• Pneumonia is a inflammation of parenchyma
of the lung.
• Most case of the pneumonia are caused by
microrgnanisms viral bacterial atypial ,but
there are several noninfections causes,which
include aspiration of food or gastric
acide,foreign bodies,and lipoid
substances;drug or radiation-induced
• 1 pathological Classification:by anatomy
2 etiologial Classification
2) Bacterial pneumonia
6) protozoan pneumonia
• 3.Classification based on course
1)acute pneumonia: the course of illness is less
2) persisting pneumonia: the course is 1-2
3)Chronic pneumonia: the course is over 3
• 4.Classification based on illness condition
• 1) mild case:
mainly involve respiratory system, no
generalized toxic symptoms.
• 2 )severe case:
besides respiratory system, other system
might severely involve, such as supervening
of congestive heart failure, abdominal
distention and intestinal paralysis ,body fluid
• bronchopneumonia is the most common form
of pneumonia in young children. Typical
bronchopneumonia is fever, cough, tachypnea
and dyspnea, fixed moist rales over lung.
• Symptoms and signs
Most cases have acute onset.
1.fever: low-grade fever:37.4-38°C,
Super high-grade fever:beyond41°C
children younger than age 3 years have fever higher
than 38,may have a seizure.febrile convulsion
2.Cough:onset cough is dry but later becomes
breath rate is more than 40-80/min.
Infant:40-45, less than1 years:30-40
nasal ala flap
4.Dyspnea :three depressing sign: suprasternal,
supra- clavircular, and inter-costal space
• 5.rales:auscultation of lungs reveal fixed
moderate or fine moist rales.
* Dry rale,ronchi:
Blood being poorly oxygenated
• Physical examination
1. inspection: tachypnea, 3 depression sign ,cyanosis
2.tactile:abnormal tactile. vocal fremitus
3.percussion:dullness to percussion
4.auscultation: fixed moderate or fine moist rales.
stridor or wheeze, decreased breath sounds.
ronchus which you can heard when children
Congestive heart failure
• 1.tachycardia:heart rate is quicker than
• 2.tachypnea:breath rate is more than
• 3.suddenly extreme restless, obvious
cyanosis, pallor or grey complexion;
• 4.the heart sound decreased, gallop
rhythm, high distention of cervical vein
• 5.liver enlarged rapidly, liver can be palpable
3cm at right subcostal region;
• 6.oliguria,facial edema and edema of lower
• Extrapulmonary findings
Severe cases caused by gram-negative bacillus even
lead to microcirculation dysfunction that looks like
1.neverous system: mild hypoxia may cause agitated,
drowsiness; cerebral edema may cause conscious
disturbance, convulsion, and irregular respiratory
2.digestive system: mild case may present
nausea, vomiting, diarrhea, and abdominal
distention; the severe case may present toxic
paralysis of intestine, bowel sounds disappear.
3.myocarditis: pallor, tachypnea, arrhythmia,
heart sound is low and dull.
1.Empyema:may occur frequently with staphylococcal,
gram-negative bacilii.have high
Tympany on the upper part
Of effusion,dullness on the
3.Pneumatocele:maily caused by staphylococcus
• White blood cell counts will
elevated(﹥15,000/ul),neutrophil count will elevated.
• C reactive protein may increase;
• PaO2 and PaCO2 may change.
• Bacteria test involves blood culture and sputum
• Virus test: rapid test, serum test
• Patchy infiltrate are most
common during infancy
• Hilar adenopathy/hilar
lymph nodes may be
• Pleural effusion
• Lobar consolidation
Patchy infiltrate are most common
• Chest radiographic findings: chest X-ray
Bilateral pneumonia and right sided pleural effusion
Lobar consolidation is not a common finding in
infants and children
,it is occur in older children
Hilar adenopathy/hilar lymph nodes may
• Invasive diagnostic:
transtracheal aspiration,bronchial brushing or
washing, lung puncture, or open or
thoracoscopic lung biopsy.
