Correct!
4. 1 or 3
Intubation or noninvasive ventilation is a clinical decision. There are some worrisome signs. His respiratory rate is 40 and even a young health man cannot sustain this for a prolonged period of time. One might expect his PaCO2 to be low given his respiratory rate, however it is normal. This suggests that he might be tiring. Bronchoscopy with bronchoalveolar lavage without a stable airway is risky in this patient. In this case he was intubated and transferred to the ICU.
Further history was obtained from his family. Of note that he had a +PPD but was being treated for latent tuberculosis with isoniazid. There was a questionable history of penicillin allergy. He was empirically treated with azithromycin and aztreonam.
What should be done next? (Click on the correct answer to be directed to the fourth of 6 pages)