At the time of transfer, the patient was afebrile, normotensive, tachycardic (110 beats/min) and tachypneic (30 breaths/min). Oxygen saturation of arterial blood measured by pulse oximetry was 93% with the patient breathing room air. She appeared uncomfortable, anxious, and diaphoretic with pleuritic and abdominal pain. Her neck was stiff, and she could open her jaw approximately 2 cm. She had hiccups and moderate, generalized rigidity of the abdominal muscles. Mild erythema, edema, tenderness, and purulent discharge surrounded a 4-cm laceration of the right knee. Laboratory data included an elevated WBC count of 15.4 × 103 cells/μL and a sodium concentration of 128 mEq/L. The other laboratory data were normal. Initial pH, Paco2, and Pao2 were 7.40, 38 mm Hg, and 75 mm Hg, respectively, with the patient breathing supplemental oxygen of 2 L/min through a nasal cannula. The levels of cardiac enzymes were normal. Electrocardiography revealed sinus tachycardia. A chest radiograph was normal. A lower-extremity Doppler duplex ultrasonographic evaluation, repeat chest CT angiography, and a pulmonary angiogram did not demonstrate deep venous thrombosis or pulmonary embolism. A CT scan of the head and neck demonstrated no evidence of cervical spine fracture or intracranial abnormality. Therapy with cephalexin was discontinued, and therapy with cefazolin was started.