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Pneumonia severe disposition — ABEM Board MCQ

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ModeratePulmonary emergenciesPneumonia severe dispositionABEM Board

A 79-year-old nursing-home resident arrives with fever, cough, and confusion. Triage acuity is ESI 2; T 103.1 F, BP 88/52 mm Hg, HR 122/min, RR 32/min, SpO2 88%. Exam shows right lower lobe crackles and delayed capillary refill. Lactate is 4.1 mmol/L. Which of the following is the most appropriate disposition?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Admit to the ICU with sepsis management

Hypotension, hypoxemia, tachypnea, confusion, and elevated lactate indicate severe pneumonia with sepsis requiring ICU-level care.

Reference: ACEP Community-Acquired Pneumonia clinical policy; Surviving Sepsis Campaign