定義
-社區肺炎(CAP):未住院或住院未滿48hrs內發生
-院內肺炎(HAP):住院48hrs後，或上次住院結束後14天內發生
-呼吸器相關肺炎(VAP):使用呼吸器48小時以後產生的院內肺炎
-健康照護相關肺炎(HCAP):90天內住院超過2天 or 30天內接受過針劑抗生素治療 or 住在安養院或長期照護機構 or 傷口照護 or 化療 or 洗腎的病人
Diagnosis and Assessment: s/s+CXR(:star:)
-急性感染症狀(fever，體溫下降，
發抖，出汗)
+新的呼吸道症狀(cough，痰，dyspnea，肋膜痛，肺功能檢驗異常)
+/-全身性症狀(噁心，嘔吐，腹瀉，疲倦，肌肉痛，腹痛，食慾差，頭痛)
-Other common features are gastrointestinal symptoms (nausea, vomiting, diarrhea) and mental status changes. Chest pain occurs in 30 percent of cases, chills in 40 to 50 percent, and rigors in 15 percent. Because of the rapid onset of symptoms, most individuals seek medical care within the first few days
-typical(ex.S.pneumoniae
-atypical(Legionella,Mycoplasma,Clamydia,virus):presentation vary from insidious to acute.
-s/s in CAP
-Clinical and imaging feature do not distinguish typical from atypical
-On physical examination, approximately 80 percent are febrile, although this finding is frequently absent in older patients, and temperature may be deceptively low in the morning due to normal diurnal variation. A respiratory rate above 24 breaths/minute is noted in 45 to 70 percent of patients and may be the most sensitive sign in older adult patients; tachycardia is also common. Chest examination reveals audible crackles in most patients. Signs of consolidation, such as decreased or bronchial breath sounds, dullness to percussion, tactile fremitus, and egophony are present in approximately one-third.
-While the clinical features outlined above support the diagnosis of pneumonia, no clear constellation of symptoms and signs has been found to accurately predict whether or not the patient has pneumonia [5,6]. As an example, the sensitivity of the combination of fever, cough, tachycardia, and crackles was less than 50 percent when chest radiograph was used as a reference standard
-physical examination
1,觸:fremitus增加
2.扣:濁音(dull)
3.聽:crackle，支氣管呼吸音
CXR
-The radiographic appearance of CAP may include lobar consolidation and interstitial infiltrates and/or cavitation
-15% case miss(subtle infiltrate)
Therapeutic options
1.severity evaluation
-PSI
-CURB-65:門診/住院/ICU，1/2/>=3
意識混亂confusion
urea>7 mmol/L
respiratory rate>30/min
BP<90/60
大於65歲