Emergency Department · CCS Case Walkthrough

Shortness of Breath — Community-Acquired Pneumonia

72-year-old female presents with 3 days of productive cough, fever to 102°F, chills, and progressive dyspnea on exertion.

Step-by-Step Approach

1. Assess vitals including SpO2, start supplemental O2 if needed
2. Obtain chest X-ray (PA and lateral)
3. Order CBC, BMP, blood cultures x2, sputum culture, procalcitonin
4. Calculate CURB-65 or PSI score to determine disposition
5. Start empiric antibiotics — ceftriaxone + azithromycin for inpatient
6. Order IV fluids if hypotensive or dehydrated
7. Reassess at 24–48 hours; narrow antibiotics based on culture results
8. DVT prophylaxis if admitted

Common Orders Checklist

Common Pitfalls

• ⚠Not ordering blood cultures BEFORE starting antibiotics
• ⚠Forgetting to assess severity — inpatient vs outpatient changes treatment
• ⚠Missing lactate in a potentially septic patient
• ⚠Not starting DVT prophylaxis on admission
• ⚠Using fluoroquinolone monotherapy in a patient who can tolerate beta-lactam

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