AED PROTOCOL FOR THE MANAGEMENT OF SUSPECTED COMMUNITY ACQUIRED PNEUMONIA

Definition of CAP (in the absence of CXR) Symptoms of an acute LRTI ( cough + at least 1 other) New focal chest signs on examination At least 1 systemic feature No other explanation for the illness

Symptoms: cough, fever, SOB, sputum production, pleuritic chest pain Signs: tachypnoea, tachycardia, abnormal chest findings Initial assessment vital signs: BP, PR, RR, T, SPO2 ./`e./`eah CXR

Abbreviated Mental Test Age DOB Time Year Hospital Name Recognition of 2 persons Recall address Date of Independence Name of Prime Minister Count backwards 20- 1
*score either 0 or 1 for each feature

*CRB or CURB- 65 severity assessment + clinical judgment Confusion: new mental state confusion defined as an Abbreviated Mental State score <8 Urea: >7 mmol/L Respiratory Rate: >30 breaths/min Blood Pressure: SBP <90mm Hg or DBP <60 mmHg Age >65 years

*1 point for each feature

Low severity (score= 0) Other reasons for admission present: unstable co-morbidity or poor social circumstances
YES NO

Moderate severity (score = 1-2) IVA- CBC, U+E, LFT, CRP, ABG, Blood Cx ECG O2 to maintain SPO2 > 94% Augmentin 1.2 mg IV Refer to TMU

High severity (score = 3-5) Senior review IVA- CBC, U+E, LFT, CRP, ABG, Blood Cx ECG O2 to maintain SPO2 > 94% Augmentin 1.2g V Refer to TMU Consider ICU referral

Refer to TMU/ Review in AED in 48 hrs Amoxicillin 500 mg po/IV tds x 7 days N OR Clarithromycin 500 mg po bd x 7 days

Allow home Amoxicillin 500 mg tds x 7 days OR Clarithromycin 500mg po bd x 7days

Alternative antibiotic for moderate and severe: 3rd gen cephalosporin plus macrolide

POINTS TO NOTE

1. These guidelines are not aimed at patients with known predisposing conditions, such as cancer or immunosuppression, with pneumonia, admitted to specialist units such as oncology, haematology, palliative care, infectious or AIDS units.

2. Repeat CXR after 6 weeks for those patients with persistent symptoms or who are at a higher risk for malignancy whether or not they have been admitted to hospital

Pulchan/ De Freitas 2013

References 1. British thoracic society. Guidelines for the management of community acquired pneumonia in adults. Update 2009. A quick reference guide [internet]. UK: British Thoracic Society. Available from: http://www.britthoracic.org.uk/Portals/0/Clinical%20Information/Pneumonia/Guidelines/CAPQuickRefGuide-web.pdf

2. Mandell L, Wunderinck R, Anzueto A, Bartlett J, Campbell D, Dean N et al. Infectious diseases society/ American thoracic society consensus guidelines on the management of community acquired pneumonia in adults. Clin Infect Dis [internet]. 2007 [cited 2012 Dec 20th] 44:S27-72. Available from: http://cid.oxfordjournals.org/content/44/Supplement_2/S27.full.pdf+html 3. Tintinalli J. Tintinallis emergency medicine. A comprehensive study guide. 7th ed. USA: McGraw- Hill Companies; 2011