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Management

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Characterize the symptoms: ❑ Chest pain ❑ Cough ❑ Cyanosis ❑ Diaphoresis ❑ Dyspnea ❑ Fever ❑ Hypotension ❑ Tachycardia ❑ Tachypnea

Patient evaluation: ❑ Obtain a detailed history: ♦ Age ♦ History of heart disease ♦ History of chest infection ❑ Examine the patient: ♦ Head/Neck - Neck veins (flat, no ↑JVP) ♦ Chest - No S3/S4, no murmurs ♦ Limbs - Hyperdynamic pulses, no edema

Urgent Labs: ❑ ABG ❑Calculate A-a gradient ❑ CBC ❑ Electrolytes ❑ BUN ❑ Creatinine ❑ CXR ♦ normal-sized heart ♦ Peripheral distribution of infiltrates ♦ Air-bronchogram (80%) Consider additional tests based on each patient's presentation: ❑ Urine electrolytes, creatinine, protein ❑ CT/MRI ❑ Renal ultrasound + doppler ❑ TSH, free T3, free T4 ❑ Serum cortisol ❑ Serum aldosterone ❑ Serum renin ❑ 24-hr urinary catecholamine & metanephrine ❑ Serum parathyroid hormone ❑ Urine and serum toxicology screen ❑ Urine pregnancy test ❑ ANA/ESR/CRP/anti-dsDNA/anti-smith/rheumatoid factor/p-ANCA/c-ANCA