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 Case #34 "Time is Money!"
by Charlene Babcock Irvin, MD
A 77 y/o female presents with chief
complaint of weakness. She has had no
appetite for 2 days, and also notes some
shortness of breath. She also has a cough
with yellow/brown sputum, and some nausea
but no vomiting. She denies chest pain,
abdominal pain, diarrhea, dysuria, fevers,
or rash. She has had some chills. Her
daughter notes that she seemed occasionally
confused for the past 2 days, and noted that
when she walked in from the parking lot, she
was confused as to why she was at the
hospital, until reminded.
PMH: MI 3 yrs ago (has a stent). HTN, NIDDM,
stroke 4 years ago
SH: lives at home, doesn’t smoke, drinks
alcohol socially
Medications: Lopressor, Actos, aspirin
PE: Elderly female in no acute respiratory
distress
RR=28, HR=90, BP=100/50, Sat 93% on room
air, Oral temp=102F
HEENT: Dry mucus membranes, otherwise normal
Neck Supple, no JVD
Heart: RRR, no murmur, no gallop
Lungs: Clear bilaterally. No wheezing, no
rales. Decreased breath sounds at right
base.
Ext: Pulses normal, no rash, no edema
Neurologic: Normal, no significant residual
from previous stroke. She is not confused
now.
1. How did the ‘Antibiotic in 4 hour’
movement begin? Should you give this patient
antibiotic now?
2. Should this patient be admitted (clinical
pneumonia), and what is the risk of death in
this patient? The only abnormal lab test was
a BUN of 32 and a glucose of 225.
Additionally, when the patient walked, her
saturation dropped to 90%.
3. How likely is the CXR to show an
infiltrate when the patient has pneumonia?
Click here for answers and to respond
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