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Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia
Published on: May 6, 2014
Emergency department management of pneumonia
1Department of Emergency Medicine, UCLA Medical Center, Sylmar, California 91342, USA.
Abstract:
Many patients with pneumonia, especially those who are more severely ill, have their first medical contact in the emergency department. Pneumonia is usually diagnosed with appropriate signs and symptoms, although these can be lacking in the very young or the old. Gram stain and culture are seldom useful. The choice of appropriate antibiotic is usually determined by degree of illness and microbiological epidemiology. The most important decision made in the emergency department is whether to admit the patient with pneumonia to hospital; this decision can be aided by the use of clinical predictive rules. Initial treatment of pneumonia includes supportive care as needed (oxygen, intubation and bronchodilators) and an empirically chosen antibiotic. Appropriate choices include macrolides and azalides for low risk out-patients, and either a combination cephalosporin and macrolide or an extended spectrum fluoroquinolone in anticipation of drug-resistant Streptococcus pneumoniae for high risk out-patients and in-patients.
Insights
Emergency departments manage pneumonia, guiding hospital admission decisions with predictive rules. Initial treatment involves supportive care and antibiotics like macrolides or fluoroquinolones based on patient risk.
Area of Science:
- Medicine
- Infectious Diseases
- Pulmonology
Background:
- Pneumonia management often begins in the emergency department (ED), particularly for severe cases.
- Diagnosis relies on clinical signs and symptoms, which can be atypical in pediatric and geriatric populations.
- Microbiological diagnostics like Gram stain and culture have limited utility in routine pneumonia diagnosis.
Purpose of the Study:
- To outline the critical decisions and initial management strategies for pneumonia patients presenting to the emergency department.
- To highlight the role of clinical predictive rules in determining hospital admission for pneumonia.
- To provide guidance on appropriate empirical antibiotic selection based on patient risk stratification.
Main Methods:
- Review of diagnostic approaches for pneumonia in the ED setting.
- Discussion of factors influencing hospital admission decisions, including clinical predictive rules.
- Analysis of current recommendations for empirical antibiotic therapy based on illness severity and local epidemiology.
Main Results:
- The decision to admit pneumonia patients to the hospital is a key ED intervention, supported by predictive rules.
- Empirical antibiotic choice depends on illness severity and epidemiological data, with specific recommendations for different risk groups.
- Supportive care, including oxygen and respiratory support, is integral to initial pneumonia management.
Conclusions:
- Emergency department physicians play a crucial role in the initial assessment and management of pneumonia.
- Clinical decision-making in the ED should incorporate predictive tools to optimize hospital admission.
- Antibiotic selection must be guided by risk assessment and the need to cover common and resistant pathogens, such as drug-resistant Streptococcus pneumoniae.
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