When to Order a Chest X-Ray
If you think this might be pneumonia:
• Unless impossible in your setting, you should do a chest x-ray to confirm the presence of a new consolidation.
• Crackles +/- wheezes are not adequate to determine if there is pneumonia. What has a better correlation with pneumonia is egophony and asymmetric chest expansion.
But remember...
- If there is no vital signs abnormalities and a normal lung exam, you most likely don’t need a chest x-ray.
- In these cases pneumonia is quite rare.
COPD Exacerbation:
You should not consider antibiotics unless there is a clear increase in sputum purulence
AND
:
- Increase in sputum volume AND/OR;
- Increased dyspnea.
Adapted from Using Antibiotics Wisely slides courtesy of Choosing Wisely Canada
