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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/one-pager-bacterial-pneumonia.pdf
June 01, 2021 - Pneumonia in Long-Term Care
Diagnosis
Pneumonia is lung inflammation described as infiltrates on chest … ’s baseline)1
• Decreased room air pulse oximetry (or increased oxygen requirements)2
• Pleuritic chest … pain (pain with breathing) in the chest, upper abdomen, or back3
In adults, about 75% of pneumonia … positive test for a respiratory virus (e.g., influenza, COVID-19) in a resident with infiltrates on chest … decreased oxygenation2,3
• CBC to evaluate for increased white blood cell count or presence of bands9
• Chest
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/manage-resident-RTI-facilitator-guide.docx
June 01, 2021 - The team decides to obtain some laboratory tests and a chest x ray. … Mary has an elevated white blood cell count and her chest x ray shows an infiltrate in the left lower … Fevers may or may not be present, and if a chest x ray is obtained, a new infiltrate is unlikely. … A lingering cough and chest x ray abnormalities may take several weeks to improve. … Nevertheless, Francisco’s chest x ray shows a new consolidation in the right lower lobe.
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/hospitals/red-toolkit/ahcpsample.pdf
September 01, 2012 - TRAMADOL HCl
50 mg
1-2 pills
Every 6 hours
If you need it
By mouth
If you need
it for
chest … pain
Chest pain
NITROGLYCERIN
0.4 mg
1 pill every 5
minutes
(if need more
than 3 pills, call … Chest Pain
When are my appointments?
Wednesday,
August 8
at 11:30 a.m. … Pain
Noncardiac chest pain is pain that is not caused by a heart
problem. … If your chest pain gets different or worse, call your
doctor.
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/hospitals/red-toolkit/ahcpsample.docx
September 01, 2012 - Headache
TRAMADOL HCl
50 mg
1-2 pills
Every 6 hours
If you need it
By mouth
If you need it for
chest … pain
Chest pain
NITROGLYCERIN
0.4 mg
1 pill every 5 minutes
(if need more than 3 pills, call 911) … Chest Pain
When are my appointments?
Wednesday,
August 8
at 11:30 a.m. … Pain
Noncardiac chest pain is pain that is not caused by a heart problem … · If your chest pain gets different or worse, call your doctor.
· Take your medicines as prescribed
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/cap-one-pager.pdf
September 01, 2022 - Diagnosis
Symptoms: Cough (generally with increased sputum), fevers, shortness of breath, or chest … community-acquired pneumonia (CAP), it is reasonable to initiate
antibiotics without obtaining a chest … Order a chest x ray if the diagnosis is uncertain, the patient has
hypoxia or significant dyspnea, or … not improve 48–72 hours after initiating antibiotic therapy.1,2
• If no infiltrate is present on chest
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-213-section-5-table-4.pdf
January 01, 2012 - Reductions in the
frequency of acute chest syndrome and
transfusions were also noted. … spleen function, subjects receiving 2011; 377(9778): 1663‐
the drug had few episodes of pain, acute chest … adolescents are HbSS (SCA) or SCD‐S β0‐
thalassemia and frequent pain episodes,
history of acute chest … HbF levels, decreases leukocyte counts, and
decreases the frequency of episodes of pain
and acute chest … decrease
severe painful episodes, hospitalizations,
number of blood transfusions, and the acute
chest
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/manage-resident-RTI-slides.pptx
June 01, 2021 - neutrophils
Elderly woman, appears fatigued
Coughing intermittently
Few crackles at base of left lung
Chest … have increased sputum production
Diagnostic Studies:
Normal to slightly elevated WBCs
Infiltrate on chest … :
~75% bacteria, ~25% viral
Symptoms:
Cough, fever is common, increased sputum production common, chest … wall pain, tachypnea
Diagnostic Studies:
Elevated WBCs
Chest x rays show infiltrates
7
Management … X Ray8
20
Chest x ray shows new consolidation in right lower lobe
WBC count 12,000 cells/µL
Image courtesy
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Lavelle_33.pdf
March 12, 2008 - Create
• Chest pain worksheet to match the standing orders. … He’s been
having chest pain for hours and just wouldn’t go to the hospital.” … Use chest pain standing orders if MD not
available. … If no pulse, begin chest compressions. … and chest pain
worksheet continue to be used.
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/respiratory-facilitator-guide.pdf
November 01, 2019 - About half of patients have chills or tachypnea and a
third will complain of chest pain. … Crackles are generally
heard upon chest auscultation. … The
absence of an infiltrate on chest x ray generally
excludes the diagnosis of CAP. … Chest x
rays should be obtained to evaluate for a new infiltrate. … A lingering cough and chest x-ray abnormalities may
take several weeks to improve.
