(Disclaimer: to preserve the following patients’ identity. NONE of the 18 HIPAA Identifiers were used when writing this post.)

It all started early March 2020 when I saw a gentleman begin the triage process and the triage note read, “diagnosed with pneumonia at urgent care, sent in for further eval.” This happens frequently in the ER when a patient is sent in from urgent care for further workup if the patient looks ill-appearing, toxic, has comorbidities, etc. Then the triage nurse put in the patient’s vitals and he was found to be febrile, tachycardic, and borderline tachypneic. In my mind, as an ER provider, this was a “slam dunk” sepsis workup and hospital admission, but little did I know that this was just the beginning…..

A gentleman in his mid-50s with no past medical history presents to the emergency from an urgent care clinic with a chief complaint of cough, fever, and chills with insidious onset x 6 days. The patient presented to his primary care doctor three days prior and was placed on antibiotics (Augmentin) with no improvement in his condition. Patient went to urgent care today and was sent into the ER for further evaluation due to abnormal vital signs and multiple lob pneumonia. Patient admits to insidious onset of cough, nonproductive, non-bloody with associative dyspnea, worse with exertion, and chills and fever. Patient denies any headache, recent travel, recent sick contacts, recent hospitalizations, lower leg swelling, chest pain, pleuritic pain, abdominal pain, rash, history of diabetes, history of alcoholism, hemoptysis, close contacts positive for COVID-19. Patient admits to taking Tylenol one hour prior to arrival. Patient admits being compliant with antibiotic regimen and admits being compliant with following with his PCP bi-annually for bloodwork and screenings. 

Patients vitals are:

• Temp: 100.1 F (likely patient was febrile prior to taking Tylenol one hour prior) 
• HR: 106 bpm
• BP: 124/79
• Resp: 20
• O2 Sat: 96% on room air

Physical exam revealed the patient was well-developed, non-toxic appearing.

• HEENT normal.
• Cardiac: Tachycardic, regular rhythm, no rubs, no murmurs appreciated
• Pulm: +Tachypnea. Rhonchi was appreciated in the left middle/left lower lung fields and also the right lower lung fields. No wheezing. 
• GI: Soft, normal bowel sounds. No guarding. No tenderness. 
• MSK: Normal ROM. No edema. 
• Neuro: Alert and oriented x 3.
• Skin: Warm, normal capillary refill. No rash noted.
• Psych: His behavior is normal.

If it sounds like a duck and walks like a duck, it’s probably a duck. Sepsis workup was initiated and I went on to see other patients.