Loading...
 

Pneumonia


Please take the time to calculate a PORT(external link) score



Inclusion Criteria

  • History, exam, and CXR consistent with acute pneumonia
  • PORT score class <3 (if calculated)
  • O2 saturation >92 % on room air at the time of CDU admission
  • Outpatient support and home capable of managing pneumonia if discharged
  • Initial dose of antibiotics given in the ED

Exclusion Criteria

  • Persistantly abnormal vitals โ€“ after ED treatment (O2 saturation <92% on RA, HR >120, SBP<100, RR >30, T<35 or >40 C)
  • Significantly abnormal ABG โ€“ if done (pCO2>45, pH<7.35)
  • Potential respiratory failure
  • Multi-lobar pneumonia
  • Unlikely to be discharged in 24 hours, poor candidate for outpatient therapy
  • Immunocompromised patients: HIV, PCP pneumonia, chemotherapy, chronic corticosteroid use, active cancer, sickle cell disease, asplenic patients.
  • High risk patients: Nursing home patient, cancer, cirrhosis, ESRD, altered mental status, nosocomial etiology, aspiration risk (ie. bulbar stroke)
  • High suspicion of โ€“ DVT/PE, SARS, H1N1, or TB (HIV/AIDS, institutionalized, recent prison, native of endemic region, history of pulmonary TB, apical disease on CXR)


Potential Interventions

  • Antibiotics based on contemporary guidelines for pneumonia
  • Supplemental oxygen and bronchodilator therapy as needed. Steroids and indicated.
  • Analgesics as needed for pain, myalgias, or cough/sputum
  • Serial vital signs, cardiac and oxygen saturation monitoring (continuous or intermittent)
  • Assistance with activities of daily living as needed

Discharge Criteria

Home

  • Subjective and clinical improvement during CDU stay
  • Acceptable vital signs during observation period
  • Patient able to tolerate oral medications and diet

Admit

  • Patient not subjectively improved enough to go home
  • Lack of clinical progress or clinical deterioration.
  • Unable to safely discharge for outpatient management
  • Physician discretion


Most-Commented

No records to display