The next morning Gladys is heavily sedated and unable to answer questions.

• She arouses to sternal rub and her pupils are sluggish but reactive.
• Her AM vitals show: Temp =  38.1°C, pulse = 130, BP = 110/70 and Resp = 28.
• Neurolgoical exam reveals no focal deficits
• All extremities withdraw to pain.
• Deep tendon reflexes are normal.
• Neck is supple and there is no evidence of thrush.
• The LP results revealed no WBCs, glucose and protein were normal.
• Hemogram blood was lost.
• Breath sounds are shallow and course, but no crackles or wheezing is heard.
• Someone does a biox and discovers an oxygen saturation of 65%

A chest X-ray is ordered and reveals diffuse, bilateral infiltrates. Click image for larger view. Gladys has pneumocystis pneumonia. Aspiration pneumonia should also be considered. She is started on Septrin, steroids and IV Augmentin. If sedation is needed, Haldol will be used as it does not suppress the respiratory drive.