Pneumonia diagnostic algorithm: Difference between revisions
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{{familytree | {{familytree | | | | | | | A01 | | | | | | | | | | A01=<div style="float: left; text-align: left; width: 28em; padding:0.5em;"> '''Symptoms that suggest a lower respiratory tract infection:'''<br>❑ [[Fever]] <br>❑ [[Cough]] with sputum <br>❑ [[Dyspnea]]<br>❑ [[Pleuritic]] chest pain</div> }} | ||
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{{familytree | {{familytree | | | | | | | B01 | | | | | | | | | | B01=<div style="float: left; text-align: left; width: 28em; padding:0.5em;">'''Physical Examination Findings:''' <br> | ||
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{{familytree | {{familytree | | | | | | | C01 | | | | | | | | | | C01=<div style="float: left; text-align: left; width: 28em; padding:0.5em;">'''Order Labs:'''<br> ❑ [[Complete blood count]] (CBC) <br>❑ [[Blood urea nitrogen]] (BUN) <br>❑ [[Gram staining|Sputum gram stain]] and [[Sputum culture|culture]] <br>❑ [[Blood culture]] and [[ABG]] if necessary<br> If [[atypical pneumonia]] is suspected, obtain: <br> | ||
:❑ Urine [[legionella]] antigen, rapid influenza test<br> | :❑ Urine [[legionella]] antigen, rapid influenza test<br> | ||
:❑ [[Enzyme linked immunosorbent assay (ELISA)|Enyzme Immunoassay]] <br> | :❑ [[Enzyme linked immunosorbent assay (ELISA)|Enyzme Immunoassay]] <br> | ||
:❑ [[Immunofluorescence]] <br> | :❑ [[Immunofluorescence]] <br> | ||
:❑ [[Polymerase chain reaction]] (PCR) for atypical and viral including [[influenza]]<br></div>}} | :❑ [[Polymerase chain reaction]] (PCR) for atypical and viral including [[influenza]]<br></div>}} | ||
{{familytree | {{familytree | | | | | | | |!| | | | | | | | | | | }} | ||
{{familytree | {{familytree | | | | | | | D01 | | | | | | | | | | D01=<div style="float: left; text-align: left; width: 28em; padding:0.5em;">❑ Order a chest X-ray if the patient presents with any of the following:<ref name="pmid21661712">{{cite journal| author=Watkins RR, Lemonovich TL| title=Diagnosis and management of community-acquired pneumonia in adults. | journal=Am Fam Physician | year= 2011 | volume= 83 | issue= 11 | pages= 1299-306 | pmid=21661712 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21661712}} </ref> | ||
* [[Fever]] (>37.8° C / 100° F) | * [[Fever]] (>37.8° C / 100° F) | ||
* [[Tachypnea]] (> 20 breaths/min) | * [[Tachypnea]] (> 20 breaths/min) | ||
* [[Tachycardia]] (> 100 bpm) | * [[Tachycardia]] (> 100 bpm) | ||
* Decreased [[breath sounds]] and [[crackles]] in the physical exam </div>}} | * Decreased [[breath sounds]] and [[crackles]] in the physical exam </div>}} | ||
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{{familytree | {{familytree | | | | | | | E01 | | | | | | | | | | E01=<div style="float: left; text-align: left; width: 28em; padding:0.5em;">'''Does the patient meets any of the following criteria for HCAP?'''<ref name="pmid21663884">{{cite journal |author=Attridge RT, Frei CR |title=Health care-associated pneumonia: an evidence-based review |journal=[[The American Journal of Medicine]] |volume=124 |issue=8 |pages=689–97 |year=2011 |month=August |pmid=21663884 |doi=10.1016/j.amjmed.2011.01.023 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(11)00291-9 |accessdate=2012-09-02}}</ref><br> | ||
* Hospitalized in an acute care hospital for 2 or more days within 90 days of the infection; | * Hospitalized in an acute care hospital for 2 or more days within 90 days of the infection; | ||
* Resided in a nursing home or long-term care facility; | * Resided in a nursing home or long-term care facility; | ||
* Received recent intravenous antibiotic therapy, chemotherapy, or wound care within the past 30 days of the current infection; | * Received recent intravenous antibiotic therapy, chemotherapy, or wound care within the past 30 days of the current infection; | ||
* Attended a hospital or hemodialysis clinic</div>}} | * Attended a hospital or hemodialysis clinic</div>}} | ||
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{{familytree | {{familytree | | | F01 | | | | | F02 | | | | | F01=<div style="float: left; text-align: center; width: 15em; padding:0.5em;">'''YES'''</div> |F02=<div style="float: left; text-align: center; width: 15em; padding:0.5em;">'''NO'''<br> The patient has '''[[CAP]]'''</div>}} | ||
