎn)的而環(huán)節(jié)分析來(lái)突出人物的性格特點(diǎn)，容易讓學(xué)生掌握。2.理清思路，抓住基點(diǎn)3.閱讀、創(chuàng)造、評(píng)論一體化在教材的處理上，閱讀、創(chuàng)造、評(píng)論要一體化。首先就要反復(fù)閱讀，不僅要讀通句子，讀出節(jié)奏，還要讀出美感，讀出感情。通過(guò)讓學(xué)生改寫(xiě)文章、演講文章、創(chuàng)作文章等語(yǔ)文活動(dòng)來(lái)啟發(fā)學(xué)生進(jìn)行創(chuàng)造活動(dòng)，加深對(duì)文章的理解。最后評(píng)論文本內(nèi)容，也是最關(guān)鍵的環(huán)節(jié)。學(xué)生對(duì)文章評(píng)論過(guò)程也是深化文本理解的過(guò)程。將三者有效的結(jié)合起來(lái)，就能夠更好的處理教材。綜上所述，高中語(yǔ)文是高中課程的重要學(xué)科，教師在處理教材以及文本解讀的過(guò)程中，必須要做到準(zhǔn)確、細(xì)致，并不斷完善自身的文化修養(yǎng)，帶領(lǐng)學(xué)生進(jìn)入到語(yǔ)文課程的完美“盛宴”中。由于傳統(tǒng)教育思想根深蒂固，許多教師觀念落后，預(yù)見(jiàn)不到信息化對(duì)現(xiàn)代教育發(fā)展的影響。他們認(rèn)為，提高教學(xué)質(zhì)量的唯一途徑就是時(shí)間+汗水，導(dǎo)致了教學(xué)模式陳舊落后，習(xí)慣了傳統(tǒng)的一支粉筆、一張嘴、一塊黑板的課堂教學(xué)，上課不能借助遠(yuǎn)程教育資源調(diào)動(dòng)學(xué)生的積極性，只能在課余布置大量的作業(yè)。學(xué)生的課業(yè)負(fù)擔(dān)過(guò)重并且枯燥無(wú)味，以致學(xué)生越來(lái)越厭學(xué)。還有許多教師認(rèn)為遠(yuǎn)程教育對(duì)農(nóng)村教育不適用，反而耽誤了教學(xué)時(shí)間，致使遠(yuǎn)程教育資源的應(yīng)用推廣難度較大。大部分教師不會(huì)用、不敢用、也不想用遠(yuǎn)程教育設(shè)備，教學(xué)水平低，不適應(yīng)遠(yuǎn)程教育的要求。校本培訓(xùn)流于形式，主要原因是：一是教學(xué)任務(wù)繁重，時(shí)間不好安排；二是教師水平參差不齊，教學(xué)內(nèi)容不好確定；三是培訓(xùn)教師不好配備，有的學(xué)校沒(méi)有一個(gè)人會(huì)用遠(yuǎn)程教育設(shè)備。我認(rèn)為要改變農(nóng)村小學(xué)遠(yuǎn)程教育的現(xiàn)狀，必須長(zhǎng)期堅(jiān)持“五個(gè)到位”。校本培訓(xùn)到位。對(duì)于校長(zhǎng)的培訓(xùn)主要是思想上的培訓(xùn)，讓他們轉(zhuǎn)變觀念，重視遠(yuǎn)程教育工作，同時(shí)加大對(duì)校長(zhǎng)的考核力度。對(duì)于網(wǎng)絡(luò)管理人員的培訓(xùn)主要讓他們掌握計(jì)算機(jī)基礎(chǔ)知識(shí)和多媒體技術(shù)，計(jì)算機(jī)網(wǎng)絡(luò)的發(fā)展、分類(lèi)及應(yīng)用、國(guó)內(nèi)國(guó)際網(wǎng)、教育資源網(wǎng)的接入、發(fā)送電子郵件、查詢信息、獲取網(wǎng)上資源及網(wǎng)絡(luò)維護(hù)。對(duì)于光盤(pán)播放點(diǎn)人員培訓(xùn)主要培訓(xùn)他們掌握設(shè)備的使用、維護(hù)、播放的方法等。