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www.ahrq.gov/antibiotic-use/ambulatory-care/best-practices/bronchitis.html
November 01, 2022 - Acute Bronchitis (Chest Cold) – Patient and Family Member Handout (English) (DOCX, 243 KB)
Acute Bronchitis … (Chest Cold) – Patient and Family Member One-Page Handout (Spanish) (DOCX, 470 KB)
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www.ahrq.gov/hai/clabsi-tools/appendix-5.html
March 01, 2018 - : ____________ Date/Time:____________
A minimum of 5 supervised successful procedures in both the chest … sterile gown and gloves)
Properly position to prevent air embolism
For chest
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www.ahrq.gov/patients-consumers/diagnosis-treatment/hospitals-clinics/10-tips/index.html
June 01, 2018 - Insert chest tubes safely. Remember UWET when inserting chest tubes. … A free 11-minute DVD provides video excerpts of 50 actual chest tube insertions to illustrate problems … Ordering information for Problems and Prevention: Chest Tube Insertion (AHRQ Publication No. 06-0069 … -DVD) is available at http://www.ahrq.gov/research/findings/factsheets/chest-tube-insertions.html .
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/cap-slides.pptx
September 01, 2022 - ., Streptococcus pneumoniae, Haemophilus influenzae):
Cough, shortness of breath, fevers, fatigue, chest … for chest x ray
Diagnosis of CAP unclear
Hypoxia
Significant dyspnea
No improvement after 48–72 hours … of antibiotic therapy for CAP
If no infiltrates present on chest x ray, CAP is unlikely
8
CAP
AHRQ … The diagnosis of pneumonia requires a chest radiograph (x-ray)—yes, no or sometimes? … Thorax. 2003 Mayl58(5):377-82. PMID: 12728155.
Aujesky D, Fine MJ.
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/respiratory-slides.pptx
November 01, 2019 - production (90%)
Fever (>90%)
Less common in older patients
Chills (50%)
Tachypnea (45%)
Pleuritic chest … pain (30%)
Crackles during chest
auscultation
5
CAP
AHRQ Safety Program for Improving Antibiotic … Use – Acute Care
5
Moment 1: Diagnosing CAP
If common signs and symptoms are present, obtain chest … Tests1
Test Notes
Blood cultures Recommended for patients who are moderately to severely ill or with chest … Thorax. 2008 May;63(5):415-22. PMID: 18234905.
Murray HW.
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www.ahrq.gov/sites/default/files/wysiwyg/takeheart/training/hycr-tools-resources-guide.pdf
June 02, 2025 - Keep your head straight, back straight and chest up. … Standing Chest Fly (Mid) With Tube Bands
Area Targeted: Middle Chest
The Standing Chest Fly From … Keep your back straight, head straight and chest up. … Standing Chest Press With Tube Bands
Area Targeted: Middle, Upper Chest
The Standing Chest Press … Keep your back straight, head
straight and chest up.
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www.ahrq.gov/sites/default/files/wysiwyg/news/events/ahrq-research-summit/brady-summit2016-breakout.pdf
September 28, 2016 - reducing diagnostic errors
Measurement Study Example
Hospital Admission
After ED discharge for Chest … examine the frequency of inpatient
admissions for related symptoms after discharge
from an ED for chest … Admissions After Discharge from an
Emergency Department for Chest Symptoms
97.0%
0.2%
1.7%
0.5% … Mental
Disorder
Study Conclusions & Implications
• Admission for AMI after discharge from an ED for chest … Admissions After Discharge from an Emergency Department for Chest Symptoms
Study Conclusions & Implications
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/CAP-one-page.docx
November 01, 2019 - cough, and increased sputum production; many will also have chills (50%), tachypnea (45%), or pleuritic chest … pain (30%)
· If symptoms are present, a chest x ray (CXR) should be obtained; the absence of an infitrate … makes the diagnosis of community-acquired pneumonia (CAP) highly unlikely
· Infiltrate on CXR or chest … Thorax. 2008 May;63(5):415-22. PMID: 18234905.
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/family-RTI.pdf
June 01, 2021 - • If she has a cough without fever or difficulty breathing, she may have a
chest cold, caused by … • If needed, we can check her bloodwork and get a chest x ray.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/clabsitools/clabsitoolsap5.doc
June 02, 2025 - : ____________ Date/Time:____________
A minimum of 5 supervised successful procedures in both the chest … sterile field, use sterile gown and gloves)
Properly position to prevent air embolism
· For chest
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www.ahrq.gov/sites/default/files/2024-12/selker-report.pdf
January 01, 2024 - Though age and sex are fairly straightforward variables to enter, the patient’s chest
pain status is … The chest pain status variable for the current ACI-TIPI electrocardiograph identifies the
absence or … presence of chest pain as a primary or secondary reason for coming to the ED. … This was done by including those patients with a presenting symptom of chest
pain, as documented in … the ED registration system, or an ACI-TIPI chest pain status of primary or
secondary.