Pneumonia in the Covid-19 Era – Emergency Room Physician’s Perspective. Part II – Diagnosis and Therapy

Abstract

In case of suspected pneumonia, as part of the work of the physician at the Emergency Department, imaging examinations and laboratory testing, including microbiological tests, can be used to confirm diagnosis. However, all diagnostic options have their limitations. Clinical and laboratory signs are nonspecific in most patients and are frequently present in other severe conditions. Biomarkers, have more value in ruling out particular etiology of infection than in establishing a definitive diagnosis. Similarly, errors in radiological interpretation occur relatively frequently. However, despite these limitations it is important that patients at high risk of severe course of disease and death receive appropriate diagnostic and therapeutic support from the suspicion of infection. The assessing of pneumonia severity is critical to make decisions regarding patient management, in particular, it is needed to decide on: site-of-care, scope of tests needed, urgency of the therapy, type of therapy. Viruses are an important cause of pneumonia and require early recognition. As a result of the global SARS-CoV-2 pandemic, patients with clinical symptoms suggestive of pneumonia are treated with the highest attention. According to instructions by the Polish Ministry of Health, the principles of triage and separation should be adapted taking into account a suspicion of Covid-19. It is important to test patients for the presence of the virus. The indications for testing as well as virological methods vary from the beginning of the pandemic, depending on the epidemiological situation. The current pandemic makes it even more difficult to manage patients with pneumonia.