對(duì)于骨干教師培訓(xùn)主要讓他們了解計(jì)算機(jī)輔助教學(xué)理論，能選擇與評(píng)估計(jì)算機(jī)輔助教學(xué)軟件，能編寫(xiě)計(jì)算機(jī)輔助教學(xué)軟件腳本，并應(yīng)用制作簡(jiǎn)單的軟件能輔導(dǎo)其他教師在教學(xué)中使用計(jì)算機(jī)。對(duì)于學(xué)科教師的培訓(xùn)，重點(diǎn)是教師應(yīng)用現(xiàn)代教育技術(shù)將教育資源融入到學(xué)科教學(xué)中。管理措施到位。要加強(qiáng)領(lǐng)導(dǎo)，周密安排，確保遠(yuǎn)程教育項(xiàng)目的順利實(shí)施，學(xué)校在制定工作計(jì)劃時(shí)，把遠(yuǎn)程教育工作納入學(xué)校整體工作量化考核中，作為年終考核內(nèi)容之一。要加強(qiáng)制度建設(shè)，建立健全各項(xiàng)制度。要加強(qiáng)考核力度，做到有獎(jiǎng)有懲。收集整理到位。學(xué)校的收集整理是很重要的一環(huán)，除了要保證按時(shí)接收，按時(shí)分類(lèi)整理之外，可采取以下幾種途徑來(lái)保存資源，進(jìn)行全程應(yīng)用。硬盤(pán)保存資源，學(xué)?？少?gòu)置幾個(gè)容量較多的硬盤(pán)作為資源庫(kù)的儲(chǔ)藏庫(kù)，對(duì)一些需要保存得較久的，有利于連續(xù)應(yīng)用的資源存在這一個(gè)硬盤(pán)內(nèi)，這樣，資源也不會(huì)丟失，硬盤(pán)每隔三個(gè)又可以重新利用。光盤(pán)保存資源，對(duì)一些適用于課堂教學(xué)的資源或?yàn)檗r(nóng)服務(wù)的資源，教學(xué)有用的課堂實(shí)錄，教學(xué)輔導(dǎo)等內(nèi)容可刻錄成光盤(pán)進(jìn)行有效利用。紙質(zhì)保存資源，如一些習(xí)題，參考資料，可打印成冊(cè)，建立分類(lèi)檔案，供老師們借閱參考。一期結(jié)束后，可將一期的資源進(jìn)行篩選、分類(lèi)、歸檔、整理，建立相應(yīng)的保存方法，形成一套完整的可利用資源。資源應(yīng)用到位。對(duì)遠(yuǎn)教資源的利用，不僅僅是收集、整理，更主要的是讓其走進(jìn)課堂，服務(wù)教學(xué)。通過(guò)遠(yuǎn)教播放設(shè)備，讓學(xué)生觀看優(yōu)質(zhì)課、示范課，達(dá)到師生共同學(xué)習(xí)名師名校教學(xué)方法的效果；充分利用空中課堂實(shí)錄，讓學(xué)生享受優(yōu)秀教師的教育教學(xué)指導(dǎo)。教育研究到位。應(yīng)用遠(yuǎn)教資源與學(xué)科整合，加快教改步伐。讓遠(yuǎn)教資源走進(jìn)課堂、面向?qū)W生、用于教學(xué)并與學(xué)科教育整合，加快教改步伐。推動(dòng)廣大教師運(yùn)用遠(yuǎn)教資源上獲取的先進(jìn)的信息技術(shù)教育手段應(yīng)于到課堂教學(xué)中去，積極推進(jìn)多樣化的教育技術(shù)手段與新型教學(xué)方式在教育教學(xué)過(guò)程中的應(yīng)用，逐步實(shí)現(xiàn)教學(xué)內(nèi)容的呈現(xiàn)方式、學(xué)生的學(xué)習(xí)自主式、教師的教學(xué)方式的變革，實(shí)現(xiàn)農(nóng)村中小學(xué)教育質(zhì)量的整體提高，促進(jìn)學(xué)生的全面發(fā)展。