On physical examination, the patient was chronically ill appearing,
tachypneic, and using accessory muscles of respiration. His temperature
was 36.8°C, and his BP was 152/85, with a pulse of 142 beats
per minute, and respiratory rate of 32 breaths per minute.
Oxyhemoglobin saturation was 96% with the patient breathing 100%
oxygen. Findings from the head and neck examination were normal.
Examination of the patient’s heart was remarkable for a rapid rate
with no murmurs, gallops, or rubs. Lung examination revealed bilateral
course rhonchi, decreased breath sounds at the left base, and no
wheezing. On admission, his abdomen was soft, nontender, and mildly
distended with diminished bowel sounds. Well-healed vertical lower
abdominal and small horizontal scars were present. His extremities were
warm with no clubbing, cyanosis, or edema. There was no subcutaneous