GetMeOuttaThisMess Posted May 20, 2016 Share Posted May 20, 2016 Compadre just returned from AAPA conference and attended the pneumonia presentation which referenced pneumococcus as being responsible for up to 50% of cases of pneumonia (amazing how numbers change based on whose data you look at). In all my years of PC, EM, etc. I have never had a pt. with rust phlegm who looked like "death warmed over" and for that matter, no one with the Klebsiella red-currant jelly. Maybe I was just never "inner city" enough to have the derelicts who would aspirate. I'm starting to wonder if it falls into the same category as unicorns. Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 20, 2016 Moderator Share Posted May 20, 2016 saw rust x1 that's it never seen a unicorn though I keep looking.... Link to comment Share on other sites More sharing options...
LKPAC Posted May 20, 2016 Share Posted May 20, 2016 I've seen it, but rarely. For the record, my daughter has a unicorn. It's pink and plush. Link to comment Share on other sites More sharing options...
Guest Paula Posted May 20, 2016 Share Posted May 20, 2016 I am a unicorn. Link to comment Share on other sites More sharing options...
sk732 Posted May 22, 2016 Share Posted May 22, 2016 Have had 3-4 cases of Klebsiella with the classic currant jelly sputum...all were very sick. The one thing about when you get the Klebsiella is it hurts like hell - there's often residual pleurisy for sometime after. Incidentally, they've all been in the last 2 years, and most fo the folks weren't inner city derelicts...I work rural EM, most of them were middle age and quite fit. SK Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted May 22, 2016 Author Share Posted May 22, 2016 Derelict statement based on historically highest incidence being due to aspiration in alcoholics. I'm more interested in how you've been so fortunate to see so many in a rural setting (unless they were to be residents in an ECF which you say they weren't)? If all within a reasonable time window and they were somehow all connected, an infected host source (usually us, the HCW)? Link to comment Share on other sites More sharing options...
sk732 Posted May 22, 2016 Share Posted May 22, 2016 Not really sure - there's been a lot of K.pneumonia in infected urine lately, your guess is as good as mine (voodoo medicine freaks drinking their piss?). However, since I had to deal with a TB outbreak for about 2 years in the little town I used to work in, I can only surmise that I'm a shyte magnet (some of my docs would tend to agree actually). SK Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted May 22, 2016 Author Share Posted May 22, 2016 Yep, TB is the gift that just keeps on giving. It is a LOT more prevalent than people know (having worked with a Co. Health Dept. and being aware of the numbers here locally). Link to comment Share on other sites More sharing options...
db_pavnp Posted May 22, 2016 Share Posted May 22, 2016 Not really sure - there's been a lot of K.pneumonia in infected urine lately Enteric flora and one of the relatively common overall UTI bugs. Link to comment Share on other sites More sharing options...
sk732 Posted May 23, 2016 Share Posted May 23, 2016 Enteric flora and one of the relatively common overall UTI bugs. Relatively being the operative word...most of our cultures are coming back as E.coli, Enterococcus and MRSA actually (eww). The Klebsiella was usually fairly low, but is now creeping up into the 1/8 + range of cultures. Thus far, we haven't got any of the mutant strains you're having to deal with in the US, fingies and toes crossed. There must be something in the water supply here or something to explain the pneumonias, since I'd only seen one case in the Army in a friend of mine, then nothing in my old family med location, then a relative pile of it here. Will have to look into it I suppose. SK Link to comment Share on other sites More sharing options...
CAAdmission Posted May 26, 2016 Share Posted May 26, 2016 No rust here. I don't think I have even ever seen the "pink frothy" sputum. Now green and yellow, those are another story. People love to bring those little plastic margarine containers into the ER full of their secretions. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted May 26, 2016 Author Share Posted May 26, 2016 No rust here. I don't think I have even ever seen the "pink frothy" sputum. Now green and yellow, those are another story. People love to bring those little plastic margarine containers into the ER full of their secretions. I love telling folks that back in the stone-age when I was in school and we were first figuring out that we could stick tubes into any human orifice and they would survive, an interesting bronchoscopy study showed that cough produced phlegm and crud specimen from the site of infection on bronchoscopy didn't match. For the older folks, this is why we don't do sputum gram stains/cultures any longer except for TB. Green, yellow, white, clear in any order, since your body has the ability to change same just to keep one interested in being sick, has no clinical significance. Usually I stick to the trifecta of rust, "strawberry jam" (easier to describe), or gross blood gets our attention. I did have a pt. last month mention black sputum and last time I checked we didn't have any operational coal mines here in N. Texas (too busy causing earthquakes from fracking) nor was this hemoptysis, so I did a little research and found that this could be due to "liquification of abscesses" which my SP's didn't know either. Man, it sure gets the patient's attention to go see their PCP if not better in several days. This is why I don't use our EMR discharge instructions for bronchitis since it says to let your provider know if you produce green sputum. And I would care why? Link to comment Share on other sites More sharing options...
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