69.A 43-year-old undomiciled man is brought to the ED after being found
intoxicated on the street. He is currently rousable and expresses a request
to be left alone. Initial vitals include a HR of 92 beats per minute, a BP of
125/80 mm Hg, and an RR of 14 breaths per minute with an oxygen satu-
ration of 93% on room air. His rectal temperature is 101.2°F. A chest radi-
ograph shows infiltrates involving the right-lower lobe. Given this clinical
presentation, what initial antibiotic coverage is most appropriate for this
patient?
a. Gram-negative coverage only
b. Gram-positive coverage only
c. Broad-spectrum with anaerobic coverage
d. PCP coverage
e. Antifungal therapy
70.A 32-year-old man is brought into the ED by EMS with fever, short-
ness of breath, and stridor. The patient was treated yesterday in the ED for
a viral syndrome. His BP is 90/50 mm Hg, HR is 110 beats per minute, tem-
perature is 101.2°F, and his RR is 28 breaths per minute. A chest radiograph
reveals a widened mediastinum. The patient is endotracheally intubated,
given a 2-L bolus of normal saline, and started on antibiotics. His BP improves
to 110/70 mm Hg and he is transferred to the intensive care unit (ICU). You
see a friend that accompanied the patient to the hospital and ask him some
questions. You find out that the patient is a drum maker and works with
animal hides. What is the most likely organism that is responsible for the
patient’s presentation?
a. Streptococcus pneumoniae
b. Corynebacterium diphtheriae
c. Coxiella burnetii
d. Haemophilus influenzae
e. Bacillus anthracis
60 Emergency Medicine