Tasty Morsels of EM 123 – #FRCEM Pneumonia

9 Aug

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here.

(Featured image: James Heilman MD on Wikimedia Commons, CC License)

Hopefully a brief one from the NICE 2014 guidance. I don’t find it the most helpful guidance but worth knowing.

What tests should we do?

  • the guidelines do allow for the clinical diagnosis in primary care without a CXR
  • for moderate/severe
    • take blood and sputum cultures (though we know esp blood cultures are rarely helpful)
    • ‘consider’ urine legionella and pneumococcus
  • the say ‘consider’ CRP for monitoring

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How do we assess severity?

  • they suggest CURB-65
  • (I have lots of issues with the CURB65 but it’s in the guideline)
  • 2 or more for hospital treatment but they allow clinical judgement to guide this

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How do we treat it?

  • for low severity use single antibiotic for 5 days
  • systems should be in place for diagnosis and antibiotics within 4 hours
  • for moderate and severe
    • ‘consider’ 7-10 days dual antibiotic
      • amoxicillin/macrolide for moderate
      • ‘beta lactamase stable’ (things like co amoxiclav and common cephalosporins) antibiotic/macrolide for severe

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What should we tell patients to expect?

(this is practice changing for me…)

  • 1 week: fever should have resolved
  • 4 weeks: chest pain and sputum production should have substantially reduced
  • 6 weeks: cough and breathlessness should have substantially reduced
  • 3 months: most symptoms should have resolved but fatigue may still be present
  • 6 months: most people will feel back to normal.

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