- fever + focal rales
- fever + SOB [clear by history, or retractions on exam]
- fever + pleuritic chest pain
- fever + purulent sputum or hemoptysis which you see for yourself
- fever + compromised host
CXR is very sensitive [rare false-negatives on Day #1].Hospitalize Adults for Pneumonia if:
- ? >65 yo; esp. >80 yo
- O2 Sat <92%
- Resp >28 / Pulse >120 / BP <90
- Comorbidities (renal insuff., liver failure, malignancy, etc)
- Pneumococcus is most common & most lethal. Certainly suspect if CXR shows lobar consolidation (but can vary)
- Consider Mycoplasma if young(ish) patient with bilateral interstitial infiltrates on CXR
- Consider Staph [real bad] if IV drug use, or if pneumonia develops several days into Influenza.
- Age >65 years
- Antibiotics in past 3-6 mos.
- Medical Co-Morbidities & Alcoholism
- Exposure to a child in a day care center [?????]
See postings Acute Cough – 2 and Infectious Disease – 3. Click for link to major professional organization Guidelines.