Identifying and Managing Pneumonia Post-Collapse

Disclaimer.  I am not a licensed health practitioner.  This is just another post on knowledge and understanding you might wish to acquire in advance of a disaster in case no higher care is available.  As long as our society is functioning, you should leave anything more substantial than applying a Band-Aid to the professionals.  No medication, including those available over the counter, should be taken without consulting a physician.  Information shared here is for educational and entertainment purposes only.  It is not medical advice nor a substitute for licensed medical care. 


Checking all my medical resources, Armageddon Medicine is the book to have if pneumonia is a concern.  The others barely address it at all.

Without a laboratory for testing specimens, there is no way you'll be able to definitively determine whether a patient has viral pneumonia or bacterial pneumonia.  It is an acute infection of the lungs that often develops after another respiratory illness, like influenza, bronchitis, or asthma.  However, it may also occur following measles, whooping cough, or any other very serious illness, especially in the very young and very old.  You're going to have to make an educated guess so that you can decide whether you want to use the precious supply of antibiotics.

Babies and the elderly (or anyone who seems a bit feeble) are at greater risk for unilateral pneumonia, meaning that the pneumonia is only in one lung.  It can be due either to aspirated food or microbes that get trapped in one lung and cause a localized infection.  Left unchecked, the fluids accumulate in the lung, preventing gas transfer--no oxygen in and no carbon dioxide out.  The patient literally drowns in his own fluids.  However, the infection can also enter the bloodstream, causing sepsis and death.  Listening to the lungs will reveal that the affected side rattles or wheezes, while the unaffected lung is clear without any sounds.  But if the respiration is very shallow, you may not be able to detect a difference between the two sides.  The nostrils may flare with each breath.  The patient may complain of one-sided chest pain, particularly when coughing or inhaling deeply.  Or there may be no respiratory symptoms at all and the patient may simply feel weak or sick.  There may be sudden chills and then a high fever.  For these patients, a doctor will want to use antibiotics.

In children, pneumonia is more likely to be viral.  No antibiotics.  In adults, pneumonia is more likely to be bacterial.  But that doesn't necessarily mean antibiotics are needed.

The next factor a physician looks at is whether the patient "looks" well or not.  In a patient that looks well, the pneumonia is more likely to be viral or the very early stages of bacterial.  And by "looking well" a doctor means that the patient is physiologically stable.  S/he can still be quite miserable, but the vital signs are normal, respiration is normal, the patient is eating and drinking and not confined to bed.  These patients should continue eating and drinking and be given fever reducers and pain relievers to be kept comfortable.  Antibiotics are not warranted, but the patients should be carefully observed for any changes.

Patients that do not "look well" display abnormal physiological reactions, including:

• elevated heart rate, 
• rapid breathing, 
• labored breathing, 
• vomiting, 
• inability to take food and drink.  

A sick child who takes more than fifty shallow breaths per minute likely has pneumonia.  These patients must be observed more carefully.  If they cannot maintain fluid intake, they must get it through an intravenous, subcutaneous, or rectal administration.  Acetaminophen can be used for reducing fever.

So when will a doctor want to use antibiotics?  They are most likely needed with:

• one-sided, or unilateral, pneumonia;
• a sick-looking patient, baby, or feeble adult;
• when a patient has other respiratory conditions such as asthma and COPD;
• in any patient that does not improve or gets worse after 3-4 days.

If an infection develops, most doctors would prescribe cephalexin, Augmentin, or erythromycin as first choices.  Second-line options would be doxycycline, ciprofloxacin, or levofloxacin.  Treatment would be continued for two days beyond the resolution of the infection.  In order to conserve the supply of antibiotics, bacitracin, silver sulfadiazine, and/or honey might also be recommended.

After two to three days on antibiotics, the patient should be improving.  If he is not improving by day three or four, or if he is worsening, the doctor will switch antibiotic classes.  Antibiotics will usually do the job in five days in an otherwise healthy adult; it may take seven to ten days for those who are older or chronically ill.  The cough may linger for weeks but is not a cause for concern.  

Regardless of whether the pneumonia is bacterial or viral, there are a few other measures that can be taken.  The patient should take several deep breaths every hour.  In addition, the head of the patient's bed should be elevated 30-45 degrees.  Warming and humidifying the air will help loosen mucus secretions in the lungs.  The patient can be given a balloon to blow up, or he can blow bubbles through a straw into a cup of water.  Both of these methods provide some back pressure when exhaling to prevent lung collapse.  The vibrations from the bubbles also help loosen the mucus.  Or the patient can yell.  These measures are better than nothing, but unfortunately, not as effective as antibiotics.

In the days before antibiotics, physicians used a stethoscope to determine where the pneumonia was concentrated and then had the patient lie on the affected side to facilitate drainage.  The caregiver then cupped his hand and clapped it against the affected area on the back rapidly and firmly enough to loosen the mucus, but not so hard as to cause pain or bruising.  This was performed several times each day.  Patients today will not be any more happy than patients of previous generations were.

Herbs that may help manage pneumonia include Usnea, oregano, rosemary, Japanese honeysuckle, and lomatium.  Some of these will be more effective against bacteria and others will be better for viruses.

Links to related posts:
Usnea  
Oregano
Rosemary
Japanese honeysuckle 
Lomatium 

For further information:
Armageddon Medicine, pp 123-129.