R. W.’s (age 56 years old) condition has continued to deteriorate. Her husband brought to her to emergency department as she was becoming confused and disoriented. R. W. has complained over the last 24 hours of pain in her left chest that intensifies with inspiration. She has a deep hacking productive cough and is using her accessory muscles to breathe. On auscultation, there are diffuse crackles and wheezing in her lower lobes bilaterally and diminished breath sounds. Sitting in a chair, she leans to her left side, holding her left chest with her right arm. Vital signs: BP 152/90, apical heart rate 112/minute and regular, respiratory rate 24/minute and somewhat labored, temperature 102.6 deg F. O2 Sat 88%. Laboratory results are WBC 17,000/mm3; neutrophils 70%, bands 15%, lymphocytes 15%. As you prepare to move her into the stretcher, she only opens her eyes when you call her name several times. She is confused and oriented to name only. She requires assistance to move to the bed. ROS: skin is warm and clammy, PERRLA, eyes are watery, mucous membranes are moist and inflamed. Mild bilateral cervical adenopathy. Breathing is labored with tachypnea. Heart rate is regular rate and rhythm and normal
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