Within the Inflamed Lung

Wednesday, August 27, 2008

Introduction

On a cold winter night, you and your partner are dispatched to the home of a 79-year-old male whose wife called 9-1-1 because her husband was confused and not answering questions appropriately. On arrival, you note a disheveled male in bed, dressed in pajamas, who's agitated and has pushed the bedspread onto the floor. His wife says he has been coughing for about two weeks and had a high fever this afternoon. His past medical history is only mild dementia.

When you approach him, he calms down enough to allow you to assess his vitals signs. His heart rate is 135 bpm and regular, respiratory rate is 22 bpm, blood pressure is 85 mmHg/palp, and his oxygen saturation is 91% on room air. You become more concerned. On examination, his skin and mouth appear dry, his neck veins are flat, and he has focal crackles in his right lower lobe on auscultation.

You administer oxygen 15 L by face mask, establish IV access and administer a 500 cc bolus of normal saline because of the hypotension and clear signs of dehydration. His finger-stick blood glucose reading is 145 mg/dL. You carefully move the patient onto the stretcher, down the front steps and into the ambulance. After the fluid bolus, the patient appears calmer.

Repeat vital signs are heart rate of 122, respiratory rate of 22 bpm and a systolic blood pressure of 100 mmHg. The oxygen saturation has improved to 100% with supplemental oxygen. You re-examine him; his lung exam remains unchanged. Your partner starts the ambulance, and you're on your way to the emergency department (ED). You breathe a sigh of relief that the vitals have improved, but your clinical concern is that this patient may have pneumonia