Update July 26, 2019
A. History
Fatigue
Pivotal Assessment | Finding | ||||
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Further History |
Dyspnea Sputum production Pleuritic chest pain |
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Physical Exam | Suspect pneumonia from symptoms and signs (often fever, cough, dyspnea, or weakness with rales or rhonchi), while recognizing that each individual symptom or finding lacks high accuracy. When symptoms suggest a possibility, order a chest radiograph; if clinical findings suggest pneumonia (with or without an infiltrate on chest x-ray), treat emprically.13 No single set of recommendations for diagnostic testing applies to all patients, requiring clinical judgment. In otherwise healthy, mildly ill, ambulatory patients, no further ancillary testing may be necessary. To optimally risk-stratify anyone over 50 years old or more than mildly ill, seek evidence of other organ affliction; this is done by including CBC, serum electrolytes, BUN, creatinine, and glucose levels. Pulse oximetry is needed in all cases because a saturation on room air of <91% is associated with more complications. An arterial blood gas analysis is reserved for those appearing ill, with underlying lung disease, with oxygen desaturation, or in respiratory distress. |
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CT Chest | |||||
Bronchoscopy | |||||
Diagnosis | Pneumonia |
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