Case 2

John is a 66-year-old smoker brought to the ED by ambulance. He complains of shortness of breath, left-sided pleuritic chest pain and a productive cough.

He has stable angina and congestive cardiac failure. His medications include aspirin, isosorbide mononitrate, lisinopril, bisoprolol, simvastatin and aspirin and he has no known allergies.

On examination, his heart sounds are normal, there is decreased expansion of his left chest, dullness to percussion of his left lower zone and a few crepitations can be heard in the same area. He is fully alert.

His ECG shows no evidence of acute ischaemia. His observations, chest radiograph and blood results are shown below.

Observations	Chest radiograph (click to view)	Blood results
Pulse 56 regular BP 140/80 mmHg RR 26 per minute Temperature 37.8 °C Oxygen saturation 91% on room air 96% on 2 L/min. of oxygen		Hb 12.5 g/dl WCC 11 (x 109/l) CRP 92 mg/l Urea 5.8 mmol/l Creatinine 114 µmol/l

Q: Using the information provided, what is John's CURB-65 score?

CURB-65 Score: score 1 point for each of the following components:

• Confusion (new onset disorientation in time, place or person) or an AMT score of (≤8/10)
• Urea: >7 mmol/l
• Respiratory rate: ≥ 30/min
• Blood pressure: low blood pressure (systolic BP <90 mm Hg or diastolic BP ≤60 mm Hg)
• Age: ≥65 years

Is the following statement true or false?

Since a CURB-65 of 1 is associated with a low mortality risk the most appropriate action would be to discharge John with antibiotics, advice and GP follow up.

Is the following statement true or false?

Although John is to be admitted the preferred route for antibiotic administration is orally in this case.

Is the following statement true or false?

If John had pneumonia on the background of influenza a different antibiotic regime may be indicated.