Pneumonia admission

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.

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