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Pneumonia with emergency care plan — SCE Geriatric Medicine MCQ

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HardAcute medical carePneumonia with emergency care planSCE Geriatric Medicine

An 89-year-old care home resident is admitted with reduced mobility and poor oral intake. She has a temperature of 38.1°C, RR 24/min, oxygen saturation 93% on air and new crackles at the right base; WCC is 14.8 ×10⁹/L and CRP 126 mg/L. She has advanced dementia, Barthel score 4/20, and a ReSPECT form recommending hospital treatment for reversible illness but no ICU. What is the most appropriate management?

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Correct answer: D — Treat pneumonia with antibiotics, oxygen as needed and care consistent with the ReSPECT recommendations

The ReSPECT plan supports treatment of reversible illness while setting a ceiling of care, so antibiotics and proportionate supportive treatment are appropriate. Advanced dementia does not mean reversible conditions should be left untreated when a plan supports treatment. ICU escalation would conflict with the documented recommendations unless circumstances have materially changed. Emergency plans should guide proportionality, not replace clinical judgement.

Reference: Resuscitation Council UK ReSPECT; NICE pneumonia guidance