利用遠(yuǎn)教資源舉辦的各種公開(kāi)課教學(xué)，播放專家對(duì)課程改革實(shí)驗(yàn)工作的討論及從衛(wèi)星教育平臺(tái)，教育網(wǎng)站刻錄的教研教改、課程改革的信息資源，使廣大教師，特別是課程改革實(shí)驗(yàn)教師對(duì)新課程體系、新課程標(biāo)準(zhǔn)、實(shí)驗(yàn)教材的教法和學(xué)法，有全面的理解和掌握。教育行政部門(mén)要整合教研、電教、技術(shù)裝備等方面的力量，擬定出教改項(xiàng)目和課題，進(jìn)行現(xiàn)代遠(yuǎn)程教育條件下教與學(xué)的研究。通過(guò)觀摩教學(xué)、專題培訓(xùn)、優(yōu)質(zhì)電教課評(píng)比、課件制作競(jìng)賽等多種形式，推廣好的經(jīng)驗(yàn)與做法。通過(guò)學(xué)習(xí)交流和課題研究推動(dòng)學(xué)校的信息化進(jìn)程，擴(kuò)大遠(yuǎn)程教育的應(yīng)用范圍，推動(dòng)農(nóng)村中小學(xué)的教育跨越式發(fā)展。針對(duì)“兩種模式”的特點(diǎn)，加強(qiáng)資源的合理應(yīng)用。農(nóng)村遠(yuǎn)程教育的現(xiàn)狀不容樂(lè)觀，要徹底改變農(nóng)村遠(yuǎn)程教育的現(xiàn)狀還任重而道遠(yuǎn)。馬彥榮，教師，現(xiàn)居甘肅會(huì)寧。時(shí)間反復(fù)無(wú)常，鼓著翅膀飛逝呼吸系統(tǒng)疾病(英文)呼吸系統(tǒng)疾病(TopicsRespiratorydisordersRespiratoryinfectionsPneumoniaTopicsRespiratorydisorders呼吸系統(tǒng)疾病(英文)共82張課件呼吸系統(tǒng)疾病(英文)共82張課件呼吸系統(tǒng)疾病(英文)共82張課件呼吸系統(tǒng)疾病(英文)共82張課件Case-1Jack,agefourmonths,issentathomebyhisgeneralpractitionerbecauseoftwodaysofrapid,labouredbreathingandpoorfeeding.Hewasbornat27weeks’gestation,birthweight979gandwasdischargedhomeatthreemonthsofage.Onexaminationhewasafeverof37.4Candarespiratoryrateof60breaths/min.Hischestishyperinflatedwithmarkedintercoatalrecession.Onauscultationtherearegeneralizedfinecracklesandwheezes.Case-1QuestionDoyouhaveanycommentsorwhatdoyouconcludeanythingfromthiscase?QuestionDoyouhaveanycommenCase-1Jack,agefourmonths,issentathomebyhisgeneralpractitionerbecauseoftwodaysofrapid,labouredbreathingandpoorfeeding.Hewasbornat27weeks’gestation,birthweight979gandwasdischargedhomeatthreemonthsofage.Onexaminationhewasafeverof37.4Candarespiratoryrateof60breaths/min.

