Patient can present with SOB, altered mental status, fevers, coughing, generalized weakness etc.
ER:
Routine Labs, CXR, EKG
Nebulization if necessary
Oxygen
IV Fluids if required
Blood Cultures
First dose of IV antibiotics-Ceftriaxone 1gm IV, and Azithromycin 500mg IV or Levofloxacin IV based on renal function
| CURB-65 Pneumonia Severity Score: Confusion (abbreviated Mental Test Score <=8) (1 point) Urea (BUN > 19 mg/dL or 7 mmol/L) (1 point) RR > 30 per minute (1 point) BP: diastolic < 60 or systolic < 90 mmHg (1 point) Age >= 65 yrs (1 point) More than 2 points==> Higher risk |
Hospitalist:
Continue antibiotics
Sputum C/S
Oxygen
Nebulization if short of breath
Urine for pneumococcal antigen, Urine for Legionella antigen
ABG if very short of breath
IR consult if pleural effusion for possible thoracentesis–>Sometimes, after thoracentesis, pneumothorax may result in which case a Chest Tube may need to be placed. Consult General Surgeons or Interventional radiology.
Common Tests to order on Pleural Fluid: pH, LDH, Protein, Glucose, Gram Stain, C/S, Cell Count with Diff, Cytology
| Modified Light’s CriteriaPleural fluid is Exudate if Pleural fluid 1. Serum Protein ratio>0.5 2. Serum LDH ratio >0.6 3. LDH >2/3 upper limit of Serum LDH 4. Protein >30gm/L If only one criteria is met, calculate Fluid to Serum Albumin Gradient If >12g/L, Consider Transudate |
Make sure the patients are not short of breath prior to discharge. Usually 24-48hr of iv antibiotics may be sufficient.
