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Community-Acquired Pneumonia in the Emergency Department (Infectious Disease CME) -
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Community-Acquired Pneumonia in the Emergency Department (Infectious Disease CME)
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Publication Date: February 2021 (Volume 23, Number 2)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 02/01/2024.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits, subject to your state and institutional approval.

Authors

Matthew DeLaney, MD, FACEP, FAAEM
Associate Professor, Assistant Residency Program Director, Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL
Charles Khoury, MD, MSHA, FACEP
Associate Professor, Assistant Residency Program Director, Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL

Peer Reviewers

Daniel J. Egan, MD
Harvard University Affiliated Emergency Medicine Residency, Massachusetts General Hospital/Brigham and Women's Hospital, Boston, MA
Benjamin Christian Renne, MD
Critical Care Physician, Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, MA

Abstract

As recommendations for the diagnosis, treatment, and disposition of patients with community-acquired pneumonia continue to evolve, this issue reviews the current evidence and guidelines for managing these patients in the emergency department. The various clinical decision aids are compared, as they assist in determining the level of inpatient care required and allow for a greater proportion of patients to be treated successfully as outpatients. A clinical pathway for emergency department management delineates optimal antibiotic regimens based on severity, comorbidities, and risk factors.

Case Presentations

CASE 1
A 30-year-old man with no significant medical history presents to the ED with 2 days of fever, cough productive of green sputum, and malaise…
  • Examination reveals left-sided rhonchi that do not clear with cough.
  • The patient has a heart rate of 105 beats/min and a temperature of 39.1°C. He is normotensive and has a 95% oxygen saturation on room air.
  • Labs show a WBC count of 17K, but are otherwise unremarkable. X-ray shows a left-sided retrocardiac opacity concerning for pneumonia.
  • The patient is clearly symptomatic, but he is asking to go home…
CASE 2
An 82-year-old woman with a history of mild COPD presents from an assisted living facility with 3 days of mild cough productive of yellow sputum…
  • She reports no fever/chills, chest pain, shortness of breath, orthopnea, or paroxysmal nocturnal dyspnea. Physical exam reveals normal vital signs and slightly diminished breath sounds in the right lung fields.
  • Labs, including lactic acid, are within normal limits, and x-ray shows a right-sided infiltrate consistent with pneumonia.
  • The patient’s daughter is concerned about the risk for an adverse outcome, but the patient says she would like to return to her assisted living facility…

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