Hischestishyperinflatedwithmarkedintercoatalrecession.Onauscultationtherearegeneralizedfinecracklesandwheezes.Case-1QuestionWhatispneumonia?

QuestionWhatispneumonia?Pneumoniaisaninflammationoftheparenchymaofthelungs.

DefinitionPneumoniaisaninflammationoQuestionHowabouttheprevalenceofpneumonia?QuestionHowabouttheprevalenPneumoniaaccountsforapproximately15%ofallrespiratorytractinfections.Worldwide,about3millionchildrendieeachyearfrompneumonia,withthemajorityofthesedeathsoccurringindevelopingcountries.PneumoniaremainsthemostcommoncauseofmorbidityinChina.IncidencePneumoniaaccountsforapproxQuestionHowtoclassifypneumoniainclinic?QuestionHowtoclassifypneumAnatomyPathogensSeverityDurationOnsetsiteClassificationAnatomyClassificationBronchopneumoniaLobarorLobularPneumoniaInterstitialPneumoniaBasedonanatomyorX-raymanifestation

BronchopneumoniaBasedonanatBasedonetiologyBacterialpneumoniaViralPneumoniaMycoplasmaPneumoniaChlamydia

PneumoniaBasedonetiologyBacterialpnAcutePneumoniaProlongedPneumoniaChronicPneumoniaBasedontheprocessofpneumoniaAcutePneumoniaBasedonthepMildPneumoniaSeverePneumoniaBasedontheseverityofpneumoniaMildPneumoniaBasedontheseCommunityAcquiredPneumonia(CAP)HospitalAcquiredPneumonia(HAP)BasedontheonsetsiteofpneumoniaCommunityAcquiredPneumoniaBronchopneumoniaBronchopneumoniaQuestionWhyarechildrenlikelyhavebronchopneumonia?QuestionWhyarechildrenlikelCharactersofchildhoodairwayanatomicstructureandtheirrespiratoryphysiologyImmunefunctionofchildhoodHighriskfactors:prematurebaby,underlyingdisorders呼吸系統(tǒng)疾病(英文)共82張課件QuestionWhatcausebronchopneumonia?

QuestionWhatcausebronchopne?Bacteria:Streptococcuspneumoniae,Haemophilusinfluenzae?Viruses?MycoplasmaCausesofBronchopneumonia?Bacteria:StreptococcuspnePathologyofPneumoniaPathologyofPneumoniaInflammaoryexudateInflammaoryexudatePathologyofPneumoniaInflammaoryexudateInflammaorQuestionWhatarethepathophysiologyofpneumonia?QuestionWhatarethepathophysPathogensURTIBronchitisPneumoniaInflammatoryexudateObstructionofairwayGasexchangeabnormalVentilationabnormalhypoxemiahypercapniatoxinemiatachypneacyanosisralesfevercoughPathogensURTIBronchitisPneumonQuestionWhatarethesignsandsymptomsofpneumonia?

QuestionWhatarethesignsandTheclinical

signsandsymptomsofpneumoniadependprimarilyonthe

age

ofthepatient,the

causativeorganism,andthe

severity

ofthedisease.TheclinicalsignsandsymptomFeverCoughCyanosisTachypeneaRalesFeverCoughCyanosisTachypeneaRaout

breathinginWithinspiration,thesideofthenostrilsflaresoutwardsNasalFlaringoutbreathingWithinspiration,thelowerchestwallmovesinLowerChestWallIndrawingout

breathinginWithinspiration,thelowerchFeverCoughCyanosisTachypeneaRalesFeverCoughCyanosisTachypeneaRaClassicfindingsofpneumoniathatoccurinadultsandolderchildren,suchas

fever,coughandrales,

areoften

absent

ininfants

andtoddlers.Generallypresentwith

nonspecific

signsand

symptomsincluding

lethargy,irritability,

poorfeeding,

vomiting.Ifitappearrespiratoryfailureorotherabnormalityofothersystem-severepneumonia.

