I recently completed a call for a patient with suspected pneumonia. We put the patient on CPAP and there was some improvement. We didn’t give the patient any nitro due to her having a fever and recent history of a cough so decided the best course was treating it as pneumonia. We did give the patient 8mg of dexamethasone and when we were talking about the call afterwards, we realized there could be some questioning about our decision to give dex. Our thoughts behind it were that since it was a steroid for breathing issues, pneumonia would be applicable since there can be some constriction with the infection. Her crackles were too coarse to hear any constriction and there was some confusion from staff on scene as to whether the patient had COPD or not so we decided that it would only benefit the patient. In our call review, we realized it probably would have been more prudent to call BHP since it wasn’t a clear cut situation. Just wondering what your thoughts are on this call and how we treated it. Thanks
Thank you for your question. Pneumonia is a radiologic diagnosis. Many patients who have fever and respiratory symptoms may have pneumonia or COPD exacerbation, or viral illness, or empyema, etc… There is no evidence for steroids in pneumonia except for patients who are severe, requiring mechanical ventilation or impending respiratory failure. Also, steroids will have no effect in the prehospital timeframe. Therefore I would avoid giving steroids in suspected pneumonia and leave this potential treatment decision for later.
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