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Diagnostic Approach

• Assess pneumonia severity.
  • Pay attention to vital signs, including oxygen saturation.
  • Always count the respiratory rate yourself for 1 min.
    • The single most useful clinical sign of severity is a respiratory rate of > 30/min in a person without underlying lung disease.
  • Ensure adequate oxygenation and support of circulation during the evaluation.
• Consider possible etiologies.
  
  • Carefully collect information on:
    • Travel
    • Occupational and other exposures
    • Underlying illnesses
    • Prior infections
  • Never forget tuberculosis and Pneumocystis infection as possible etiologies.
  • Consider pulmonary embolus in all patients with pleuritic chest pain.
• Perform etiologic workup.
  • Chest x-ray
  • Sputum stains and cultures
  • Blood cultures, if bacteremia is likely
  • Urine antigen tests for S. pneumoniae and Legionella pneumophila type 1 can be helpful.
  • Serology can be helpful in identifying certain pathogens.

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