Chest Infection Consultation Aid
Ph.

Chest Infection Consultation Aid

A structured minor-illness template for adults presenting with acute cough or suspected lower respiratory tract infection. It walks the assessment, prompts the red flags, calculates CRB-65 when pneumonia is suspected, and drafts a paste-ready note.

Clinical logic sourced from NICE CKS Chest infections (adult), NICE NG250 & QS110 (CRB-65), NG120 (acute cough antimicrobial prescribing) and NG12 (suspected cancer referral).

Decision support, not a decision. This aid structures documentation and surfaces recognised thresholds. It does not replace your clinical judgement, examination, or local antimicrobial and admission guidance. CRB-65 applies only once a clinical diagnosis of community-acquired pneumonia is being considered. Nothing entered here is stored or transmitted; the page holds data in memory only and clears on reset or refresh.

01

Presentation & history

Acute respiratory infection is an illness present for 21 days or less with cough, sputum, breathlessness, wheeze, fever or chest discomfort, and no alternative explanation.

Chronic cough: outside the acute infection pathwayA cough over 8 weeks is chronic. Reassess the diagnosis rather than treating as infection: consider asthma, reflux and ACE inhibitor cough. Arrange a chest X-ray and apply the urgent lung cancer pathway if aged 40 or over or other features are present.NICE NG12; CKS Cough
Subacute coughOften post-infective and settling, but broaden the differential and reassess if it is not improving as expected.
Blood-stained sputum is haemoptysisThe differential extends beyond infection: PE, TB, bronchiectasis and malignancy. Arrange a chest X-ray, screen for TB risk, and apply the urgent lung cancer pathway if aged 40 or over. Tick the haemoptysis red flag below if this changes disposition.NICE NG12
02

Observations

Record the baseline set before deciding on next steps. Respiratory rate, blood pressure, age and confusion feed the CRB-65 below; oxygen saturation is assessed separately.

°C
bpm
/min
%
mmHg
mmHg
03

CRB-65 severity

One point each: new confusion, respiratory rate 30/min or more, blood pressure (systolic under 90 or diastolic 60 or less), age 65 or over. Use alongside clinical judgement once pneumonia is suspected.

0
Low risk
Home-based care usually appropriate.
Confusion RR ≥30 Low BP Age ≥65
04

Red flags & escalation

Any single item here overrides the CRB-65 band and points toward urgent assessment or admission. Tick what is present.

Sepsis and respiratory compromise
Suspicion of a different or serious diagnosis
Consider pulmonary embolismThink PE where breathlessness is out of proportion to the chest signs, or with tachycardia, hypoxia, a unilateral swollen calf, or VTE risk factors (immobility, recent surgery, malignancy, oestrogen). Assess a Wells score and consider D-dimer or CTPA. A sudden sharp pain with breathlessness also raises pneumothorax.
Haemoptysis: widen the differentialBeyond pneumonia, consider PE, TB, bronchiectasis and lung cancer. Assess the volume, arrange a chest X-ray, screen for TB risk, and apply the urgent lung cancer pathway if aged 40 or over.NICE NG12
Manage on the underlying disease pathwayIf this is an exacerbation of COPD, asthma, bronchiectasis or heart failure, treat per that condition rather than as simple bronchitis. Consider rescue therapy, cultures where relevant, and the person's usual management plan.
05

Working impression

Acute bronchitis is airway inflammation, usually self-limiting over 1 to 3 weeks. Pneumonia is more likely with focal chest signs, high fever, marked systemic upset or hypoxia.

06

Management & antibiotic decision

For uncomplicated acute cough or bronchitis, an antibiotic is not routinely needed. Consider a back-up or immediate antibiotic if the person is systemically very unwell, at higher risk of complications, or has significant comorbidity. Confirm choice against local formulary.

07

Safety netting & follow-up

Set clear return criteria and consider whether a persistent or high-risk cough warrants imaging.

08

Consultation note

Generates a structured summary from the fields above. Review before pasting into the record.

Your note will appear here.

References. NICE CKS, Chest infections (adult), Diagnosis / Assessment. NICE NG250 Pneumonia in adults, and QS110 (CRB-65 mortality risk). NICE NG120, Cough (acute): antimicrobial prescribing. NICE NG237, Suspected acute respiratory infection in over 16s. NICE NG12, Suspected cancer: recognition and referral. Verify against current guidance and your local antimicrobial formulary before acting.

Note copied