An 82 M with COPD, s/p bioprosthetic AVR for AS, afib s/p CV, right
   nephrectomy for RCC, colon ca s/p colectomy who presents with 9 day
   hostory of productive cough and fevers.light of stairs baseline.
   dyspnea and productive cough of several weeks. Otherwise patient is
   without any complaints
   In the ED, initial vs were: 80, sbp 100, mid 90s on 6L/NC. Last vital
   signs prior to ER transfer were 98.1, 83, 116/40, 20, 95% on 3L/NC.
   Patient looked comnfortable. 90% room air, INR 8, ABG, ARF, 2 liters
   ivf. guiac + brown, got levo, ceftriaxone.
   
   Physical Examination
   General Appearance: No acute distress
   Eyes / Conjunctiva: PERRL
   Head, Ears, Nose, Throat: Normocephalic
   Cardiovascular: (PMI Normal), (S1: Normal), (S2: Normal), (Murmur:
   Systolic)
   Peripheral Vascular: (Right radial pulse: Present), (Left radial pulse:
   Present), (Right DP pulse: Present), (Left DP pulse: Present)
   Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds: Crackles :
   RLL, Wheezes : diffuse)
   Abdominal: Soft, Non-tender, Bowel sounds present
   Extremities: Right lower extremity edema: Absent, Left lower extremity
   edema: Absent
   Skin:  Warm
   Neurologic: Attentive, Follows simple commands, Responds to: Verbal
   stimuli, Oriented (to): x3, Movement: Purposeful, Tone: Normal