- CXR
- If moderate-large effusion: Consider obtaining ultrasound to evaluate for size of effusion and loculated/septated effusion
- If under immunized for Hib (i.e., did not receive at least 2 doses of Hib vaccine), progression of CAP despite appropriate therapy, severely ill, or complicated CAP (i.e., large effusion, any size loculated/septated effusion, empyema, abscess, necrotic lung, pneumatocele):
- Obtain CBC w diff, lytes, blood culture (aerobic), procalcitonin
- For complicated CAP: add anaerobic blood cultures
- Consider adding: MRSA nasal swab if concern for MRSA pneumonia (abscess, cavitation, empyema, or necrosis), viral testing if virus is circulating (influenza, SARS-CoV-2 PCR, RSV; BIOFIRE only if concerned for pertussis, atypical pneumonia, or if result would change antibiotic management; see Appendix A)
Note: If signs of sepsis, exit pathway and follow Septic Shock Clinical Pathway