When should I consider referring a patient with suspected Pneumocystis pneumonia to secondary care?

Consider referring a patient with suspected Pneumocystis pneumonia (PCP) to secondary care if they show signs of severe illness or respiratory compromise.

Specifically, referral should be considered if the patient has any of the following clinical features: respiratory rate ≥24 breaths per minute, heart rate >100 beats per minute, systolic blood pressure ≤90 mmHg, oxygen saturation <90% on room air, abnormal mental status, or inability to eat without assistance.

These criteria align with severity indicators used in pneumonia management to identify patients who require hospital assessment and more intensive treatment.

Additionally, if the patient’s condition is deteriorating or not improving as expected after initial treatment, urgent referral to secondary care is warranted.

Use clinical judgement alongside these signs, considering comorbidities and overall risk, to decide on referral.

Note that while the provided guidelines do not explicitly mention Pneumocystis pneumonia, these severity criteria for pneumonia in adults are applicable to suspected PCP cases given its clinical severity and need for specialist management.

Therefore, any patient with suspected PCP exhibiting these severity signs or clinical deterioration should be referred promptly to secondary care for further assessment and management.

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