Hi, we’re gonna be talking about pneumonia and pulmonary infections
and how to workup and evaluate for these in the emergency department.
So, we’re gonna start out by talking about a case study.
So, a 55-year-old woman comes to the emergency department
with a productive cough, fever, and shortness of breath.
Her past medical history is significant for diabetes and hypertension.
So, whenever someone comes in with these complaints,
we always think about what’s on our differential of consequence.
That’s our first thing we think about in the ED.
Now, on our differential of consequence is pneumonia, possibly a viral illness,
possible a PE, pericarditis or myocarditis as possibilities, and in this situation,
we’re gonna be talking about pneumonia primarily.
We’ll also be touching a little bit on viral illnesses
because there can be a little bit of overlap there as well
when we’re thinking about these concepts.
So, thinking about pulmonary infections.
What are the things that patients who have a pulmonary infection
present with when they come to the emergency department?
So, the classic symptoms, and keep in mind,
I know I’ve sort of stressed this in the past that not every patient
will present with these classic symptoms.
Patients I say don’t always read the book.
They don’t always say we’re gonna come in complaining of the most
classic things but these are – this is what we think about
when we think about patients coming in with pneumonia.
So, we think about a productive cough.
So, when someone coughs, they bring up stuff that's white or yellow,
or whatever color it might be.
We think about patients complaining about shortness of breath,
of reporting a fever, or having a fever in the emergency department,
or feeling generally tired.
Other symptoms that patients may experience are chest pain.
Sometimes it’s a pleuritic chest pain and what that means
is that when someone takes a deep breath in, that it hurts more.
And then, hemoptysis is something else that patients can present with.
And hemoptysis is when you cough and you see some blood in your sputum.
The other thing to remember that’s really important about pneumonia
is this is one of the big infections that can lead to sepsis.
Sepsis is basically when you have infection or bacteria in your bloodstream
that causes a lot of physiologic changes including low blood pressure,
elevated heart rate, and patients who have sepsis have a very high rate of mortality.
So, it’s very important that when we hear patients are coming in
with these symptoms and we’re concerned about pneumonia,
one of the key things that we know that helps in sepsis is getting treatment
and evaluation started as quickly as possible.
So, when we’re worried about this and our patients have these
classic symptoms as well as some vital sign changes,
we wanna go ahead and get on top of this patient right away.
We wanna make sure that they’re getting their treatment
and their evaluation as rapidly and quickly as we possibly can.