Because of somnolence he is intubated. Just prior to intubation he is given 2 mgm of IV midazolam.
Exam reveals distant breath sounds bilaterally.
Bag him until chext x-ray can determine if there is pneumothorax or atelectasis. Re-start mechanical ventilation with a lower inspiratory flow rate. The large airways are generally not affected. Pathology shows granulomas and in late stages may show fibrosis. Silo Filler's disease, one example of HS, is due to inhalation of molds that grow in poorly-ventilated silos.