ImportantPointsClassicfindingsofpneumoniaComplicationsEmpyemaPyopneumothoraxPneumatoceleLungabscessesAtelectasisComplicationsEmpyemaLaboratoryExamination

WhitebloodcellcountandC-reactionprotein

Pathogensexamination:1)Sputumcultures2)Bloodcultures3)RapidscreeningtestsforvirusorbacterialBronchoscopyBloodgasanalysis:hypoxiaand/orhypercapniaLaboratoryExaminationWhiteRadiographEvaluation

TypicalX-raymanifestationofbronchopneumoniaispatchyinfiltratesbilaterallyComplication:lungabscesses,empyema,pyopneumothorax,pneumatocele,atelectasisCT

RadiographEvaluationTypicalNormalchestX-rayNormalchestX-rayPatchyinfiltratesPatchyinfiltratesLobarpneumoniaoftherightlowerzone

consolidationLobarpneumoniaoftherightllungabscesseslungabscessespyopneumothoraxpyopneumothoraxQuestionHowtodiagnosispneumoniaclinically?QuestionHowtodiagnosispneumAccordingtothetypicalclinicalmanifestationofbronchopneumonia.AccordingtoX-raymanifestation

PayattentiontotheatypicalmanifestationofinfantsEvaluatetheseverityofpneumoniaFindtheetiologyofpneumoniaAccordingtothetypicalclinDifferentialDiagnosis

BronchitisForeignBodyInspirationTuberculosisDifferentialDiagnosisBronchQuestionHowispneumoniatreated?

QuestionHowispneumoniatreatManagementSupportivecareAntimicrobialstherapyHospitalizationinselectedcases

ManagementSupportivecareSupportiveCareAdolescents.Respiratorycaremayrangefromoxygenation,

bronchodilatorsforwheezing,humidificationormist,suctioning,andposturaldrainage,intubationandmechanicalventilation.Hydration(sometimesintravenous)

ControloffeverManagementofcomplicationsSupportiveCareAdolescents.AntimicrobialTherapy

Adolescents.OrganismAntimicrobialS.pneumoniae

Penicillin(ifnotresistant).third-generationcephalosporine.g.cefotaxime\ceftriaxone(ifresistanttopenicillin)H.influenzae

AzithromycinorAmoxicillin(ifnotresistant)Betalactamase

Cefuroximeorthird-generationcephalosporin(ifbetalactamaseandresistant)S.aureusMethicillin(ifnotresistant)Vancomycin(ifMRSA-methicillinresistantS.aureus)ifpenicillinallergy:vancomycin,clindamycin

Chlamydia

Azithromycin(othermacrolidese.gerythromycin);alternative,sulfadrugs

MycoplasmaAzithromycin(othermacrolides);alternative,tetracycline(ifolderthan8years)

RSV

Ribavirin(optional)InfluenzaAmantadine(ifsevere)BacteriaAtypicalVirusesAntimicrobialTherapyAdolesceAgeGroup

Bacterial

Viral

EmpiricTherapyNeonate(0-28days)GroupBstreptococcus,gram-negativeentericE.coli,Klebsiella,Listeriamonocytogenes,S.aureus,othergram-positive)CytomegalovirusHerpessimplexAmpicillinandaminoglycoside(gentamicinortobramycinoramikacin,orthird-generationcephalosporin).Note:Avoidceftriaxone2°tobilirubin

Infants3-16weeks;afebrilepneumoniainfancy

ChlamydiatrachomatisUreaplasmaurealyticumCytomegalovirusPneumocystiscariniiErythromycinSulfonamideInfantsfebrileorillappearingage1-3monthsSameorganismsasforneonateplusS.pneumoniae,H.influenzae,S.aureusNotapplicableAntibiotic(nafcillin,oxacillin,ormethacillin)Broad-spectrumcephalosporin(e.g.,cefotaxime)ToddlerorpreschoolageS.pneumoniae,H.influenzaeM.pneumoniae,ChlamydiaRSVParainfluenzaAdenovirusInfluenzaAzithromycin

