X-rays show infiltration which is often lobar in distribution but sometimes can also be patchy.
Pneumococci are present in the sputum and often in the blood.
Leukocytosis.
Newly-contracted acute febrile diseases or seasonal diseases including the wind and warm symptom complex and winter fever or suppurative infections of the lungs in traditional Chinese medicine.
Treatment in Western medicine.
A blood culture and a good sputum specimen for smear and culture should always be obtained before treatment is started. The dosage and route of administration of antimicrobial drugs are influenced to some extent by the clinical severity of the disease, the presence of unfavourable prognostic signs and the presence of complications.
Antibacterial therapy
Penicillin G is the drug of choice. It is given initially in dosages ranging dequate (if not optimal) for many cases of pneumococcal pneumonia.
General supportive treatment
Ventilation and oxygenation. An adequate airway must be maintained, if necessary, by tracheal suction, endotracheal tube or trachostomy. Oxygen maybe supplied by nasal catheter, soft rubber mask or oxygen tent.
Management of shock and pulmonary edema. Shock and pulmonary edema are the most frequent causes of death in pneumonia. Oxygen administration tends to prevent pulmonary edema and impending right heart failure must be managed and digitalization is urgent.
Management of toxic delirium. Toxic delirium occurs in any severe pneumonia and may be particularly difficult to manage in alcoholics. Delirium, anxiety and restlessness during waking hours may be treated with diazepam 5mg or chlordiaz- epoxide 10mg or phenobarbital 15 to 30 grams orally 4 to 6 times daily. Pentobarbital 0.1g or flurazepam (Dalmane) 30mg at bedtime helps to ensure adequate rest.
Fluids. Patients with pneumococcal pneumonia may perspire profusely and lose much fluid and salt. Sufficient fluid must be given to maintain a daily urinary output of at least 1500ml. Electrolytes must be kept in balance yin and yang.
Pleuritic pain. For mild pain, spray ethyl chloride over the area of greatest pain for about 1 minute or inject a local anesthetic to anesthize the involved dermatomes to provide temporary relief.
Codeine phosphate 15-30mg may be given as necessary for pain. For very severe pain, use meperidine 50-100rag subcutaneously or morphine sulfate 10-15rag subcutaneously.
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