General Appearance: Respiratory distress, dehydration. Note whether the patient appears septic, ill, well, or malnourished.
Vital Signs: Temperature (fever), respiratory rate (tachypnea), pulse (tachycardia), BP (hypotension).
HEENT: Tympanic membranes, pharyngeal erythema, lymphadenopathy, neck rigidity.
Chest: Dullness to percussion, tactile fremitus (increased sound conduction); rhonchi; end-inspiratory crackles; bronchial breath sounds with decreased intensity; whispered pectoriloquy (increased transmission of sound), egophony (E to A changes).
Extremities: Cyanosis, clubbing.
Neuro: Gag reflex, mental status, cranial nerves 2-12.
Labs: CBC, electrolytes, BUN, creatinine, glucose; UA, ECG, ABG.
Chest X-ray: Segmental consolidation, air bronchograms, atelectasis, effusion.
Sputum Gram Stain: >25 WBC per low-power field, bacteria.
Etiologic Agents of Community Acquired Pneumonia Age 5-40 (without underlying lung disease): Viral, mycoplasma pneumoniae, Chlamydia pneumoniae, Streptococcus pneumoniae, legionella. >40 (no underlying lung disease): Streptococcus pneumonia, group A streptococcus, H. influenza. >40 (with underlying disease): Klebsiella pneumonia, Enterobacteriaceae, Legionella, Staphylococcus aureus, Chlamydia pneumoniae. Aspiration Pneumonia: Streptococcus pneumoniae, Bacteroides sp, anaerobes, Klebsiella, Enterobacter.
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