Pneumonia diagnosis and treatment

Voiceover: So it's not hard to tell that our buddy here is not feeling so well, right? He's kinda look like he's seen better days. Let's just pretend for a second, we're going to use our imagination to work through diagnosing and treating a pneumonia. Let's say that you're working in a doctor's office, and this guy walks in. I think we should give him a name, let's call him Paul. I just feel like when you give an animation a name somehow it becomes real. Let's say that Paul comes in to see you, and Paul says, "I've been having this cough," so here's his coughs. "I've been having this terrible cough, "and sometimes I bring up something with it." "Sometimes I have some nasty stuff "that comes out of it," so i'm going to draw some sputum there so you can sometimes he's coughing out some mucus, and sometimes it's dry. Then let's say, you know what, he says that "Oh gosh, I can't breathe." "I'm really having a hard time breathing, "and i'm really short of breath." You get this information from Paul, and you start to think to yourself you know what? This sounds a lot like pneumonia. If you suspect that, based off of the information that he's given you based off of these clues and this data, well how do we go about diagnosing pneumonia? That's what we're going to talk about. We're going to talk about diagnosing pneumonia. I'm actually going to make two little lists down here. We're going to have a diagnostic, so diagnostic tests that we can do, check for pneumonia, and labs. By labs I really mean collecting specimens whereas diagnostics would be a procedure, right? Before we get into that, let's just make sure that our brains are ready to talk about pneumonia, so i'm going to come over here, and i'm just going to erase away a pair of lungs. Let's pretend that these are Paul's lungs. What do we know about pneumonia? Remember that pneumonia's a lung infection, right? I have his right, his left lung, I got my trachea here, right? That branches off into my right and to my left bronchus, or main airway. Then that branches off to even smaller airways and even smaller airways, and those are our broncials, and then we can see at the very end of all of this we have these tiny air sacs, and we call those alveoli. I'm going to write that because it's certainly not a term that we see too often. These tiny air sacs, this is actually where all the gas exchange happens. What does that mean? That means that as we're breathing in, and let's make this a nice color blue, so as we're breathing in, I don't think you can see that too well. Let me go for a darker blue. That's better, so as we're breathing in air, right? Breathing breathing breathing, it's going to get all the way to the end, to our alveoli. Well what happens here is that the oxygen is absorbed into our blood system because we've got these tiny capillaries that run beneath our, and around, beneath and around I should say, our alveoli. That oxygen is absorbed into our blood system, and then we actually have an exchange. Then we're going to have some, let me pick a different color. Then we're going to have carbon dioxide being picked up and excreted out. The process is that we breathe in the oxygen, right? We breathe in O2, and we're going to exhale CO2. That happens here; that happens in our alveoli. As you can see, i've painted these green so you can imagine that it's filled with this fluid, and this is infected fluid, and that's infected fluid secondary to an organism that's caused us to be ill. That can either be a virus, that could be a bacteria, that could be a fungus, it could be any organism that can cause disease, and we call that pathogens. The long and short of pneumonia is that it really is an infection of our lung, however the infection is occurring here in our air sacks or alveoli, and that infection causes an inflammatory response that fills up those air sacks with this nasty material. The nasty material's taking up the space where we should have air exchange happening. Now with that said, and his symptoms, you can see that they go hand in hand and it's making sense. This is what lead us to believe he might have pneumonia. Let's talk about some diagnostic tests. The first thing that we can do, now i'm going to abbreviate this. CXR would be a chest x-ray, and a chest x-ray is going to allow us to actually look inside Paul's chest so just like I can see here, right? With the naked eye, I can't see inside of his chest, I can't see his lungs at all, but with a chest x-ray I can actually see inside and i'll be able to visualize his lungs. What we'd be doing is looking for some type of fluid or inflammation in the lungs. Another thing that we can do to visualize would be a CT scan. This is very similar to a chest x-ray, and i'm just going to write this here, a CT scan except the difference is that this is a more detailed visualization of the lungs. An x-ray will give us a black and white image just some dense areas and less dense areas, so like bone and air and fluid as well, whereas a CT scan i'd be able to see tissues. If we wanted to move forward and do some things that were a little bit more invasive, we