Mrs. Tom, a 79 year old female presents to the ER with complaints of a persistent productive cough, fatigue, fever and shortness of breath. Mrs. Tom reports that she has had a persistent cough and shortness of breath with activity for several months.Ā She was given a prescription for antibiotics for a presumed infection 4 weeks ago, with only slight improvement in symptoms.Ā Her past medical history includes stroke 6 months ago.Ā She also smokes 20 cigarettes per day.Ā On exam, she has a fever with decreased lung sounds bilaterally to auscultation with the right side slightly more obvious than the left.Ā She is obviously short of breath and presents with 4-word dyspnea.Ā Her vital signs are BP 110/70, HR 99, SP02 94% on 4 L of oxygen via nasal prongs, Temp 38.9