A middle-aged woman with a medical history of COPD on 3 L of home oxygen, idiopathic thrombocytopenic purpura status postsplenectomy, and hypothyroidism presented to the ED with fever and change in mental status. On presentation, she was febrile (temperature 39.6°C), tachycardic (heart rate, 130-140 beats/min), and hypotensive (blood pressure, 89/57 mm Hg). Her respiratory rate was 24 to 26 breaths/min and oxygen saturation of 84% on room air, which improved to 95% on 40% Venti mask. Physical examination revealed a middle-aged woman who was unresponsive, moaning, and grunting. She had labored breathing with bilateral crackles. Cardiac examination revealed tachycardia with a collapsed jugular vein.