can do a bronchoscopy. I'm writing these terms because it's not too often that we actually see them, and I think it's important that we get familiar with it if we're going to talk about diagnosing and treating pneumonia. I'm going to show you what a bronchoscopy looks like but first I want to erase this stuff because we already talked about his cough, right? We talked about his [protective] cough, we talked about his symptoms. A bronchoscopy is a procedure where we actually take a thin flexible tube, and this is a device, and we feed this device either through the mouth, so through Paul's mouth, down through his trachea, and into his main airway, or we could do it through the nose as well and end up in the same place. Of course Paul's going to be asleep for this. At the end of this device we have a camera, so i'm going to make this little black dot and that's going to be my camera. What a bronchoscopy is going to allow is that the person on the other end, or in this case it's going to be the physician, is actually going to be able to see inside of the airway. They can tell if there's excess mucus present, if there's a blockage, if there's a tumor, so a bronchoscopy really is the method for us to visualize what's happening in the lungs. A fourth thing we can do which I also say is invasive because it involves actually going inside the body is a bronchoalveolar, talk about a big word, lavage. This is done in the same manner as a bronchosocopy however the difference is instead of us just going in here to look, we're actually going in there to collect, and so instead of this camera, we're actually going to instill some fluids. You see these blue lines? That's normal saline. We're going to instill fluid into the airway, and we're going to then collect that fluid because what's happened is that fluid was able to mix with all the other substances and the content of the airway. We can collect the fluid, and we can test it to see if there's any organisms present. That's going to help us to indicate what's causing this infection. Now if we come down here we can talk a little bit more about labs. Now remember Paul said that he was coughing up some nasty sputum? Well we can actually test that sputum. Here's my sputum. He said that he was coughing up some sputum, and we can actually test that to see what grows. We call that a sputum culture. Another lab that we can do would be to do a blood culture. I'm just making these little red droplets here to indicate blood. Just as we do a sputum culture to check the sputum for organisms, we're going to check the blood for organism. Again, both of these things are going to let us know what exactly is causing the problem. Is it a virus that's causing the problem? Is it a bacteria that's causing a problem? What's the organism that's causing a problem? Just as a side note, viral pneumonia is the most common cause of all pneumonias. Now that we've done these diagnostic tests, and now that we've done these labs, we're actually now ready to treat it, so let's make a treat column. How do we treat it, right? If it's caused by a bacteria, our treatment choice is going to be an antibiotic, so these here are just going to represent some pills. We're going to give an antibiotic medication to Paul to help kill that bacteria. If it's caused by a virus, unfortunately there's no treatment for a viral infection. We're really just treating the symptoms, so that means that we want to keep Paul as comfortable as possible. There are some ways that we can do that. One of the ways we want to treat the symptoms is to promote and to encourage hydration. That means we really want Paul to be drinking as much fluids as possible. There's my glass of water. In addition to keeping him hydrated, drinking a lot of fluids is going to help thin out the secretions. Remember this glob of sputum that I made? Well by increase the amount of fluid that we intake we can actually thin this out and that's a good thing because the thinner it is the easier it's going to be for Paul to cough it out of his airway. Another thing that we can do is we can provide oxygen. I'm going to make a cloud, and this cloud's going to represent oxygen. In cases that pneumonia is severe enough, oxygen absorption can be severely impaired, so it's really important that we can provide supplemental oxygen to make sure the body has the O2 that it needs to function. Then one last thing that I want to add is something that we call CPT. I'm going to come over here and i'm going to write "CPT," and we can make that our number three thing. I'm going to go ahead, i'm going to make these vibration marks next to it. That's what I want you to think of when you hear CPT. Now CPT stands for Chest Physiotherapy. What happens in this case is that a trained professional is actually going to use their hands, and then cup their hands, did I make the right amount of fingers? I hope so. They're going to cup their hands, and they're going to tap on the patient's back and their chest, and you know what this is for? This is actually to help break up the secretions that they have in their airway so that it's easier for the patient to cough it out.