The patient was in obvious respiratory distress and denied having headaches, visual changes, sore throat, cough, chest pain, abdominal pain, dysuria, nausea, vomiting, myalgia, or rash. His vitals in the ED were temperature of 36.3°C; heart rate, 157 beats/min; BP, 71/49 mm Hg; respiratory rate, 22 breaths/min; and peripheral capillary oxygen saturation, 75% on room air. Auscultation revealed diffuse crackles in all lung fields. Petechiae were present bilaterally on the upper extremities. The patient’s abdomen had normal bowel sounds and was soft and nontender. The rest of the physical examination was unremarkable.