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{{familytree | {{familytree | | | G01 | | | | | G02 | | | | | G01=<div style="float: left; text-align: left; width: 15em; padding:0.5em;">'''Does the infection occurred ≥48 hours after admission and it was not present at admission?'''</div> |G02=<div style="float: left; text-align: left; width: 15em; padding:0.5em;">'''Does the patient has at least 2 of the following CURB65 criteria? ''' | ||
* '''C'''onfusion ([[abbreviated mental test score|AMT]] ≤8) | * '''C'''onfusion ([[abbreviated mental test score|AMT]] ≤8) | ||
* '''U'''rea greater than 7 mmol/l (BUN > 20) | * '''U'''rea greater than 7 mmol/l (BUN > 20) | ||
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* '''B'''lood pressure ≤ 90 systolic or ≤ 60 diastolic | * '''B'''lood pressure ≤ 90 systolic or ≤ 60 diastolic | ||
* Age '''65''' or older</div>}} | * Age '''65''' or older</div>}} | ||
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{{familytree | H01 | {{familytree | H01 | | H02| |H03| | H04 | | H01=<div style="float: left; text-align: center; width: 12em; padding:0.5em;">'''YES'''<br> | ||
---- | |||
<div style="text-align:left"> If the patient had an endotracheal tube placed ≥48 hours ago, suspect '''[[VAP]]'''. Otherwise, the patient has '''[[Hospital-acquired pneumonia|HAP]]'''</div></div> |H02=<div style="float: left; text-align: center; width: 12em; padding:0.5em;">'''NO''' <br> | |||
---- | |||
The patient has '''HCAP''' </div> |H03=<div style="float: left; text-align:center; width: 12em; padding:0.5em;">'''YES'''<br> | |||
---- | |||
Admit the patient and administer [[Community-acquired pneumonia medical therapy#Empirical Treatment|empiric inpatient antibiotic regimen]]</div>|H04=<div style="float: left; text-align: center; width: 12em; padding:0.5em;">'''NO''' <br> | |||
---- | |||
Administer [[Community-acquired pneumonia medical therapy#Empirical Treatment|empiric outpatient antibiotic regimen]]</div>}} | |||
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Revision as of 19:47, 8 December 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
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Overview
Diagnostic Algorithm
Shown below is an algorithm for the diagnostic approach of pneumonia.[1][2]
Abbreviations: HCAP: Healthcare-associated pneumonia; CAP: Community-acquired pneumonia; VAP: Ventilator-associated pneumonia; HAP: Hospital-acquired pneumonia; AMT: Abbreviated mental test score
Physical Examination Findings:
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Order Labs: ❑ Complete blood count (CBC) ❑ Blood urea nitrogen (BUN) ❑ Sputum gram stain and culture ❑ Blood culture and ABG if necessary If atypical pneumonia is suspected, obtain:
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❑ Order a chest X-ray if the patient presents with any of the following:[3]
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Does the patient meets any of the following criteria for HCAP?[4]
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YES | NO The patient has CAP | ||||||||||||||||||||||||||||||||||||
Does the infection occurred ≥48 hours after admission and it was not present at admission? | Does the patient has at least 2 of the following CURB65 criteria?
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NO The patient has HCAP | |||||||||||||||||||||||||||||||||||||
References
- ↑ "http://cid.oxfordjournals.org/content/44/Supplement_2/S27.full.pdf+html". Retrieved 13 March 2014. External link in
|title=(help) - ↑ Solomon, Caren G.; Wunderink, Richard G.; Waterer, Grant W. (2014). "Community-Acquired Pneumonia". New England Journal of Medicine. 370 (6): 543–551. doi:10.1056/NEJMcp1214869. ISSN 0028-4793.
- ↑ Watkins RR, Lemonovich TL (2011). "Diagnosis and management of community-acquired pneumonia in adults". Am Fam Physician. 83 (11): 1299–306. PMID 21661712.
- ↑ Attridge RT, Frei CR (2011). "Health care-associated pneumonia: an evidence-based review". The American Journal of Medicine. 124 (8): 689–97. doi:10.1016/j.amjmed.2011.01.023. PMID 21663884. Retrieved 2012-09-02. Unknown parameter
|month=ignored (help)