Community Acquired Pneumonia with High NEWS2

Question

A 68-year-old woman is referred to MAU by her GP with a 4-day history of cough productive of green sputum, fevers, and increasing breathlessness. On arrival she is confused, RR 32, SpO₂ 89% on air, HR 122, BP 92/58, temp 38.9°C, NEWS2 of 11. CXR shows right lower lobe consolidation.

Accepted Answer

This is severe community-acquired pneumonia with sepsis. I would approach with ABCDE while initiating the Sepsis 6 in parallel within the first hour. Airway: patent, talking. Breathing: 15L O₂ via non-rebreather titrated to SpO₂ 94–98%. Circulation: two large-bore cannulae, 500ml crystalloid bolus reassessed, send FBC, U&E, CRP, LFTs, clotting, blood cultures before antibiotics, VBG with lactate, and urine output via catheter. I would give empirical IV antibiotics per local policy — typically co-amoxiclav and clarithromycin, or piperacillin-tazobactam if severe sepsis. Disability: GCS (she is confused, contributing to CURB-65), glucose. Exposure: temperature, rashes. I would calculate CURB-65 — confusion, urea likely raised, RR 32, BP 92/58, age >65 — putting her at ≥3, severe CAP. Investigations include CXR (already done), ECG, urinary pneumococcal and Legionella antigens, atypical screen, and consider CTPA if PE remains a differential. ICU escalation triggers: lactate >4, persistent hypotension after 30ml/kg fluid, NEWS2 ≥7, or rising CO₂. I would inform my senior immediately, document clearly, and update the family.

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