A 52 year-old male presents in clinic with abrupt onset of rigors, high fever, and dyspnea. He reports pain with breathing an productive cough with blood-streaked sputum X 3 days. Medical History includes hypertension. Medications include an Ace antihypertension. Temp 103.5 degrees F, Pulse 120 and regular, Respiration Rate 28.
Patient is coherent but appears ill.
Skin is hot, diaphoretic, without rash. ENT is unremarkable. Lymph nodes reveal no adenopathy. CV rate is increased, rhythm regular, no murmurs, no carotid bruits, no edema of lower extremities. Chest wall is tender with palpation.