Case 3

Anne is a 71-year-old who has been generally unwell for a few days. Her daughter called an ambulance after finding her breathless and confused. She has a history of rheumatoid arthritis and hypertension and is on bendroflumethazide, paracetamol and prednisolone. She has no known allergies.

Her ECG is normal other than a sinus tachycardia. She is disorientated in time, place and person, which her daughter says is not normal. You can hear crepitations over the right upper zone posteriorly.

Observations	Chest radiograph (click to view)	Blood results
Pulse 112 irregular BP 108/74 mm Hg RR 36/minute Temperature 38.2 °C Oxygen sats. 90% on room air 96% on 15 L/min oxygen		Hb 12.7g/dl WCC 17 (x 109/l) Urea 11.3 mmol/l Creat 140 µmol/l

Q: Using the information provided, what is Anne's CURB-65 score?

CURB-65 Score: score 1 point for each of the following components:

• Confusion (new onset disorientation in time, place or person) or an AMT score of (≤8/10)
• Urea: >7 mmol/l
• Respiratory rate: ≥ 30/min
• Blood pressure: low blood pressure (systolic BP <90 mm Hg or diastolic BP ≤60 mm Hg)
• Age: ≥65 years

Is the following statement true or false?

The critical care outreach team should be alerted to Anne’s condition at this point.

Choose the investigations from the following list that the BTS recommends performing on all patients with severe pneumonia.

Is the following statement true or false?

Sputum produced in the ED should be discarded as the yield is better from samples produced following chest physiotherapy on the ward/unit.