General: Withdrawn, confused, thin young woman in mild respiratory distress lying in bed in the emergency department. She nods yes and no to questions but does not make eye contact.
Vital signs: Pulse 125/min, respiratory rate 30/min breathing spontaneously, temp 38.8 degrees Celsius, BP 78/46, urine output since admission is negligible.
HEENT: Pupils mid-position with brisk response to light. Mucous membranes dry, no evidence of bruising or petechia.
Neck: Normal jugular venous pressure (JVP) and no lymphadenopathy.
Lungs: Breath sounds on the left greater than on the right. Fine inspiratory crackles bilaterally with coarse airway crackles heard over the trachea. Heart: Rapid rhythm with a regular rate, no murmurs, gallops or rubs.
Abdomen: Soft, scaphoid, with bowel sounds present. No organomegaly, masses, or tenderness.
Extremities: Warm to palpation with no edema. There is cyanosis and clubbing.
What further tests would you order and why?
