Pneumonia cases

RE: Pneumonia cases

Anthony Todd — Thu, 08 Nov 2018 10:11:07 GMT

[quote user="Alistair Graham-Evans"]Also sometimes common sense seems inversely related to intelligence.[/quote]

But when the report forms are a mixed sheet of values without any rating for "criticality", which is where medicine differs ffrom aviation, errors are much more likely.

I hope vet. labs soon have a look at report design to highlight and emphasis life-threatening measurements or values.

Easy to miss a critical value in a long list read out over a dodgy phone line in a noisy environment!!

RE: Pneumonia cases

Gillian Mostyn — Thu, 08 Nov 2018 07:34:07 GMT

[quote user="Alistair Graham-Evans"]Unfortunately the quality of medical care is a lottery, dependent on geography, personnel and facilities. Also sometimes common sense seems inversely related to intelligence.[/quote]

Same as veterinary medicine then.

RE: Pneumonia cases

Alistair Graham-Evans — Wed, 07 Nov 2018 23:21:35 GMT

Many years ago I got mycoplasmal pneumonia in the UK which is surprisingly common in young people.

My GP sent me for a chest X-ray when my flu signs were not resolving - I asked to see it at the time it was taken and was told it was none of my business - despite me pointing out that it was my chest. The protocol involved a long convoluted reporting process and my GP got the results 4 days later.

Meanwhile a day or two after the X-rays I was admitted to hospital as a cyanotic emergency ( self-diagnosis)

In this case common sense failed - if I were the radiographer and seen total consolidation of one lung ( ie appearance of liver) I would have taken a minute out of my schedule to phone the GP to enable appropriate action.

Unfortunately the quality of medical care is a lottery, dependent on geography, personnel and facilities. Also sometimes common sense seems inversely related to intelligence.

RE: Pneumonia cases

David Mills — Wed, 07 Nov 2018 22:27:22 GMT

Whilst the OPs story is unfortunate, and I've heard similar, it has to be appreciated against the wider picture, and whether we would prefer abx being dished out if there was a risk (define that, and the cut off level) of it being pneumonia (plenty of them are viral, as it goes). I don't know the answer, but with any system of pharmacovigilance there will be those that miss out or are 'harmed' - this however does not mean the whole system is wrong or there is someone to blame (misdiagnosis is not negligence).

RE: Pneumonia cases

Kate Richardson — Wed, 07 Nov 2018 22:00:31 GMT

@Jo Dyer jeez that’s just horrible and so so sad Much as I hate to attribute blame I sincerely hope lessons have been learned and compensation applied.

Also scary as I had pneumonia a couple of years ago. How horribly sad for her family and children and you all

RE: Pneumonia cases

Beats — Wed, 07 Nov 2018 19:33:03 GMT

[quote user="Beats"]Any details? Presumably the antigens/antibodies being tested for are pretty limited?[/quote]

Not AB/AG but C-reactive protein:https://www.nice.org.uk/news/article/simple-blood-test-for-pneumonia-can-help-limit-use-of-antibiotics

Thanks.

This is though assessing whether significant systemic inflammation is present, i.e. severity, rather than strictly whether bacterial or viral. Obviously I agree that is useful and fulfils the stated aim, apologies for the pedantry.

My Irish wolfhound with presumed pneumonia the other week had a very high CRP also.

Things have moved on a lot since ReactivLab [bought out by Avacta in the end I think it was] first started doing APP testing for dogs/cats/horses etc and it is now well commercialised. I'll admit to using an external lab (Idexx usally) for this, but can do in-house also if you wish: https://www.idexx.eu/serbia/products--solutions/in-house-diagnostics/in-house-diagnostic-parameters/crp---c-reactive-protein/

Human CRP tests are not accurate for canine CRP however.

Personally, I think it's useful in a canine pneumonia case for monitoring treatment also (you don't always get a useful culture result - I was lucky).

