Pneumonia: The Daily PANCE Blueprint

Home Pneumonia: The Daily PANCE Blueprint

Pneumonia: The Daily PANCE Blueprint

A 32-year-old male with no prior medical diagnoses presents to the ER in February 2022 complaining of diarrhea, worsening dyspnea, congestion, and fatigue x 4 days. He is hypoxemic (SpO2 88% on RA) and tachycardic (HR 110 bpm). He has labored breathing. Labs show elevated liver enzymes, elevated d-dimer, and elevated ferritin. He is unvaccinated for COVID-19. CTA chest demonstrates no pulmonary embolism but diffuse bilateral ground-glass opacities. Which of the following is the most appropriate management option for this patient?

A. Admit for intravenous antibiotics
B. Give oxygen, start on dexamethasone, and admit
C. Albuterol treatments and then send home
D. Aggressive fluid resuscitation, IV antibiotics, admit
E. Emergently intubate and start high-dose steroids

Answer and topic summary

The answer is B. Give oxygen, start on dexamethasone, and admit

The patient has a viral pneumonia (more specifically COVID-19 pneumonia). Common clinical features include fever, hypoxemia, cough, dyspnea, diarrhea, headache, elevated LFTs, elevated CRP, elevated ferritin, and elevated d-dimer. Treatment for this specific patient includes oxygen, dexamethasone 6 mg x 10 days (per RECOVERY trial), possibly tocilizumab if CRP is elevated, +/- remdesivir (although it is contraindicated in AKI and has unclear/mixed benefits). You should avoid giving these patients copious amounts of fluid. Antibiotics are not indicated unless you suspect a superimposed bacterial infection.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Pulmonary ⇒ Pneumonia (PEARLS) ⇒ Viral pneumonia

Also covered as part of the General Surgery Rotation, Family Medicine Rotation, Emergency Medicine Rotation, Internal Medicine Rotation, and Pediatric Rotation EOR topic lists.

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