Medical Staff –5.31.2016

Talk Ten (ICD 10) Tuesday Tips….Got a Minute:

Specificity: noun spec·i·fic·i·ty \ˌspe-sə-ˈfi-sə-tē\ the quality or condition of being free from ambiguity

So which is it…Bronchitis or Pneumonia???

Symptom/Study Acute bronchitis Pneumonia Cough  Dry cough at first (does  Cough often brings up mucus from not produce mucus) the lungs.  After a few days, cough  Mucus may be rusty or green or may bring up mucus tinged with blood. from the lungs. The mucus may be clear, yellow, or green, and may be tinged with blood.  May be accompanied by bronchospasm.  Can last 10 – 20 days Fever  Fever is not present or is  Fever is often higher than 101°F mild. (38.5°C). WBC  Often normal and may  A white count that is significantly be slightly elevated elevated or indicates marked neutrophilia ("left-shift") is more consistent with bacterial pneumonia. Constitutional Symptoms  Few systemic symptoms  Tachycardia  Usually goes away in 2  Tachypnea to 3 weeks  Shaking, "teeth-chattering" chills  Dyspnea  Pleuritic Chest Pain  May last longer than 2 to 3 weeks Chest Examination  May have ronchi, yet  Often, audible crackles clears with coughing  Evidence of consolidation  No signs of consolidation or rales CXR  Appear Normal  Used to definitively diagnosis if abnormalities in above (fever, cough, The indications for a chest radiograph in etc) Abnormalities seen: The patients with an acute cough syndrome, presence of an infiltrate on plain to exclude pneumonia, are abnormal chest radiograph is considered the vital signs (pulse >100/minute, gold standard for diagnosing respiratory rate >24 breaths/minute, or pneumonia when clinical and temperature >38°C), or rales or signs of microbiologic features are consolidation on chest examination. supportive; May include: lobar Patients of advanced age (over 75 consolidation; interstitial infiltrates; years of age), however, may have and/or cavitation. pneumonia without mounting a significant fever. http://www.uptodate.com/contents/acute-bronchitis-in- adults?source=machineLearning&search=bronchitis+vs+pneumonia&selectedTitle=1%7E150§ionRank=1&anchor=H14751396#H8

Chest radiographs are indicated only when clinical features suggest pneumonia. The role of procalcitonin (PCT) in distinguishing patients who would benefit from antibiotic therapy is emerging. PCT is a more specific marker of bacterial infection than white blood count or C-reactive protein [24].