Amoxacillin-clavulanate:notactiveagainstatypicalorganisms(Mycoplasma,Chlamydia)OrganismsCausingPneumoniaandEmpiricTherapyinPediatric

AgeGroup

Bacterial

Viral

EmpiQuestionHowabouttheclinicalcourseofpneumonia?QuestionHowabouttheclinicalWithtreatment,pneumoniacausedbybacteriacanusuallybecuredin1or2weeksPneumoniacausedbyavirusoftenlastslongerClinicalCourseAdolescents.ClinicalCourseAdolescents.SpecificPneumoniasSpecificPneumoniasBrochiolitisBrochiolitisisthemostcommonseriousrespiratoryinfectionofinfancyTwotothreepercentofallinfantsareadmittedtohospitalwiththediseaseeachyearduringannualwinterepidemics.Ninetypercentareaged1-9monthsbronchiolitisisrareafteroneyearold.Respiratorysyncytialvirus(RSV)isthepathogenin75-80%casesBrochiolitisBrochiolitisistClinicalFeatures

Coryzalsymptomsprecedeadrycoughandincreasingbreathlessness.Wheezingisoftenbutnotalwayspresent.Feedingdifficultiesassociatedwithincreasingdyspnoeaareoftenthereasonforadmissiontohospital.Recurrentapnoeaisaseriouscomplicationininfantsinthefirstfewmonthsoflife.Infantsbornprematurelywhodevelopbronchopulmonarydysplasiaandinfantswithcongenitalheartdiseasearemoreseverelyaffected.Thefindingonexaminationarecharacteristic:

Sharp,drycoughTachypnoeaSubcostalandintercostalsrecessionHyperinflationofthechest

ClinicalFeaturesCoryzalsInvestigationsRSVcanbeidentifiedrapidlyusingafluorescentantibodytestonnasopharyngealsecretions.ThechestX-rayshowshyperinflationofthelungsduetosmallairwaysobstructionandairtrapping.Bloodgasanalysis,whichisrequiredinonlythemostseverecases,showsloweredarterialoxygenandraisedCO2tension

InvestigationsRSVcanbeideHyperinflationofthelungswithflatteningofdiaphragmHyperinflationofthelungswiManagementIssupportive.Humidifiedoxygenisdeliveredintoahead-boxMist,antibioticsandsteroidsarenothelpfulNebulisedbronchodialatorsdonotreducetheseverityordurationoftheillnessTheantiviraldrugribavirinonlymarginallyshortensviralexcretionandclinicalsymptoms,andshouldbeconsideredonlyforinfantswithunderlyingcardiopulmonarydisordersorimmunodeficiencyFluidsmayneedtobegivenbynasogastrictubeorintravenouslyMechanicalventilationisrequiredinabout2%ofinfantsadmittedtohospitalManagementIssupportive.HuEtiology：Respiratorysyncytialvirus(RSV)isthepathogenin75-80%casesClinicalfeatures:Age:3-6monthSeasonWheezingX-rayDuration:7-10daysManagement:

BronchiolitisEtiology：RespiratorysyncytiaStaphylococcusaureus

.

S.aureusisanuncommonbutimportantcauseofpneumoniathatcanoccurinanyagegroup.

S.aureusisarapidlyprogressivefulminantillnessS.aureuspneumoniaeasilyoccurscomplications.Bloodculturesarepositivein20-30%ofpatients.Thepleuraleffusionsshouldbedrainedbythoracentesisor,iflarge,byachesttube.

Pneumatocelesarealsocommonandarefoundin45-60%ofpatientswithS.aureuspneumonia.

Methicillinorvancomycinshouldbeadministeredfor3-4weeks.

