Shock-type pneumonia

　　Shock-type pneumonia, also known as toxic pneumonia or fulminant pneumonia, is a severe form of pneumonia characterized by toxicemia and microcirculatory disorders. The causative agents are usually Streptococcus pneumoniae, Staphylococcus aureus, hemolytic streptococci, and are more common in the elderly and weak. It is more prevalent in winter and spring, and the elderly, those with chronic weakness, or patients with cardiovascular and pulmonary diseases are more prone to developing the condition. Shock-type pneumonia has an acute onset and rapid progression of the condition.

　　Systemic shock, when the body temperature is high, it can cause convulsions, seizures, cerebral edema, etc. Some patients may also experience psychiatric symptoms and bleeding tendency when using large doses of corticosteroids. Special attention should be paid to patients with peptic ulcers, as the use of large doses of corticosteroids can increase the secretion of gastric acid and pepsin, reduce gastric mucus, induce or worsen ulcers, and even lead to perforation. Some severe shock patients, even after active blood volume expansion, the use of corticosteroids, and anti-infection, the blood pressure may still not rise, or small blood vessels may become significantly spasmodic, leading to grayish or even blue lips, moist skin, and cold extremities.

　　The main clinical manifestations are lung infection and shock, shock often occurs within 24 hours, most children have cough, sputum, general malaise, lung signs are often atypical, and in 1-3 days, especially within 24 hours, sudden shock may occur, presenting as: blood pressure drop, pale complexion, profuse sweating, cold extremities, rapid pulse, cyanosis of the lips and limbs, oliguria or anuria, confusion, irritability or drowsiness, and even coma.

　　In the variable spring climate, if the elderly have a history of catching a cold, once there is an acceleration of breathing, pulse, and blood pressure drop, one should go to the hospital immediately for an early diagnosis and treatment. After assuming a supine position, raise the head and legs by 30°, as raising the legs helps venous return, and raising the head is beneficial for breathing. Pay attention to keeping warm, try to move the patient as little as possible to avoid aggravating the condition. Food can be high-calorie, vitamin, and potassium-rich liquid food. According to the condition, urinary catheterization is left in place and the changes in urine volume are observed to prevent bedsores. Due to tissue ischemia, hypoxia, and changes in capillary permeability in severe shock patients, slight carelessness in the compressed areas can lead to bedsores, so prevention is important. For restless patients, sedatives can be used to avoid aggravating shock.

　　1. X-ray chest film, inflammatory infiltration shadows in the lungs (should avoid moving and take bedside films).

　　2. Pathogen examination: It is necessary to do sputum smear and culture as soon as possible to identify the pathogenic bacteria.

　　3. Blood white cell count and neutrophils are often elevated, and there may be nuclear left shift.

　　4. Blood gas analysis: PaO2, pH value, standard bicarbonate (SB), actual bicarbonate (AB) may decrease, and serum lactic acid may increase, presenting metabolic acidosis; severe cases may have urinary routine and liver and kidney function damage.

　　For diet to nourish the lungs, it is recommended to eat more corn, soybeans, black beans, winter melon, tomatoes, lotus root, sweet potatoes, pork skin, abalone, clam, sea cucumber, pear, and so on, but it should be selected according to personal constitution and gastrointestinal function.

　　To unblock blood vessels and improve the lung environment, the effective ingredients in the Wenshen Qingfei decoction can fully eliminate the lung toxins that have been killed, clear the deposits that have been obstructing the lung capillaries for a long time, unblock the lung blood vessels, enhance the lung's blood supply and oxygenation function, and thoroughly improve the internal environment of the lungs.

　　1. General treatment

　　Supine position, oxygen inhalation, and attention to keeping warm.

　　2. Antimicrobial treatment

　　It should be based on the principles of early, broad-spectrum, and effective treatment. Before the pathogen is determined, piperacillin (oxacillin), cefmetazole (ticarcillin plus potassium clavulanate); cefuroxime, cefotaxime, cefoperazone, ciprofloxacin, ofloxacin, and others can be used for treatment (see bacterial pneumonia). After obtaining the results of pathogen culture and drug sensitivity test, the antibacterial drugs can be adjusted accordingly.

　　3. Anti-shock treatment

　　For patients without renal insufficiency, rapid fluid resuscitation of 800-1000ml can be administered based on the patient's heart rate, blood pressure, and urine output to restore blood pressure. After the urine output is >30ml/h, the rate of fluid administration can be slowed down. The fluid intake within 24 hours can reach 3000-4000ml. The choice of fluid is mainly crystalloids (normal saline, 5% glucose saline, balanced salt), and colloidal solutions such as albumin, whole blood, etc. can be supplemented as necessary. The commonly used one is not more than 100ml of low-molecular-weight dextran in 24 hours. On the basis of fluid resuscitation, vasoactive drugs such as dopamine, dobutamine, metaraminol, or scopolamine can be used appropriately.

　　4. Correction of acidosis

　　The amount of alkali supplementation is calculated as 1mmol = 0.3 × (normal - measured HCO3-) × body weight (kg) (1mmol = 2.1ml of 4% sodium bicarbonate). First, 1/3 of the calculated amount is administered, and then supplemented according to the condition and blood gas values. It is also possible to correct acidosis with 11.2% sodium lactate and 3.63% trimethylolpropane triamine.

　　5. Adrenal cortical hormones

　　Hydrocortisone 200-600mg/d or dexamethasone 10-30mg/d can be added to the fluid in divided doses and administered intravenously for 3-5 days. At the same time, ranitidine 150mg, 1-2 times/d, can be used to prevent stress ulcers.

　　6. Prevention and treatment of complications

　　When there are signs of early heart failure or acute pulmonary edema, 2.4mg of digoxin can be added to 20-40ml of 5% glucose solution and administered slowly intravenously. 20-40mg of furosemide can be used simultaneously. For acute respiratory distress syndrome, disseminated intravascular coagulation, renal failure, and arrhythmia, appropriate treatment should be given.