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| ==Diagnostic Tests==
| | #REDIRECT [[Management of community acquired pneumonia]] |
| *CBCD, electrolytes, glucose, BUN, Cr
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| *ABG on RA
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| *blood cultures (draw 2 before treatment, at least 10 min. apart)
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| *sputum gram stain and culture
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| *CXR (PA and lateral)
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| *acid fast stain of sputum if cough > 1 month or suspicious CXR for TB
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| *thoracocentesis if pleural effusions present
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| **stain, culture, pH, leukocyte count, differential
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| ==General Management==
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| *analgesics/antipyretics
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| *ensure adequate hydration
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| *oxygen therapy to O2 sat ≥ 90%
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| *consult RT, PT, OT, speech language pathologist, dietician as needed
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| ==Hospitalization==
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| *When to admit
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| **Age >65 yrs
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| **Decreased immunity (cancer, diabetes, AIDS, splenectomy)
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| **Mental status changes
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| **Increased A-a gradient
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| **Two or more lobes involved
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| **No home
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| **Organ failure (↑Cr, bone marrow suppression, severe hypotension, liver failure)
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| **WBC > 30,000/mm3 or < 4000/mm3 (sepsis)
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| ==Treatment==
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| *if no pathogen identified, empirically treat
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| **NO COMORBIDITIES: po macrolide or doxycycline
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| **WITH COMORBIDITIES: po beta-lactam plus macrolide, or fluoroquinolone, quinolones (levofloxacin)
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| **if suspect ASPIRATION: amoxicillin-clavulanate or levofloxacin and metronidazole
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| *treat empirically until pathogen identified by sputum or blood culture, then use specific therapy
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| *OUTPATIENT: treat for 10 - 14 days
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| **Followup with GP, CXR in 8-12 weeks
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| *INPATIENT: treatment length based on response to therapy, comorbid illnesses, complications
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| **usually treat bacterial infections until patient is afebrile for >72 hours
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| ***resolution of respiratory symptoms, fever, PaO2 level, WBC, and findings on serial CXR
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| *give influenza and pneumococcal vaccine on day of discharge
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| *smoke cessation
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| ===Poor prognostic factors===
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| *age, men, nursing home
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| *comorbidities: cancer, liver, CHF, CVD, renal
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| *O/E: LOC, RR, BP, pulse, temperature
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| *labs: pH, pO2, ↓hematocrit, ↑BUN, ↓Na, ↑glucose, pleural effusion
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| {{OSCE2}}
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| [[Category:Medicine]][[Category:OSCE]]
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