Staphylococcusaureus.S.MycoplasmaPneumoniaMpneumoniaeisacommoncauseofsymptomaticpneumoniainolderchildren.Endemicandepidemicinfectioncanoccur.Theincubationperiodislong(2-3weeks),andtheonsetofsymptomsisslow.Althoughthelungistheprimaryinfectionsite,extrapulmonarycomplicationssometimesoccur.MycoplasmaPneumoniaMpneumoClinicalFeatures

Fever,cough,headache,andmalaisearecommonsymptomsastheillnessevolves.Ralesarefrequentlypresentonchestexamination,decreasedbreathsoundsordullnesstopercussionovertheinvolvedareamaybepresent.

ClinicalFeaturesFever,coLaboratoryfindings

Thetotalanddifferentialwhitebloodcellcountsareusuallynormal.Thecoldhemagglutinintitiershouldbedetermined,becauseitmaybeelevatedduringtheacutepresentation.Atiterof1:64orhighersupportsthediagnosis.

LaboratoryfindingsThetotaImagingChestx-raysusuallydemonstrateintersititialorbronchopneumonicinfiltrates,frequentlyinthemiddleorlowerlobes.Pleuraleffusionsareextremelyuncommon.ImagingChestx-raysusuallydComplicationsExtrapulmonaryinvolvementoftheblood,CNS,skin,heart,orjointscanoccurDirectCoombs-positiveautoimmunehemolyticanemia,CoagulationdefectsandthrombocytopeniacanalsooccurAwidevarietyofskinrashesincludingerythemamultiformaandStevens-JohnsonsyndromeComplicationsExtrapulmonaryTreatmentAntibiotictherapywitherythromycinfor7-10daysusuallyshortensthecourseofillness.Supportivemeasures,includinghydration,antipyretics,andbedrest,arehelpful.TreatmentAntibiotictherapChlamydialPneumoniaPulmonarydiseaseduetoCtrachomatisusuallyevolvesgraduallyastheinfectiondescendstherespiratorytract.Infantsmayappearquitewelldespitethepresenceofsignificantpulmonaryillness.Appropriateage:2-12weeksInclusionconjunctivitis,eosinophilia,andelevatedimmunoglobulinscan

beseen.ChlamydialPneumoniaPulmonarClinicalFeatures

About50%ofpatientswithchlamydialpneumoniahaveactiveinclusionconjunctivitisorahistoryofitRhinopharyngitiswithnasaldischargeorotitismediamayhaveoccurredormaybycurrentlypresentCoughisusuallypresent.ItcanhaveastaccatocharacterandresemblethecoughofpertussisTheinfantisusuallytachypenic.Scatteredinspiraotrtralesarecommonlyheard,butwheezesrarelySignificantfeversuggestsadifferentoradditionaldiagnosisClinicalFeaturesAbout50%LaboratoryfindingsAlthoughpatientsmayfrequentlybehypoxemic,CO2retentionisnotcommon.Peripheralbloodeosinphiliahasbeenobservedinabout75%ofpatients.Serumimmunloglobulinsareusuallyabnormal.IgMisvirtuallyalwayselevated,IgGishighinmany,andIgAislessfrequentlyabnormal.Ctrachomatiscanusuallybeidentifiedinnasopharyngealwashingsusingfluorescentantibodyorculturetechniques.LaboratoryfindingsAlthoughImagingChestx-raysusuallyrevealdiffuseinterstitialandpatchyalveolarinfiltrates,peribronchialthickening,orfocalconsolidation.Asmallpleuralreactioncanbepresent.Despitetheusualabsenceofwheezes,hyperexpansioniscommonlypresent.ImagingChestx-raysusuallyrTreatmentErythromycinorsulfisoxazoletherapyshouldbeadministeredfor14days.Oxygentherapymayberequiredforprolongedperiodsinsomepatients.TreatmentErythromycinorsSummaryPneumoniainpediatricpatientsencompassesawidespectrumofetiologiesandillnessfrommildtosevereandlifethreatening.Therapyshouldincludeanantibioticifabacteriaoratypicalbacteria(chlamydiaormycoplasma)issuspected.Noantibioticsarenecessaryforviralpneumonia.Supp