Key Points
- Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
- Use system-specific risk tools to guide testing and disposition.
- Order high-yield tests first; escalate imaging when indicated.
- Start evidence-based initial therapy and reassess frequently.
Algorithm
- Primary survey and vitals; IV access and monitors.
- Focused history/physical; identify red flags and likely etiologies.
- Order system-appropriate labs and imaging (see Investigations).
- Initiate guideline-based empiric therapy (see Pharmacology).
- Reassess response; arrange consultation and definitive management.
Clinical Synopsis & Reasoning
For Cap Adult Management, frame the differential by acuity and pathophysiology, then align diagnostics to the leading hypotheses. Prioritize stabilization while obtaining high‑yield studies such as CBC (Inflammation/infection), Lactate (Hypoperfusion), Blood cultures (Pathogen ID). Incorporate bedside imaging and targeted labs to define severity and identify complications; synthesize results with clinical trajectory to refine the working diagnosis and disposition needs.
Treatment Strategy & Disposition
Initiate disease‑directed therapy alongside supportive care, titrating to objective response. Pharmacologic options commonly include Broad-spectrum antibiotics. Use validated frameworks (e.g., Common Regimens (Adult)) to guide escalation and site of care. Address precipitating factors, de‑escalate empiric therapies with data, and arrange follow‑up for monitoring and risk‑factor modification; admit patients with instability, high risk of deterioration, or needs for close monitoring.
Epidemiology / Risk Factors
- Immunosuppression, devices; recent hospitalization
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC | Inflammation/infection | Leukocytosis/leukopenia | |
| Lactate | Hypoperfusion | Elevated | Trend |
| Blood cultures | Pathogen ID | Positive/negative | Before antibiotics if feasible |
Common Regimens (Adult)
| Setting | Example |
|---|---|
| Outpatient healthy | Amoxicillin or doxycycline |
| Outpatient with comorbidity | Amoxicillin clavulanate plus macrolide or doxycycline |
| Inpatient non ICU | Ceftriaxone plus azithromycin |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Amoxicillin (high dose) | Cell-wall inhibition | Hours | Healthy outpatient first-line | Allergy |
| Doxycycline | 30S ribosomal inhibition | Hours | Outpatient alternative/atypical coverage | Photosensitivity; avoid pregnancy |
| Levofloxacin | DNA gyrase inhibition | Hours | Monotherapy in select cases | Tendinopathy; QTc |
| Ceftriaxone + azithro | β-lactam + macrolide | Hours | Non-severe inpatient | QT; biliary sludging |
| Amox/clav or cefuroxime + azithro | β-lactam ± macrolide | Hours | Comorbid outpatient | GI upset; QT with macrolides |
Prognosis / Complications
- Depends on host and source control; sepsis/organ failure risk
Patient Education / Counseling
- Explain red flags and when to seek emergent care.
- Reinforce medication adherence and follow-up plan.
Notes
Test for influenza and COVID based on prevalence and presentation. Encourage vaccination and smoking cessation.