EDIT -As a patient, I used to wonder what is the difference between "chest infection" / "lower respiratory tract infection" and "pneumonia"; to me, "pneumonia"/"pneumonitis" had always simply meant "inflammation of the lungs". I think the term is mainly used as a clinical term by medics to refer solely to acute bacterial infections of the lung parenchyma, but on googling I see that there is still some confusion, e.g. "The Editorial Board members who participated in the discussion would most likely agree that pneumonia is an acute infection distinguishable from chronic infections, although this should not be confused with several other acute lower respiratory tract infections with well-recognised and distinguishable patterns, such as bronchiolitis and bronchitis." https://pneumonia.biomedcentral.com/articles/10.1186/s41479-016-0012-z

RE: Pneumonia cases

Iain Richards — Wed, 07 Nov 2018 19:18:25 GMT

[quote user="Beats"]Any details? Presumably the antigens/antibodies being tested for are pretty limited?[/quote]

Not AB/AG but C-reactive protein:https://www.nice.org.uk/news/article/simple-blood-test-for-pneumonia-can-help-limit-use-of-antibiotics

RE: Pneumonia cases

Anthony Todd — Wed, 07 Nov 2018 17:12:34 GMT

[quote user="Jo Dyer"]Where she was found dead the next morning when they went to wake her.[/quote]

But it's all OK, the head of the Trust apologises deeply [don't they always] and "lessons have been learned" [again and again, and always] blame is shifted downwards, but the staff who were totally incompetent and negligent usually just carry on without penalty.....

There's nothing like the procedure in an aircraft accident where lessons really are learned and the reasons for any errors, not apologised for, but analysed exhaustively to reduce the chance of a repeat.

The lever for flaps has a flap profile on the end; for undercarriage a wheel!

There is a followup to the death of Jack Alcock [Eye 1477] where Leicester Royal Infirmary listed "79 domains of systemic failure", makes "23 recommendations", and reveals that the scapegoat really should have been the junior doctor's Consultant who ignored a pH of 7.084 and a high blood lactate, then blamed his junior.

For instance, it seems that blood lactate elevation is so important that the information forms should be redesigned so that elevated values for blood lactate should always be in bold and set out to be very obvious, even in red??

But I'll bet that's too obvious and unnecessary.

Anecdote alert: BITD when we used distilled water in our steriliser [just a pressure cooker with knobs on] the water was labelled, but in the same colour as ethyl alcohol.

We nearly had a disaster when we put alcohol in instead!

The manufacturers distainfully said staff should "always read the label"!!

RE: Pneumonia cases

Lesley Strong — Wed, 07 Nov 2018 16:21:14 GMT

Yes been there. Pneumonia is scary when you feel like you are suffocating. GP exam lasted about 10 secs and got a dose of antibs that wasn't big enough to treat a 10kg dog and had no interest in sending off the chicken soup sputum sample I brought in with me.

Of course when you get carted in to A&E in an ambulance a few days later then everyone goes into panic mode and you get every blood/fluid sample/xray/scan known to man/ 3 different antibs and a massive doses of steroids. At the end of all this the diagnosis was we don't know but you seem better !

RE: Pneumonia cases

Jo Dyer — Wed, 07 Nov 2018 14:57:34 GMT

[quote user="Jill Butterworth"]

The pneumonia was pretty scary, and misdiagnosed by a GP as viral (I was pretty sick, but masked by paracetamol). I got a cursory clinical examination (less well than I might do before vaccinating a cat or dog), but to be fair, my signs were very confusing, with joint and abdominal pain as well as the brief intermittent chest pain (for the record it feels like being stabbed, I could retrospectively identify the affected lobe on my radiographs) and several junior doctors couldn't hear anything. It's taken many months to recover.

[/quote]

Oh my goodness Jill, I'm so glad they got you on the right treatment in the end.

