Keywords: pneumonia in the elderly
(1) the general treatment of pneumonia in the elderly: intensive care and warmth is quite important. Eating nutrient-rich, easily digestible, bland diet is appropriate, the appropriate amount of the water; coma patients should be given a nasal feeding liquid. Elderly cough, phlegm, it is appropriate expectorant, not antitussive, often turning to shoot back to help expectoration; accompanied by high fever, should take physical cooling, such as alcohol sponge bath, ice pack to the forehead, neck and armpits , groin, etc., should not use antipyretic agents, in order to avoid the fever profuse sweating led to the collapse or hypovolemic shock. Hypoxia should be given to low-flow continuous oxygen, to do dynamic observation of blood gas analysis, the best so that the partial pressure of oxygen maintained at 7.98kPa above.
(2) anti-infection: pneumonia, once diagnosed, should immediately do a blood, sputum culture and drug sensitivity test, continuous inspection 2 to 3 times. In before pathogens undetermined, clinician characteristics according to the disease, with clinical experience drug selection. Considering caused by pneumococcal infections, various types were sensitive to penicillin, penicillin therefore should be the drug of choice, it is appropriate to penicillin G, not suitable for application of large doses of penicillin sodium, because sodium excretion while away a lot of potassium ions, easy low potassium; suspected influenza bacillus mixed infection, you should use ampicillin. Later use of antibiotics based on culture results and susceptibility testing. Staphylococcus aureus pneumonia, a semi-synthetic penicillin and cephalosporin, vancomycin, clindamycin can also be used. Gram-negative bacilli infections, the choice of the aminoglycoside and a cephalosporin or a semi-synthetic penicillin. Pseudomonas aeruginosa infections preferred carbenicillin, methyl benzyl or furosemide benzyl penicillin. Less renal toxicity of antibiotics, such as penicillin, erythromycin, chloramphenicol, it is the best choice due to the elderly is often accompanied by renal dysfunction. Renal toxicity of antibiotics such as aminoglycosides, sulfonamides, such as the need to be applied, it should reduce the amount of regular doses of 2/3 to 1/2; if there is renal damage, you should try to do not.
(3) prevention of complications: pneumonia in the elderly prone to complications, should pay attention to prevention and treatment. Since the elderly the humoral total and intracellular fluid than young adults less tubular reabsorption function decline, so the elderly patients prone to dehydration, the low ionic acidosis and arrhythmia, should be closely monitored, abnormal timely processing. Dehydration required intravenous rehydration, the elderly poor cardiac function, we must control the infusion rate. Pneumonia and rapid infusion due to the elderly often can induce pulmonary edema, it can also be applied as appropriate cardiac stimulant. Respiratory failure and respiratory stimulant available, mechanical ventilation in treatment when necessary. Patients with airway obstruction can cause carbon dioxide retention, precipitating respiratory acidosis; frequency of breathing too fast can cause respiratory alkalosis; pneumonia organs of the body hypoxia, can cause metabolic acidosis; iatrogenic metabolism may also occur alkalosis. These often affect the treatment effect and prognosis of patients should pay attention to prevent and rectify.
In addition, the elderly diabetic patients with pneumonia, should be actively controlled diabetes, or simply treat pneumonia poor efficacy; physical weakness, malnutrition, hypoproteinemia or anemia in the elderly should be special attention to strengthening nutrition support therapy, appropriate increase in quality protein intake or intermittent input of a small amount of blood, plasma or albumin, plays a very important role in promoting the recovery of the disease.