• Culture of material from the respiratory tract
• 1.Acute bronchtis: cough is the main symptom,
afebrile or low -grade fever ;previously
audible ronchi or moist rales is not audible
after cough or change of position, the unfixed
rales is the characteristics.
2.tuberculosis:low grade fever ,night sweat ,a positive
tuberculin test ,chronic cough, weight loss or failure to
gain weight ,and chest X-ray.
3.Foreign body aspiration:
a history of foreign body, a
choking spell followed by
persistent cough, and
radiograph are diagnostic
tools of it. it leading to
atelectasis or emphysema.
the room should be maintained good
ventilation of air, proper temperature(18-
20℃)and comfortable humidity(60%).
WHO recommends 4 kinds of drug: compound
sulfamethoxazole, penicillin, ampicillin, and
if the etiologic agent is staphylococci, following drugs
are commended : ampicillin, chloramphenicol,
oxacillin,cloxacillin, and gentamycin. Gentamycin is
effective for gram-negative bacillus.
antimicrobial duration of therapy:
In general children with the usual bacterial
pneumonia are treated till 5 to 7 days after
fever declined and 3 days after clinical status
mycoplasma pneumonia is treated for 3 to 4
weeks to avoid recurrence.
Staphylococcal pneumonia total duration of
therapy should be at least 6 weeks.
Anti-virus: clinically used anti-virus include
virazole (ribavirin) and interferon.
Chinese herb: banlan gen, daqing ye and so on.
Duration of therapy is 5 to 7 days.
• 3.symptomatic treatment
1)maintain airway unblocked, (expectorants,
bronchial antispasmodic,) clearing secretion of
upper respiration tract in time.
2)correct body fluid deficit: 50-60ml/kg/d.
3)fever is controlled by antipyretics : aminopyrine,
if hypoxia occurs and is definitely indicated in
the presence of cyanosis. giving oxygen by
nasal catheter (flux 0.5-
1L/min ,concentration<40%)or head box (flux
2-4L/min ,concentration 50-60%)
4.Treatment of heart failure
• Medical palliation of congestive heart failure
has two goats: to decrease oxygen
consumption and improve oxygen deliver to
• Sedation:Luminal, chloral hydrate,( clysis)
• Bed rest
Drug therapy attempts to improve the relationship
between cardiac output and filling pressure.
1) digoxin :It results when the heart can't pump
blood well enough to supply the body's needs. If you
have heart failure, digoxin can improve your heart's
ability to pump blood.
loading dose is dose 20-40 ug/kg, which is
usually given in three divided doses. Initially
one half of the total is given and then one
fourth of the total is given after 4-6 hours and
the remaining one fourth is given after another
Maintenance is 5-10ug/kg/d , usually divided
into two doses and given twice daily.
3).Cardia output can also be improved by decreasing
ventricular afterload. if the systemic vascular
resistance is high, vasodilator particulary shows the
phentolamine is one of the commonly used drugs
of this type.
furosemide is one of the most
patent.1mg/kg,iv.however,diuretics can cause
numerous electrolyte and metabolic problems,
including hypokalemia , hypochloremia,
metabolic alkalosis and urinary calcium loss.
inhaled steroids, prednisone,dexamethason
1) toxic symptom is very severe,
3)brain edema, toxic encephalopathy, infection
shock, breath failure,
4) Pleural effusion case
• Therapy of complication:
1. if the pneumonia is complicated with
emphysema or pyopneumothroax,
thoracentesis for aspiration of purulent
effusion and air should be performed without
• 2.following conditions should be treated
with continuous closed drainage using
intercostal tube placement or thoracotomy:
the younger age ,the presence of
overwhelming toxic symptom, ropy pus,
and repeated aspiration can not expel pus
completely which results in tension
6. Hydration and electrolyte supplementation
7.Fever is controlled by antipyretics,alcohol
sponging is also used.
8.Early chest tube drainage of empyema
fluid due to S aureus