Our nurse was in a huge amount of pain as well, along with her 'flu symptoms'. After a catalogue of errors (including her partner calling an ambulance and the GP cancelling it), she was finally admitted to hospital. On an orthopedic ward. Where she was found dead the next morning when they went to wake her.

RE: Pneumonia cases

Bob Russell — Wed, 07 Nov 2018 11:16:01 GMT

I have no doubt that your diagnosis would have been equally sound via telemedicine. You probably could have demanded antibiotics (and got them for a fee) and might have got better sooner.

One vote for telemedicine (or is it patent power?)??

RE: Pneumonia cases

Jill Butterworth — Wed, 07 Nov 2018 10:42:05 GMT

RE: Pneumonia cases

Beats — Wed, 07 Nov 2018 09:35:41 GMT

[quote user="Iain Richards"]There are now in house lateral flow devices to distinguish bacterial form viral respiratory infection.[/quote]

Any details? Presumably the antigens/antibodies being tested for are pretty limited?

RE: Pneumonia cases

Iain Richards — Wed, 07 Nov 2018 09:22:58 GMT

There are now in house lateral flow devices to distinguish bacterial form viral respiratory infection. About £12 a go. And no, they don't work for animals - I asked!

RE: Pneumonia cases

Jo Dyer — Wed, 07 Nov 2018 09:13:12 GMT

[quote user="Julie Innes"]I do sometimes wonder about the "no antibiotics at any cost" rule the medical service seem to have adopted.[/quote]

The trouble is, it's very selective. One of our nurses died, undiagnosed until post mortem, of sepsis after seeing the GP numerous times and being told her condition was viral so no need for antibiotics. Yet, if you are ancient with no functional immune system, the threshold for supplying them is extremely low, and rarely involves c and s. It's not PC to say so, but I think this must be a major contributor to AMR. I think antibiotics can only work in conjunction with some sort of immune system; trying to get them to work single-handedly must be asking for trouble. But somehow we have got into this position where we must keep old people alive at all costs, while younger people and children are left to get ill or even die.

Sorry. Still a bit traumatised by that death, 15 years on. 35-year old mother of two.

RE: Pneumonia cases

Julie Innes — Wed, 07 Nov 2018 09:02:25 GMT

I do sometimes wonder about the "no antibiotics at any cost" rule the medical service seem to have adopted. One of my nurses went recently with a wound to her foot which was dripping pus and smelly and was told to wait until the infection spread up her leg before seeking antibiotics.

More upsettingly a friend's very young child had an ear infection and was sent away 4 times with calpol, until the abscess developing down there burst into his middle ear, he went into DIC and ended up having to have antibiotics directly into his skull, was on life-support for weeks, then treatment for months

RE: Pneumonia cases

Clare Tapsfield-Wright — Mon, 05 Nov 2018 08:52:55 GMT

Blimey Jill , I hope you are now fully recovered. I had a friend develop pneumonia recently and nagged him to return to the doctor as he looked really sick , far more than “just a cold“ warranted. Did your GP actually listen to your chest ? It seems that clinical examinations by GPS are far less frequent than they used to be. If a vet and a fellow medical professional feels bad enough to go to see the doctor one would hope that they were taken more seriously than the patients who are there every week.

RE: Pneumonia cases

Beats — Mon, 05 Nov 2018 07:36:31 GMT

Had suspected case pneumonia in Irish Wolfhound, cultured Bordetella, recently.

RE: Pneumonia cases

Silvia Maldonado — Sun, 04 Nov 2018 22:50:24 GMT

[quote user="Jill Butterworth"]

Over my career I have seen very few cases of kennel cough progress to pneumonia, is anyone noticing a different pattern in veterinary species?

[/quote]

Most of the KC progressing to pneumonia I've seen were also associated to compromised immune system (already poor health, other conditions, old age, young puppies, after vaccines...). Sames as "cat flu" seems to be more aggressive to the weakest kittens in the litter.