Management of severe community acquired pneumonia in the emergency department
Severe community acquired pneumonia (CAP) is a medical emergency and thus, it should be managed as such. Prompt recognition of severe CAP and timely, appropriate initiation of antimicrobials and execution of resuscitation bundles in the emergency department (ED) will save lives and reduce the burden of disease in hospital and patient morbidities downstream. However, these are complex multifaceted interventions which require deliberate planning and design, careful implementation sustained by close monitoring and maintenance efforts. Widespread implementation of these measures is further hampered by uncertainties, controversies and debates between researchers on the evidential basis for the precise strati cation of CAP disease severity and the relative merits of different treatment options. Physicians in the ED however should not hesitate to act but apply the best available evidence in the local settings heuristically with pragmatic interventions to improve critical outcomes for patients with severe CAP. In this regard, we have performed a qualitative, aggregative type review of the management of severe CAP in the ED concluding each section with a realist synthesis. We describe the implementation of resuscitation bundles in the management of severe CAP in the ED and the process of sustaining such an enterprise.