 You are working in the emergency department today. Your next patient has been brought in by his family member because of fever and cough for three days. His triage vital signs includes the following. Fever, tachycardia, hypotension, tachypnea, and hypoxia. He's quickly put into a monitored bed. You hook the patient up to a cardiac monitor and give him oxygen by nasal prongs. His oxygen saturation goes up to 93%. You ask the nurses to start too large a variety and start him with a saline bolus of a liter. Your nurse draws some routine labs including CBC, chemistry, and renal function. You also ask for a 12-lead EKG and a portable chest x-ray. When you talk to the patient, he seems confused. His family said that he has not been feeling well for the past three days. He was complaining of fever, shortness of breath, and chills. He started having rusty color sputum this morning. According to the family, he has not had any sick contacts or travel history. The patient has not had any history of surgery or cancer. He has had a remote stroke. The only medication he is on is aspirin. On examination of the patient, his vital signs is now the following. He is still febrile, hypotensive, tachycardic, and tachypneic. His oxygen saturation is normal with oxygen. He still seems confused. He has no focal neurological deficits. On examination of the lungs, you notice a tracheotug and tachypnea. You also notice there is decreased air entry in the left lung base. His cardiac examination and the rest of examination is normal. You decide to give him a second leader of saline. His chest x-ray shows a left lower lobe infiltrate with a pleurofusion. His blood work shows a normal white cell count, hyponitremia, and a high creatinine and urea. You start on the patient on empiric antibiotics and continue to monitor his vital signs. You calculated this patient's risk score based on his conical picture and lab results. Based on your calculation, the patient needs to be admitted. You then speak to the inpatient consultants who then takes over his care. In the next few videos, we will go through the classification and the approach to the patient with pneumonia in the emergency department.