Pneumonia admission

Patient can present with SOB, altered mental status, fevers, coughing, generalized weakness etc.


Routine Labs, CXR, EKG

Nebulization if necessary


IV Fluids if required

Blood Cultures

First dose of IV antibiotics-Ceftriaxone 1gm IV, and Azithromycin 500mg IV  or Levofloxacin IV based on renal function

CURB-65 Pneumonia Severity Score: Confusion (abbreviated Mental Test Score <=8) (1 point) Urea (BUN > 19 mg/dL or 7 mmol/L) (1 point) RR > 30 per minute (1 point) BP: diastolic < 60 or systolic < 90 mmHg (1 point) Age >= 65 yrs (1 point) More than 2 points==> Higher risk  


Continue antibiotics

Sputum C/S


Nebulization if short of breath

Urine for pneumococcal antigen, Urine for Legionella antigen

ABG if very short of breath

IR consult if pleural effusion for possible thoracentesis–>Sometimes, after thoracentesis, pneumothorax may result in which case a Chest Tube may need to be placed. Consult General Surgeons or Interventional radiology.

Common Tests to order on Pleural Fluid: pH, LDH, Protein, Glucose, Gram Stain, C/S, Cell Count with Diff, Cytology

Modified Light’s CriteriaPleural fluid is Exudate if Pleural fluid 1. Serum Protein ratio>0.5 2. Serum LDH ratio >0.6 3. LDH >2/3 upper limit of Serum LDH 4. Protein >30gm/L If only one criteria is met, calculate Fluid to Serum Albumin Gradient If >12g/L, Consider Transudate  

Make sure the patients are not short of breath prior to discharge. Usually 24-48hr of iv antibiotics may be sufficient.