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The clinical decision at that point was to admit for IV cefuroxime and hydration.

The consensus at the conference would have been to tap the pleural fluid for diagnostic and therapeutic purposes, leaving a chest tube in place for drainage.

A gram stain of the blood was positive for Gram + cocci in chains.

36 hours into admission, T° 39.2, RR 80, O2 sat 92% on room air.

The patient was grunting.

NOW WHAT WOULD YOU DO?



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