1 infec 79 - tabish60102

[ArchivalUser]

A 62-year-old man is evaluated in the emergency department because of a 3-day history of fever, progressive dyspnea, and cough. Medical history is significant for hypertension, coronary artery disease, and a myocardial infarction 3 years ago. Current medications are atenolol, lisinopril, atorvastatin, and low-dose aspirin.

On physical examination, the patient appears to be in respiratory distress. Temperature is 39.4 °C (103 °F), pulse rate is 120/min and regular, respiration rate is 24/min, and blood pressure is 88/60 mm Hg. Arterial oxygen saturation is 82% by pulse oximetry with the patient breathing room air. Scattered crackles and rhonchi are heard throughout both lung fields. A chest radiograph shows patchy infiltrates in the right upper and lower lobes and left lower lobe.

Sputum and blood cultures are obtained, intravenous fluids and supplemental oxygen are started, and intravenous levofloxacin and ceftriaxone are begun. The patient is admitted to the intensive care unit.

Which of the following should also be done at this time?

] A Request fiberoptic bronchoscopy
B Schedule a CT scan of the chest
C Order urine specimen for Legionella antigen
D Add intravenous vancomycin

[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

Correct Answer = C)
Key Points

* The decision about whether admission to an intensive care unit is needed for patients with community-acquired pneumonia is based on the presence of specific major and minor criteria.
* Because Legionella pneumonia is of particular concern in a patient with severe community-acquired pneumonia, testing for urinary Legionella antigen is indicated.

This patient with community-acquired pneumonia has underlying cardiopulmonary disease and significant arterial oxygen desaturation at the time of admission. The need to admit patients with community-acquired pneumonia to the intensive care unit is based on the presence of specific major and minor criteria. Admission is indicated in the presence of one or more major criteria (need for mechanical ventilation, presence of septic shock) or two or more minor criteria (systolic blood pressure ≤90 mm Hg, multilobar pulmonary disease, ratio of arterial blood Po2/FIo2