Mrs. Taylor had a 3-day history of progressive fevers, nausea, and vomiting. She presented to the emergency department at 2:30 a.m., where she appeared to be moderately ill and dyspneic. Her initial temperature was 38.3 °C, her blood pressure was 112/70 mm Hg, her heart rate was 118 beats/min, and her respiratory rate was 26 breaths/min. Her oxygen saturation was 92% on room air. The examination was remarkable for crackles at her right lung base. The examination of her cardiac, abdominal, and neurologic systems was unremarkable. Laboratory studies showed a leukocyte count of 14 × 109cells/L with a left shift, a creatinine level of 1.3 mg/dL (114.9 µmol/L), and a sodium level of 129 mmol/L. A chest radiograph showed a dense right lower lobe infiltrate. Bacterial pneumonia was diagnosed. The patient began receiving levofloxacin, metronidazole, and oxygen and was admitted to the medical ward of the hospital. A pulmonologist was consulted by telephone about the initial treatment choices.