Sandbox/22

Management

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 if necessary: ❑ Bronchoalveolar lavage - gram stain, culture & cytology ❑ Bronchoscopy ❑ BNP - <100 pg/mL ❑ CT ❑ Echocardiography ❑ EKG - sinus tachycardia, non-specific ST-T wave changes ❑ Lung biopsy ❑ PAWP - <15 mmHg